This inspection took place on the 19 and 20 July 2018 and was unannounced. Our inspections in May 2016 and June 2017 found breaches of regulation and were rated Requires Improvement. This was because they had not sustained the necessary improvements needed to meet the breaches of regulation. We received an action plan from the provider that told us they would meet the breaches of regulations by June 2018.
Brooklands Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Brooklands Nursing Home is located close to the village of Forest Row and backs on to the Ashdown Forest. The service provides nursing care and support for up to 29 people most of whom have limited mobility, are physically frail with health problems such as heart disease, diabetes and stroke. There were people at the service living with dementia and some people were receiving palliative care. At the time of our inspection there were 23 people living at the home, two of whom were in hospital.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check the provider had followed their action plan and confirm the service now met legal requirements. We found improvements had been made in the required areas.
The overall rating for Brooklands Nursing Home has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.
People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.
The quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. Nurses were responsible for reviewing the care plans, risk assessments and daily records and, although most of these were up to date with clear guidance for staff in how to deliver safe, effective and responsive care, we also found some information that was not clear or had not been updated. This included changes to people’s risk assessments when their nutritional needs had changed and food and fluid charts not being consistently recorded. Staff were aware records were not consistently up to date and the changes in the care planning process would take time to be embedded into day to day practice.
People were relaxed and comfortable with staff. They said they felt safe and there were sufficient staff to support them. One person said, “I feel safe, the staff are kind and look after me.” A relative said, “I really don’t think we could have found a better place, we looked at a lot of homes. Here it is always clean and never smells, my relative is kept nicely and able to do what she wants. She phoned me at 10 last night, which shows the kind of freedom she has, she uses the phone a lot.” When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems that ensured medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire or emergency situations. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.
Staff received training in order to undertake their role. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and were aware of current guidance to ensure people were protected. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS applications had been requested where appropriate to ensure people were safe and the registered manager was waiting for a response from local authority. People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.
People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day. Activities were mixed and people could choose either group activities or one to one. People were encouraged to stay in touch with their families and receive visitors. The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents the service must inform us about.
Staff were asked for their opinions on the service and whether they were happy in their work. Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff could contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.