Brookview Nursing Home

Updated 14 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of two inspectors and an Expert by Experience who spoke with people’s relatives by telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Brookview Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. [Care home name] is a care home [with/without] nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from local authority and health care commissioners. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all of this information to help plan our inspection.

During the inspection

We communicated with 5 people who used the service and 7 relatives about their experience of the care provided. We spent time observing how staff interacted with people and we spoke with 14 staff. This included, the registered manager, 2 nurses, 1 team leader, 1 senior care staff member and 4 care staff. Along with a cook, 2 cleaning staff, 1 laundry person and 1 maintenance person. We also spoke with a senior external manager for the provider. We reviewed a range of records at the inspection visit. This included 11 people's care records, multiple medicines records, staffing, operational policies, quality assurance and management records. Following the inspection, we continued to seek clarification from the provider, to validate evidence found.

Updated 14 December 2023

About the service

Brookview Nursing Home is a residential care home providing accommodation for up to 60 adults who require nursing or personal care. This includes people who may have dementia or a physical disability. At the time of our inspection there were 33 people using the service, including 13 people receiving nursing care.

People’s experience of the service and what we found

The provider’s governance systems were not effective, to consistently ensure the quality and safety of people’s care and timely service improvements when needed. Effective management, communication, decision making and accountability for people’s care was not fully assured.

Premises and equipment were not always kept clean, secure, properly used and maintained. The environment did not provide effective signage for people’s safety, orientation and independence.

Staff were not always effectively informed, supported or trained to perform their role and responsibilities. Provider assurance regarding planned staff training and supervision sent following this inspection, did not yet include all areas of training needed, or fully demonstrate embedded and sustained staff supervision arrangements ongoing.

We found gaps in care plan record keeping and concerns relating to the arrangements for people’s medicines, health and least restrictive care needs. Equality Act considerations were not always fully ensured for people’s care.

Staff mostly followed the MCA to obtain people’s consent or appropriate authorisation for their care when needed. However, staff did not always support people in the least restrictive way possible, in their best interests. Systems did not consistently support this practice.

Remedial actions agreed with the local safeguarding authority, were in progress following concerns raised, to help prevent any reoccurrence and demonstrate lessons learned. However, related service improvements were not yet fully demonstrated as embedded or sustained.

The provider did not consistently ensure good care outcomes or individualised care for people. Systems relating to Equality Act considerations, care plan record keeping and staff training did not fully support this. People’s care was not always delivered in a way that sought to optimise opportunities for their orientation, communication, independence, choice and comfort.

Staff often understood people’s individual health and related care needs and supported people to help maintain or improve their health. Referral to external health professionals was not always timely, or without delay, when needed for people’s care.

People were supported to eat meals they often enjoyed, which met their dietary requirements. People's hydration needs were not always effectively accounted for. People could be supported at the end of their life, to have a comfortable, dignified and pain free death.

People were often treated with dignity, respect and supported well by staff who generally knew them well. Access to relevant advocacy services was promoted and supported when needed for people’s care.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At this inspection there was no person with a learning disability or autistic people receiving care at the service. Some staff had received recognised training to support people in this way, if needed.

People were supported to engage in home life and maintain contacts with family and friends who were important to them. Whist the home did not have their own transport to access the local community, staff would hire a mini bus to arrange trips to the local cafes and garden centres.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published January 2021).

At this inspection sufficient improvements had not been made and we found breaches of regulation in relation to premises and equipment, staffing and governance. The service remains rated as requires improvement. This is based on the inspection findings. The service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was a comprehensive ratings inspection, which was prompted in part due to concerns received about environmental cleanliness, staffing, medicines, care planning, restrictive care practices, management and governance arrangements. A decision was made for us to inspect and examine those risks.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

You can see some of the action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Brookview Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Premises and Equipment, Staffing and Governance

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.