Archived: Brook House Care Centre

Updated 8 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a fresh rating for the service under the Care Act 2014.

This inspection took place from 26 to 28 April 2017 and was unannounced. On the first day the inspection team consisted of two inspectors, a specialist advisor in nursing and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of service. A single inspector returned on the second day with another expert by experience and on the third day the inspector was accompanied by a pharmacy inspector.

Before the inspection we looked at the information we held about the service including any notifications they had sent us. A notification is information about important events that the provider is required to send us by law. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We also asked the local authority commissioners for the service and the safeguarding team for their views of the home.

At the inspection we spoke with thirteen people at the home and two relatives. We spent time observing staff and people interacting and tracked that the care provided met their needs. During the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us about all aspects of their care.

We spoke with seven care workers, four nurses, one senior care worker, the activities team, the administrators, the maintenance person, the chef, the clinical lead, the deputy manager, the current manager and the regional manager.

We looked at 14 care records of people who used the service and six staff recruitment and training records. We spoke with a visiting GP and two visiting health care professionals. We also looked at records related to the management of the service such as fire and maintenance checks and audits.

Updated 8 June 2017

This unannounced inspection took place from 26 to 28 April 2017. At the last inspection on 27 and 28 September 2016, we found serious concerns at the home and it was rated Inadequate overall and placed in special measures. We took enforcement action in relation to some of the more serious concerns we found relating to staffing levels, risks to people’s safety not being identified or monitored and the providers quality assurance systems not identifying or acting on issues. We placed a restriction on the provider’s registration to prevent any new admissions to the home and to ensure the provider sent us regular update about staff training.

We also served requirement actions in respect of a number of other regulations. We found people were not always protected from abuse or neglect, people’s care plans did not always meet their needs or reflect their preferences, arrangements to comply with the Mental Capacity Act and Deprivation of Liberty Safeguards were not always followed and the provider had not ensured that CQC were informed of all relevant and notifiable incidents as required under the regulations.

Brook House Care Centre is registered to provide accommodation and nursing care for up to 74 adults. People using the service include adults with a range of disabilities including brain injury, people with nursing needs and people with dementia. At the time of this inspection there were 47 people using the service.

At this inspection there was no registered manager in place. The previous registered manager had left the home after the last inspection. A new manager had started work in November 2016. 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. The new manager was aware of the requirements to notify CQC about particular events.

At this inspection on 26 to 28 April 2017, we found the serious concerns we had about people’s health and safety had been addressed. Possible risks to people were identified and monitored to reduce risk of the occurring. Staffing ratios at the home had improved as staffing levels had not been amended to reflect the reduced numbers of people currently living at the home. We are in discussion with the provider about their plans for future staffing levels at the home. Staff had received training on a wide range of areas to help them develop their skills. We found the new manager had been instrumental in making significant improvements across all aspects of the home which had a clear positive impact on people’s care.

There had been a considerable amount of change required much of which had been implemented. However, there was a continued breach of regulations, as we found there remained some areas for improvement needed with the provider’s quality assurance system. The provider’s application form did not request an applicant’s full employment history. The audit of staff training had not identified a need for mental health training for some staff. improvements to records to evidence effective systems to reduce the risk of legionella. The provider's admission policy had been reviewed but did not fully reflect learning from recent safeguarding investigations. You can see the action we have asked the provider to take at the back of the full version of this report.

There were also areas for improvement identified which included improvements to some risk management records and care plans were required, in particular on the ground floor unit of the home; this included better archiving of old records. Some improvements were also needed to meet people’s needs for stimulation on one unit at the home, although, this had been identified as a work in progress by the manager. Aspects of medicines management on one unit of the home also required addressing.

There were marked significant improvements to people’s care and to the environment at the home. People told us they felt safe and well looked after. Staff knew how to identify and respond to any safeguarding concerns. We saw people felt comfortable in staff presence and interactions were positive and we heard laughter and evidence of good relationships between staff and people. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s dietary needs were met and a range of health professionals were available to support their health needs.

People and their relatives told us they were treated with dignity and respect and that they were now more involved in their care planning. Improvements had been made to the activities on offer at the home. Complaints were managed appropriately.

People, their relatives and staff told us they thought the home was well run and improvements had been made. There was a range of meetings to ensure effective communication between staff at the home and people’s views were sought through regular residents and relatives meetings.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.