Archived: Brooklands

Updated 7 October 2020

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 Care Act 2014.

Inspection team

The inspection team consisted of two inspectors.

Service and service type

Brooklands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we have received about this service since the last inspection. We reviewed information of concern received from the local authority and other professionals who work with the service. We carried out a second Emergency Support Framework (ESF) assessment with the registered manager which highlighted further concerns regarding the management of Covid-19.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We used all of this information to plan our inspection.

During the inspection

We spent time to see how people were cared for by staff throughout the day. We spoke with one person who used the service about their experience of the care provided. We spoke with two members of staff at the home and with the registered manager who is also the nominated individual on the telephone. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with two staff members employed by the local authority who were working at the home to provide assistance and support.

We reviewed a range of records these included two peoples’ care records and multiple medication records. We looked at a variety of records related to the management of the service including policies and procedures, management of the environment and the management of risks to people. We observed staff interactions with people in communal areas of the home.

After the inspection

We continued to seek clarification from the registered manager to validate the evidence we found during the inspection. As the registered manager was not on site at the time of the inspection staff were unaware of or unable to access information regarding recruitment and managements checks. We asked for this to be supplied to us. Following this inspection, we discussed our findings with other stakeholders including the local authority and Hereford and Worcester Fire and Rescue Service, so they were aware of the safety risks and concerns we identified.

Updated 7 October 2020

About the service

Brooklands is a residential care home providing accommodation and personal care to four people with learning disabilities. The service can support up to nine people. Brooklands accommodates people in one adapted building consisting of a converted period house. Bedrooms were located on the first and ground floor of the property. A communal lounge, kitchen and conservatory/ dining room were on the ground floor.

The service has been developed taking into account best practice guidance and the principles and values underpinning Registering the Right Support. The home is located close to Evesham town centre and the facilities provided for the community.

People’s experience of using this service and what we found

People living at Brooklands did not receive a safe, effective and well led service. The registered provider had not ensured oversight was in place to maintain people’s safety and welfare. Shortfalls identified as part of previous inspections regarding the service were not always actioned to prevent further or similar occurrences.

Care plans and risk assessments did not contain up to date and accurate information to inform staff how to provide safe care to people. Records were not always completed to evidence the care and support people had received and in line with people’s health care needs.

People were at increased risk of experiencing harm because the systems in operation failed to identify concerns with the premises and repairs were not promptly actioned. Fire prevention best practice was not adhered to. Risks regarding the building were not always considered and were not in line with the provider’s own procedures. Practices to reduce the risk of Covid-19 infection within the home were not always implement by staff members and areas of the home were not able to be effectively cleaned.

Safe systems were not always implemented to ensure staff were aware of protocols regarding people’s medicines. Accurate records regarding people’s medicines and prescribed creams were not always maintained placing people at risk.

The dependency needs of people were not considered to establish the required staffing levels to meet these needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service didn’t always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. For example, in addition to restrictions in place due to the Covid-19 pandemic people’s freedom of movement without supervision was further restricted. Terminology used in recording and while supporting people was not always in line with person-centred care.

Staff had received training in line with the provider’s procedures. Skills and knowledge were not always in place during the inspection and within the record keeping and management seen.

The governance of the service had not ensured people received the care and support required to meet their individual needs. Systems in operation had not identified shortfalls and had not driven continual improvement.

The provider had failed to notify the Care Quality Commission of certain important events which had occurred within the home as required by law.

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 03 October 2019). There were two breaches of regulations and we served a Warning Notice highlighting the areas requiring improvement and a timescale for this to be achieved. The provider informed us of the actions taken following the inspection.

This service has been rated requires improvement for the last two consecutive inspections.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of the service including the management of Covid-19. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led only. We were also aware of the death of a person and an injury to another. The information CQC received indicated concerns about the management of the incidents. These are currently subject to a police investigation. As a result, this inspection did not examine the circumstances surrounding these.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and people’s treatment, staffing, personalised care, management of a safe environment and the governance of the service at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.