Archived: Brooklands

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.

Brooklands is a residential care home providing personal care to six people with learning disabilities, autistic spectrum disorder and / or a physical disability at the time of the inspection. The service can support up to nine people.

Brooklands accommodates six people in one adapted building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were exposed to risk of harm because the provider’s own policies were not consistently followed. There were not always trained staff available to ensure people were not exposed to risk. Staff did not always have up to date guidance to follow to ensure medicines were administered safely. Medicines were not always stored at safe temperatures to follow manufacturers’ guidance.

The provider did not have robust systems in place to monitor the quality of care provided. Shortfalls were not identified, and continuous improvement was not followed through to constantly drive up standards of the care provided.

The service didn’t always consistently 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 the following reasons people did not consistently have access to the community, either through the lack of transportation or the lack of person-centred opportunities available.

People enjoyed their meal time experience and celebrated special events regularly at the home. People and relatives said they thought staff were kind and caring and supported people safely. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was requires improvement [published 27 July 2018].

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to systems in place to ensure people were not exposed to risk of actual harm This was a breach of regulation 12 (Safe Care and Treatment) and regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 for 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.

At our last unannounced comprehensive inspection on 7 February 2017, the overall rating was 'Good'. At this inspection the rating has changed to ‘Requires Improvement.’

Brooklands 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 accommodates up to nine people in one adapted building. There were six people living at the home at the time of our inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

At the time of our inspection visits, the registered manager was currently on leave of absence. The registered provider had arranged for a registered manager from one of their other homes to provide temporary management support in their absence. 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.

People’s medicines were made available and people received these as prescribed. However, the management arrangements to ensure medicines were administered in line with the registered provider’s procedures were not always effective and required improvement. The acting manager was acting to ensure improvements were made including staff training.

People’s records to support risk management had not consistently been reviewed at the stated intervals. Some people’s care plans lacked information about how to use of distraction techniques to consistently and safely meet people’s behavioural needs.

The registered provider’s quality checks did not consistently identify shortfalls in risk management plans and medicine management. There was also a lack of oversight in the managements procedures, so the registered provider could be fully assured staff continued to provide care which mitigated risks to people’s safety and welfare. The registered provider had missed opportunities to analyse accidents and incidents on a regular basis, so trends could be identified and to support the reduction of similar events happening.

People told us they felt safe living at the home. Staff understood their responsibilities in reporting abuse and the action they should take if they were concerned a person was at risk of harm.

People had developed positive relationships with staff who knew people’s needs well.

There were sufficient staff to meet people's needs. The registered provider ensured pre-employment checks had been completed before staff started work to make sure, as far as possible, they were safe to work with the people who lived there.

Staff enjoyed working at the home and felt supported by the registered manager and acting manager. Staff felt able to make suggestions about the management of the home and quality of care people received.

The registered provider encouraged people who lived at the home and relatives to share their views about the quality of the care and how it was run to assist in driving forward improvements.

At the last inspection on December 2015, we asked the provider to take action to make improvements to ensure Dol applications were made when required, at this inspection we found this action has been completed.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People we spoke with said they had support from regular staff who knew them well, and they felt safe at the home. Relatives told us their family members were cared for in a safe way. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, while remaining focussed on supporting people to be as independent as possible. People were supported to receive their medicines by staff who were trained to do so and knew about the potential risks associated with people’s medicines.

Staff had up to date knowledge and training to support people living at the home. Staff always ensured people agreed to the support they received. The registered manager ensured people were supported in the least restrictive way and were supported to make their own decisions where possible. People told us they enjoyed the food at the home and were encouraged to make their own meal choices. They explained that they were supported to make their own decisions and be as independent as they could. People and their relatives told us staff would access health professionals as soon as they were needed.

People said the staff and the registered manager were caring and always treated them with dignity and respect. Relatives told us they were involved as part of the team to support their family member. Staff understood people’s human rights and adapted their communication skills to ensure people understood them. People had access to the wider community and said their cultural needs were met.

The staff team were adaptable to changes in peoples’ needs and knew people well to recognise when additional support was needed. All the people we spoke with and the feedback collected by the registered manager and provider said how happy people were to be living at the home. People and their relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and appropriate action taken. Staff were involved in regular meetings and one to one time with the registered manager to share their views and concerns about the quality of the service.

The registered manager and the provider had systems in place to monitor the quality of care provided. The registered manager ensured there was a culture of openness and inclusion for people using the service and staff.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks of infection as the provider had arrangements in place for keeping the home clean. The registered manager regularly checked the cleanliness of the home to help ensure the risk of infection was reduced.

Staff employed by the home had been recruited effectively. The provider demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. Staff had been trained to understand when an application should be made and no current applications were in place. The provider might find it useful to note that there were no policies and procedures in place for staff to follow should a referral be required.

Is the service effective?

People were involved in identifying their own health and care needs. The provider had also considered information and involvement from relatives, other health professionals and staff.

The provider had been able to demonstrate that they had cooperated with other providers to ensure people received the care and treatment that met their needs. For example, we saw that people were supported with having dental checks and sight tests.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people's views and opinions.

Is the service responsive?

People regularly completed a range of activities in and outside the service and staff supported them in arranging and attending these activities.

We saw the home had been responsive to people's changing needs and had listened to professional advice that had been provided. For example, we saw the home had requested an occupational therapist assessment and had obtained the required equipment to meet the change in needs.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions. One person we spoke with told us: 'I have asked for new curtains'. We saw that this had been recorded and was in the process of being completed.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home provided a good quality of service and people were well cared for. They also told us they felt the home had continued to improve for the benefit of people who lived there. They told us that they felt supported in their role and knew where to find information when needed. For example, there was information in each person's care plans and a record of the care provided.

We looked at care records for two people and other supporting documents for the service. Staff told us they: 'Always ask people if they are happy with me giving care before I give it'.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs. People told us they were: 'Happy' with the staff who worked at the home. We saw that staff were kind and caring in their approach to people who lived in the home.

We saw that people were protected from the risk of harm and abuse because staff had received training in how to safeguard vulnerable people. Staff had a clear understanding of their roles and responsibilities for keeping people safe.

The staffing levels for the home were sufficient to meet the needs of the people who lived at the home. We found people received the care and support when they needed it.

There was a complaints procedure in place at the home. We found people knew how to make a complaint and felt supported in that process.

One of the people we spoke with said, "I get looked after, it's really nice". Another said that, "The care is good".

However there were times when the people living there were not doing any meaningful activities. The provider told us that they will now increase the opportunities for activities.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said, "I feel well supported in my job". This meant that staff had the support and knowledge to meet

the care and welfare needs of people who lived there.

There were regular meetings for people who used the service and staff. The views of families and professionals were sought by the provider. The provider also did regular checks including medicines and cleanliness. This meant that the provider was able to review the quality of the service and to ensure appropriate care was being provided.