We carried out a review of the data available to us about OSJCT Brookside on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about OSJCT Brookside, you can give feedback on this service.
Brookside is a care home registered to support up to 50 people, based in Melksham in Wiltshire. The provider is The Orders of St. John Care Trust.
People’s experience of using this service and what we found
Individual risks were assessed and risk reducing measures devised. Care plans were devised for people who expressed their anxieties and frustrations through behaviours staff found difficult to manage. For some people the care plans were detailed on managing these situations. However, for some people where the levels of anxiety had increased their care plans did not reflect the changes. The actions from staff were not detailed on how staff were to divert or distract the person.
Personal emergency evacuation plans (PEEP) needed detail on how to support people to safely evacuate the premises.
Medicine systems needed to improve in areas of when required protocol and seeking advise from a pharmacist for best method of disguising medicines. We recommended the provider consider current guidance on giving when required medicines as well as taking action to update their practice and procedures accordingly.
While care plans were person centred and staff knew people well some action plans lacked detail. People’s advanced wishes were not gained and for people with diabetes the signs of deterioration were not detailed in the care plan. The registered manager had identified these areas for improvement and appropriate action was being taken to develop care plans for advance decisions.
There was a strong culture where people views were at the centre of the way the home operated. Some staff practices and facilities exceeded standards.
The people we spoke with said they felt safe living at the home and relatives confirmed their family members had a sense of security with the staff. Safeguarding of adults at risk procedures were accessible to staff. Staff were knowledgeable about the expectation on them to report concerns of abuse.
People and staff felt valued. We saw kind and caring interaction. People were supported to follow their preferred routines. People chose how and where they spent their day. Relatives and people said the staff were kind and caring.
People's care needs were assessed before admissions for respite of permanent stays were agreed. There were introductory visits before stays at the home took place. This meant people’s anxieties were reduced because they recognised staff when they arrived for stays.
The staff were supported to meet the responsibilities of their roles. New staff received an induction when they started work at the home. The staff attended a wide range of training which ensured they were able to meet the needs of people.
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.
There were good relationships within the local community. A healthcare professional told us the home was responsive to their suggestions and recommendations.
The registered manager had good leadership oversight. People and staff felt confident to approach the registered manager. The staff, people and relatives said the registered manager had a good presence in the home.
There were effective quality assurance systems in place and plans on developing the service were also in place.
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 Outstanding (published 22 February 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the time of our inspection there were 48 people living at the home. Accommodation was arranged over two floors. Brookside care home has a registered manager in place. 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 service was last inspected in March 2014 and was found to be compliant. This was the first rated inspection.
The service excelled in encouraging and enabling people to voice their opinion about how the home was run. People were at the forefront in making decisions such as, the building of a sun lounge, the choice of having a juice dispensing system, how the home would be decorated and the selection of furniture for the lounge and the new sun lounge. People made friends and staff understood the importance of enabling and supporting friendships and relationships that people may form.
The culture in the home was one of care and compassion for each person and small examples such people decorating stones for the rockery demonstrated how the service valued each person. Staff were proactive in putting forward ideas on how they could better support people, such as putting a toaster on the tea trolley to encourage people to eat more. Staff worked together with people to improve their emotional wellbeing through the use of life story books and there were many positive outcomes for people particularly those living with dementia.
People told us they felt safe living at Brookside. Medicines were managed safely and people received their medicines on time and in a place of their choosing.
Staff had received appropriate mandatory and specific training in order to meet the changing needs of people. Staff told us they felt well supported by the management team. They received support and on-going development through reviews and an annual appraisal with their line manager.
There was a policy and procedure in place in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The MCA is a law about making decisions on what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom. The policy and procedure in place were being implemented effectively and consistently within the service.
People had sufficient to eat and drink and the food choices on offer were varied and nutritious. People told us the food was “really good” and ”excellent” and they felt they had a good diet. People took an active role in making decisions about the menu choice on offer.
A range of activities over five days a week were available which people were free to take part in if they wished. The service was soon to implement an activity programme over seven days a week because of the uptake of the activities so far on offer. People told us they enjoyed taking part in different events and social events which the home provided.
Before people moved into Brookside an assessment of their needs was undertaken. Care plans had been completed which explained how people wished to be supported and care needs were monitored and reviewed to ensure the support given continued to meet people’s needs.
The registered manager and the staff team strove constantly to improve the quality of the service people received by ensuring people were at the forefront of making decisions which affected them. The local mayor praised the home for the way it interacted with the community and the quality of care and support it gave to older people.
At this visit we saw equipment was well maintained. The systems in place for the use of specialist cleaning equipment had been reviewed and the home had sufficient systems in place to stop the spread of infection.
During our visit we spoke with people who used the service about the standard of cleanliness in the home. One person said 'the home is always clean and tidy.' Some people had complex needs which made it difficult for some to tell us about their experiences but we saw they were cared for in a hygienic environment.
We saw some equipment was damaged which may have increased infection control risks. We saw the provider did not have adequate systems in place for the use of specialist cleaning equipment and products to maintain cleanliness and hygiene or prevent the spread of infection.
We looked at records which showed the provider followed a recruitment and selection processes for the employment of new staff. The people we met spoke positively about staff. One person told us 'staff treat me very well and do things the way I like.' Another person said 'staff are excellent and very kind.'
We looked at how care needs were being monitored and evaluated for people. The provider had an audit system to monitor the homes quality and care standards. We observed a lack of information some areas. This meant it was not possible to show how some information had been analysed and evaluated or how service improvement plans had been developed.
People said they liked living in the home. One person told us 'I do just what I want to do here'. Another person told us, 'they look after us so well'. People said they liked the meals. One person told us there was 'lots of choice about meals'. People said staff supported them when they needed. One person told us 'I ring my bell and they come'. A person described the home as 'wonderful'.
We observed the provider had taken action to make improvements in a wide range of areas. This included ensuring improvements were made in assessments and care plans for people. The home now had clear systems to make sure their own infection control policies were followed. Systems for staff training had improved; a care worker told us there was 'lots of training here'. The provider had taken action to ensure people had the equipment they needed. The quality of care was monitored regularly and included listening to a range of different people about the services provided.
Although some people were very positive, other people told us the home did not meet their needs in a range of areas. They said the reason largely related to a need for more staff. One person told us 'it has deteriorated here, there is a lack of staff'. We observed some people's privacy and dignity was not up-held as staff were not always available to care for them when needed. Care was not consistently assessed, planned and delivered in the way people needed. While people who went to the dining room received their meals promptly and were fully supported, this was not the case for people who remained in their own rooms. Staff were not fully trained to meet people's needs and in some instances sufficient suitable equipment to meet peoples care needs was not provided. Procedures were not being followed to make sure the risk of the spread of infection was prevented.
We spoke to two relatives. They told us that they had some concerns about their relatives' care. They told us 'There are lots of very good staff but care is not consistent. We constantly have to remind them to do the most basic tasks. When we visit we have to brush her hair and clean her nails. Sometimes when we visit she has been given a drink but it is out of her reach or in a china cup which she cannot manage".
Another relative, who visited the home frequently said they regularly undertook tasks to support their relative because the staff had not had time. They said they were concerned that their relative was not receiving adequate food and drink and had been losing weight. They acknowledged that there was nutritional care plan in place to ensure that their relative was supported and encouraged to eat and drink but they were not confident that this was always followed. They told us they did not trust the records as they believed they had been falsified in the past. They told us that they had reported their concerns to the home's manager on numerous occasions. They felt that the manager listened to their concerns and put measures in place to address them but 'things keep slipping back because some staff do not follow instructions and they are not adequately supervised'. One relative said that the manager was never seen 'on the floor' of the home and 'spends all of her time in the office'.