Brinnington Hall

Brinnington Hall is a residential care home providing personal care for people living with dementia. The service can accommodate up to 67 people in a purpose built three storey building with a variety of communal areas, and single person bedrooms. At the time of our inspection there were 65 people using the service.

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

Medicines were managed safely, however we recommend that the service reviews how thickeners are recorded and ensure that all relevant paperwork is accurate.

Feedback about staffing levels was mixed, although there were enough staff to meet people’s needs on the day. Safer recruitment practices were being followed. People’s needs were assessed and mitigated as much as possible and people felt safe.

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.

People, relatives and staff spoke positively about the culture of the home, felt able to raise concerns and share views, and told us they were confident any feedback would be acted on by the management team. The management team and staff were committed to making Brinnington Hall a good place for people to live and were keen to learn and improve the service.

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 good (published 17 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed based on the findings of this inspection.

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

Recommendations

We have made a recommendation that the service ensure the use of thickeners in people’s drinks is accurately recorded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff had received training in how to use and dispose of personal protective equipment (PPE) safely. The registered manager conducted regular audits of handwashing and how PPE was used to ensure guidance was correctly followed. The home was clean throughout and additional cleaning of high touch areas completed throughout the day. The provider had invested in various hygiene products designed to minimise the spread of infection.

People, visitors and staff were tested for COVID-19 in line with Government guidance. Where people had confirmed COVID-19, designated staff were allocated to support them. These staff members used separate entrances and did not access any communal areas to reduce the risk of the virus spreading. Each person had a risk assessment in place highlighting how their care would be provided should they test positive for COVID-19. This ensured systems could be implemented quickly if necessary.

Arrangements were in place to support people to receive visitors safely. Visitors were provided with information regarding the procedures they were required to follow. A designated area had been established which visitors could access without walking through the home. People were also supported to keep in touch with loved ones through the use of telephone and video calls.

Brinnington Hall is a residential care home providing care and support for people living with dementia. The service can accommodate up to 67 people. At the time of our inspection there were 65 people using the service.

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

Staff we spoke with confirmed they had received training in safeguarding and knew what action to take if they felt people were being abused. Staff confirmed that they had been safely recruited and pre-employment checks and references had been carried out. Risks associated with people’s care and support had been identified and actions taken to minimise risks. Medicines were managed in a safe way to ensure people received their medicines as prescribed.

The premises were safe, well maintained and exceptionally clean with infection prevention and control measures in place. It was well lit and decorated and furnished to a high standard. There were coloured doors and signage for ease of recognition and access for those living with dementia.

People’s needs were assessed, and care was delivered in line with their preferences and choices. Staff received support, induction and training to ensure they had the skills to carry out their role. Staff were complimentary about the management team and felt they were supported in their role. People were supported to eat and drink enough to maintain a healthy and balanced diet in line with their dietary requirements. People had access to healthcare professionals.

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.

Care plans showed that people’s preferences and choices had been considered when planning their care. Staff enjoyed their role and were happy to know they had made a difference and supported people well.

We observed staff interacting with people in a positive way. People were happy with the care and support they received and were content in the company of staff. Relatives were complimentary about the care provided to their loved ones. The provider was thoughtful and compassionate about how they supported people receiving end of life care and worked in partnership with other professionals to ensure comfortable and considerate care was provided.

Care plans were held on electronic hand-held pads. They clearly identified people’s risk and support needs and how these were to be met.

People were supported in line with their needs and preferences and were involved as partners in their care. People enjoyed a wide range of creative social activities which were meaningful and there was good community involvement including a work placement. This helped to enable people to live as full a life as possible.

People who used the service had access to a complaints procedure and were encouraged to make complaints where required and had the opportunity to express their views. The provider had a range of audits in place to monitor the service delivery.

Staff were complimentary about the support they received from the registered manager and the management team. The registered provider and manager were committed to ensure continuous improvements were made at the service. The registered manager was passionate about increasing the range of activities available and the homes presence in the local community.

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 comprehensive rating for this service was requires improvement (published 20 September 2018) This was because of concerns about the safety of medicines. We returned to the home in September 2018 and carried out a responsive inspection found improvements had been made (published 23 October 2018). This improved the overall rating back to good.

Why we inspected

This was a planned inspection based on the previous rating of the comprehensive inspection.

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.

Our last inspection took place on 10 and 23 May, 8 June, 10 and 11 July 2018 and was promoted by a statutory notification we received of an incident relating to medicines management. During our inspection we had ongoing concerns about medicines management particularly relating to the reconciliation of medicines when new people were admitted into the home or when discharged from hospital.

We found that Brinnington Hall was in breach of the Health and Social Care Act 2008 (Regulated Activities); Regulations 12 Safe Care and Treatment.

Following this inspection, we asked the registered provider to clarify their position in relation to future admissions to ensure that people's medicines could be received and booked in safely at Brinnington Hall. The registered provider made the decision to suspend admissions into the home until improvements were made. The home then started to admit one person a week between office hours on Monday to Thursday only to ensure sufficient time was available to book in medicines accurately.

We received an action plan from them and held a meeting with the registered manager, regional director and head of compliance to reassure ourselves that action was being taken.

At this inspection we looked at the safety of medicines management arrangements at the home and the action taken by the registered manager to address our previous concerns and prevent this type of incident happening again. We found improvements had been made.

Brinnington Hall 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. 61 people were receiving personal care only during our inspection.

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. There was a registered manager in place and they were present during the inspection. The registered manager was supported by the regional director throughout this inspection.

We checked the admissions records relating to the reconciliation of medicines since our last inspection. We found that improvements had been made in the systems to ensure that people had the right medicines in place at the point of admission, returning to the home from hospital and when medicines records were transferred from one month’s cycle to the next. This had been achieved by improving the homes admission procedures for people moving in to the home, increasing the numbers of the management team on both days and nights and putting systems in place to make regular spot checks of medicines.

We were satisfied that the actions on the plan we received from the registered provider had been met or were in progress.

We saw that the supplying pharmacist had carried out a pharmacist advice visit. The report into this visit shows no major concerns. Following our inspection visit we contacted the local authority quality assurance office and the clinical commissioning group to check if they had any concerns about the safety of medicines management at the home. No concerns were raised with us.

At this inspection we looked at the safety of medicines management arrangements at the home and at what action had been taken by the registered provider to prevent this type of incident happening again. Due to further medicines management concerns raised with us pharmacy inspectors returned to the service on 23 May and 8 June 2018. Ongoing concerns remained and we returned to the service on 10 and 11 July 2018 to complete a responsive comprehensive inspection.

Brinnington Hall 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. Brinnington Hall provides accommodation and personal support for up to 67 people. Sixty two people were using the service at the time of our initial visit on 10 May 2018.

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. There was a registered manager in place and was present during the inspection. The registered manager was supported by either the regional director or the compliance manager during our inspection visits.

At our comprehensive inspection undertaken in October 2016, the home was in breach of safe medicines management. At our last comprehensive inspection in July 2017, we recommended that whilst some improvements had been made to the management of medicines, all the issues had yet to be resolved. Plans were in place to change the supplying pharmacist and the home were being supported by the local Clinical Commissioning Group to help make these changes.

At this inspection we found that although the pharmacy had recently changed there were continued shortfalls in the safety of medicines management, including the reconciliation of medicines for a person recently admitted into the home.

You can see what action we told the provider to take at the back of the full version of the report.

Staff had received training in safeguarding adults. They could tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager. Systems were in place to ensure staff were safely recruited.

Care records we reviewed included information about the risks people might experience and what action needed to be taken by staff to reduce them.

The home had achieved 98% compliance with an assessment undertaken by the local authority infection control and prevention nurse.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively.

The registered manager had taken appropriate action to apply for restrictions to be put in place, in a person’s best interests, to be legally authorised by the local authority.

People told us they enjoyed the food. We found meal times were social occasions and saw the food provided was plentiful and very well presented.

People had access to the health care professionals they needed.

The registered provider had continued to make improvements to the home to help make it more dementia friendly.

The atmosphere at the home was relaxed and calm. Everyone we spoke with spoke highly of the staff and the kind and caring nature of the support they received.

Care plans were in place to help ensure staff provided the level of support necessary to manage the identified risks. Care plans were regularly reviewed to address any changes in a person’s needs.

There were a wide range of meaningful activities on offer. People were supported to maintain links with their local community. People were encouraged to be maintain friendships and be socially active.

Systems were in place to manage complaints and reviews about the home were very positive.

People spoke highly of the registered manager and the efforts they had made to make improvements to the service. Staff we spoke with told us they enjoyed working in the service and felt valued by both colleagues and the registered manager.

We found that the managers demonstrated a commitment to continuing to drive forward improvements in the service. For example, a larger management team, a new electronic care planning system that enabled staff to spend more time with people and the new lifestyle manager.

Brinnington Hall is a care home providing personal care and accommodation for up to sixty seven older people, some of whom live with dementia. The home is located in the Brinnington area of Stockport and is a large purpose built building with secure gardens. All rooms are single with en suite facilities. At the time of the inspection there were 64 people living at the home.

The service has a manager who was registered with the CQC. They were present throughout the inspection. 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.

Staff spoke positively about the registered manager who had just been appointed at the time of our last inspection in September 2016. They felt she was open and approachable and that necessary improvements were being made to enhance the service provided.

Issues and concerns had been identified with regards to the management and administration of people’s prescribed medicines. Whilst some improvements had been made, this had not yet been resolved. We have made a recommendation about the safe and effective management of people’s medicines.

All information and checks required when appointing new staff were in place ensuring their suitability for the position so that people were kept safe.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedures and confirmed they had completed relevant training.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans and monitoring charts had been put in place so that staff could quickly respond to people’s changing needs.

Suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken so that people were kept safe.

All areas of the home were clean and well maintained and procedures were in place to prevent and control the spread of infection.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where able people were encouraged and supported to make decisions for themselves.

We found staff received on-going training and support essential to their role so they were able to do their job safely and effectively. Sufficient numbers of staff were available. Staffing levels were kept under review to ensure they were able to meet the current and changing needs of people.

People were offered a choice food and drink throughout the day. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed. People told us and records showed that people had regular access to health care professionals so changes in their health care needs could be addressed.

People were provided with a good standard of accommodation that was well maintained. We saw people’s rooms were comfortable and had been personalised with their own photographs and belongings.

People were supported by staff in a friendly and respectful manner. Staff responded promptly when people asked for assistance and were seen to support people in a patient and unhurried manner. People’s visitors told us that staff were kind and considerate and they were always made welcome when visiting the home.

A range of opportunities were made available for people to participate in activities both in and outside the home promoting their health and well-being.

We saw effective systems to monitor, review and assess the quality of service were in place so that people were protected from the risks of unsafe or inappropriate care.

The registered manager had a system in place for the reporting and responding to any complaints brought to their attention. People and their visitors told us the registered manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

The service had notified CQC of any DoLS authorisations, accidents, serious incidents and safeguarding allegations as they are required to do.

The CQC rating and report from the last inspection was on the provider web site and displayed in the entrance hall.

Brinnington Hall is a residential care home providing care and support for up to 67 older people, some of whom have a diagnosis of dementia. The home is located in the Brinnington area of Stockport and is a large purpose built care home with secure gardens. All rooms are single and have en-suite facilities.

There was not a registered manager in post at the time of inspection. The former registered manager had worked at the home for around six months and had left in August 2016. The acting manager had been in post for three weeks and told us they intended to submit an application to register with CQC. 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.

Prior to our inspection we received concerns in relation to staffing levels, medicines management and respecting people’s dignity. The provider had also acknowledged some shortfalls in relation to staffing levels and governance at the home. We identified breaches of seven of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe management of medicines, risk management, recruitment processes, staff training and supervision, care planning and assessment, meeting the requirements of the deprivation of liberty safeguarding, dignity and respect, and good governance. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

We found there were sufficient numbers of staff to meet people’s needs in a timely way. The provider had recently recruited staff and staff told us staffing levels had improved. Rotas showed that shifts were covered and there was decreasing use of agency staff. The provider acknowledged there had been previous staffing issues and the acting manager accepted this might have contributed to the high number of minor injuries/accidents we saw recorded in September 2016.

Prior to our inspection we were made of a substantiated safeguarding concern relating to a person who sustained an injury having fallen from bed in February 2016. One of the recommendations made was that staff should receive falls training. This training had not been provided at the time of inspection. The acting manager told us they were aware this training was required and had submitted a request to the providers’ training department. We are continuing to carry out enquiries in relation to this concern.

Staff we spoke with knew how best to respond to the people they supported. People told us staff were kind and caring in their approach and that staff respected their privacy and dignity. We observed staff had time to spend talking with people and observed many positive interactions.

People told us staff respected their privacy and dignity. However on two occasions we heard staff speaking loudly across communal areas to other staff members discussing people’s personal care needs. This showed a lack of consideration for those people.

A range of activities were offered to people during our inspection. This included flower arranging, a visiting musician and an exercise group. Staff told us that since staffing levels had improved, they had found they had time to support activities and spend meaningful time with people. Trips out from the home were offered on a regular basis, and there were initiatives such as a ‘pop-up restaurant’ that we were told had been popular with people using the service and their relatives.

Care plans in most instances had been recently reviewed. However, we saw there had been gaps in the review of care plans in previous months and care plans were variable in their content and accuracy. Some care plans were not person-centred and contained limited information on preferences.

People told us they enjoyed the food on offer and we saw people were provided with a choice of meal. People were observed to receive the support they required to eat and drink. However, we found information about peoples’ dietary requirements was not always clear.

The environment was clean, bright and spacious. There were a variety of communal areas within the home, including a recently completed cinema room, a family room and a mock bar area. Adaptations had been made to make the environment more accessible to people living with dementia, such as colour theming, pictorial signage and use of contrasting colours.

Records of medicines administration were not always accurately completed, which made it difficult to know whether people had received their medicines as prescribed. There was evidence that not all staff had followed safe procedures in the administration of medicines, which had resulted in one person not receiving one of their medicines as prescribed.

Staff received two weeks of training prior to commencing work at the home. Staff told us they found the induction to be good, although one staff member told us they would have liked to have been able to shadow more experienced staff for a longer period of time in order to further build their confidence. Staff told us they felt they received sufficient training and that training was of good quality. However, we saw a number of staff were overdue the provider’s annual training refreshers. Provision of supervision had also been ‘ad-hoc’.

The provider and acting manager were open and honest with the inspection team, and had identified a number of the shortfalls we also found prior to our visit. There was evidence that the provider had carried out regular support visits to help the former manager address areas of concern. The acting manager sent us an updated action plan and other evidence following the inspection that showed progress against identified actions was being made. Most actions had a completion date of the end of November 2016.

There was evidence that a staff member had commenced work at the home prior to their references and criminal record check having been returned. The acting manager told us the staff member would only have been training and not working directly with people during the period these checks were not in place.

Staff were consistently positive about the acting manager who had been in post for three weeks at the time of our inspection. They told us they had seen improvements being made at the home since the acting manager took up post, and told us they were approachable and fair.

The acting manager told us they found staff were caring and dedicated. They gave an example of staff bringing in resources for activities in their own time out of choice. The acting manager said the provider was supportive and provided the resources they needed to manage the home effectively.

Staff had received training in dementia care, including taking part in a ‘dementia experience’ session, which aimed to allow staff to experience some of the impairments that dementia can cause. During the inspection we saw staff responded effectively to reassure people who could become upset or anxious.