This inspection took place on the 16 and 17 August 2017 and was unannounced. The service was last inspected in July 2016 and was rated as requires improvement. Brownlow House is registered to provide accommodation, support and personal care for up to 31 people. The home provides support for people living with dementia or a mental health issue. The home works with people who have had a history of abusing alcohol.
At the time of our inspection 29 people were living at Brownlow House. Twenty eight people had their own room and two people wished to share one room. Brownlow House is an older building with three floors, accessed by a lift. People used shared bathrooms on each floor. There is a dining area, main lounge and two smaller lounges which are quieter. There is a large well-tended garden to the rear of the property.
The service had a registered manager in place as required by their Care Quality Commission (CQC) registration. 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 registered manager was supported by a deputy manager.
At our last inspection we found two breaches of the Health and Social Care Act 2008 regarding medicines management and the maintenance and decoration of the home. Following this inspection the provider was required to submit an action plan to the Care Quality Commission (CQC) outlining how they would meet the regulations. An action plan was submitted for the breach in medicines management; however an action plan was not submitted upon request, regarding the maintenance and decoration of the home. The CQC wrote more formally to the provider, at their request, following their initial response to clarify for them the legal position in relation to the submission of action plans. A response to this was received and improvements implemented.
At this inspection we found improvements had been made within the home. Repairs had been completed, new carpets and flooring laid and rooms re-decorated. New furniture had been purchased for the lounges and people’s bedrooms. The doors on the lift at the home were damaged, although it had been passed as serviceable by a specialist lift company. Following the inspection the provider told us they were planning to replace or repair the lift doors.
People received their oral medicines as prescribed and the medicine administration records (MARs) charts were fully completed. We found prescribed topical creams were applied by the care staff but the MAR was signed by the senior staff. Where people had been assessed as at risk of choking thickeners were added to fluids. The staff did not sign a MAR or other chart to state that they had done this. The deputy manager said they would design and implement charts for topical creams and thickeners for staff to sign when they applied the cream or added the thickener to fluids.
Protocols for when ‘as required’ medicines should be administered were not always in place. Liquid medicines and creams were not dated on opening as per good practice guidelines.
People we spoke with said they liked living at Brownlow House and felt safe. They were complimentary about the staff team. People said the staff treated them with kindness and respect and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.
People said there were enough staff to support them within the home, but they were not supported to access the local community very often. The registered manager told us they ensured people were supported to attend medical appointments.
We saw the number of activities arranged within the home had increased since our last inspection. A weekly programme of activities was available and external entertainers visited the home.
Care plans were written in a person centred way and identified the support required to meet people’s health and social are needs. We saw risks were identified and guidance given to staff to mitigate these risks. However, one care plan we saw stated staff were to monitor for signs that a person’s mental health was changing, but the care plan did not detail what these changes might be. When we spoke with staff they were able to describe people’s needs and the signs to be aware of that people’s mental health may be changing.
Senior staff completed a handover at the start of each shift. This provided information about any changes in people’s health and wellbeing. The seniors then informed the care staff working on the shift of the relevant information. One staff member said this worked okay; however another said they sometimes got information later in the shift as they were busy supporting people in the morning.
A system of recruitment was in place with checks being made to ensure applicants were suitable to work with vulnerable people. However, full employment records were not always provided. We have made a recommendation that best practice guidelines are followed for ensuring full employment histories are recorded and the reason for any gaps in applicants’ employment were explained.
Staff had completed training the service considered mandatory. Staff had completed or were enrolled on the care certificate. Experienced staff had completed a nationally recognised qualification in health and social care. Staff were being enrolled on specific courses to meet the needs of people living at Brownlow House such as dementia and managing challenging behaviour.
Staff said they felt supported by the registered manager and deputy manager. Staff had supervisions and regular team meetings were held. Staff said they were able to discuss any issues or concerns they had. This meant the staff received the training and support to meet people’s health and social care needs.
Systems were in place to meet people’s health and nutritional needs. People were regularly weighed in line with their assessed risk and we found evidence of referrals made to the Speech and Language Team (SALT), district nurses and other medical professionals as needed. Medical professionals told us the service made appropriate referrals and followed any advice they were given.
Mental capacity assessments had been completed and applications for a Deprivation of Liberty Safeguards made to the local authority where required. People confirmed the staff gave them choices over day to day decisions and supported them to complete the tasks they could do for themselves so that they maintained their independence. Staff knew who was able to access the local community on their own and would open the door for them when asked. A record was kept of when people left and returned to the home.
All accidents and incidents were recorded and then reviewed by the registered manager. One notification to the CQC had not been made during a period when the registered manager was not in work. Since our inspection appropriate notifications have been received.
A range of audits was in place, including health and safety, mattress audits and medicines.
The home was clean throughout. However there was a malodour on the ground and top floors. New flooring was due to be laid on the top floor which should help eliminate this.
The home was registered with the Six Steps programme for end of life care. Information had been provided to people about making plans for their end of life care. We were told many people did not want to discuss this subject; however this was not recorded in the care files.
Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place of the fire systems and equipment.
Regular resident meetings were held where people were asked for their feedback on the service. A resident survey had been completed and a relative’s survey had just been issued at the time of our inspection. The replies received were positive about the home.