About the service Brookdale House is a care home, without nursing, accommodating up to 27 people. The accommodation is arranged over two floors with a stairlift available to access the upper floor. There is no passenger lift. There is a mature garden to the rear and a patio with seating areas. Many of the people using the service were living with dementia. Brookdale House is owned by Tuella Limited who, throughout this report, are referred to as the provider. At the time of our inspection there were 23 people using the service.
People’s experience of using this service and what we found
Some of the risks to people’s wellbeing had not been adequately managed or mitigated.
Learning following a recent significant safety related incident at the service had not been sufficiently embedded.
Medicines continued to not be managed in line with best practice guidance and the provider’s policies and procedures.
The provider’s guidance on the use of personal protective equipment (PPE) was not consistently followed. Records did not provide assurances that cleaning schedules were completed as planned.
We were not assured that there were sufficient staff, effectively deployed, to meet people’s needs.
We have made a recommendation about records relating to recruitment.
Where incidents of safeguarding concerns had occurred, these had been escalated appropriately to external agencies.
Rating at last inspection (and update)
The last rating for this service was requires improvement (Published January 2020). We found one breach of the Regulation regarding safe care and treatment. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We carried out this short notice, focussed, inspection of this service on 22 September 2020 to check that the provider had followed their action plan and to confirm they now met legal requirements.
The inspection was also prompted in part due to concerns we had received from whistle-blowers about medicines management, staffing levels and staff culture. There had also been a recent safety related incident and we wanted to be assured that steps had been taken to prevent similar incidents from happening again.
We did look 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 coronavirus and other infection outbreaks effectively.
Audits and quality assurance checks were not being fully effective at driving improvements or embedding change.
Records relating to people’s care did not always support staff to meet people’s needs in an effective or safe way. We were not assured that the provider had robust systems in place to always keep records securely and to ensure they are only accessed by people authorised to do so.
We have made a recommendation that the provider implement systems to ensure that the information required by the Care Quality Commission is readily available and accessible in the service in order that they can demonstrate their compliance with relevant Regulations.
Staff raised concerns about morale and told us they had lost confidence in the provider to address their concerns.
Most relatives felt the service engaged with them well, although this was not everyone’s experience.
In discussions with the nominated individual they demonstrated a good understanding of their responsibility to be open and honest with external agencies and with people using the service and there was evidence that the service worked in partnership with other organisations to meet people’s needs.
This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. We reviewed all the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
We have found evidence that the provider needs to make substantial improvements. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Brookdale House 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 treatment, staffing and governance.
Please see the action we have told the provider to take at the end of this report
Follow up
We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.