We inspected this service on 20 January 2016. This was an unannounced inspection. Brookfield is a care home providing nursing care for up to 66 people. At the time of our visit there were 63 people living at the service.
At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds with three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were in relation to the care and welfare of people, supporting staff, maintaining accurate care records and monitoring the quality of the service people received. The provider sent us an action plan to tell us how they would ensure the service met the legal requirements of the regulations. At this inspection in January 2016 we found improvements had been made. However, we also identified some other areas of concern.
People were asked for their consent before care tasks were carried out. However, staff did not fulfil their responsibilities under the Mental Capacity Act 2005 (MCA) because they had not always taken appropriate action where people might not have the capacity to consent to other decisions about their care.
People had a range of risk assessments in place. However, the service had not ensured people were always protected from the risks associated with their care in relation to falls, pressure area care and the administration of medicines.
People felt safe when being supported by staff. Staff were clear about the action they would take to keep people safe from abuse. People and staff were confident they could raise any concerns and these would be dealt with.
People told us there had previously been staff shortages but now felt there were enough staff to meet their needs. There had recently been new staff employed at the service. There were enough staff on the day of the inspection.
People told us staff were kind and caring. People looked well kempt and were dressed appropriately for the weather. People felt respected and valued. However, we noted some interactions that did not demonstrate people were always supported in a respectful way.
People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff were aware of people’s preferences in how they wanted to be cared for. People were supported to maintain their health and were referred for specialist advice as required.
Some aspects of the service required improvement to ensure it always met the needs of people living with dementia. This was in relation to the activity provision and decoration of the units where people were living with dementia.
People enjoyed the food and were supported to have their nutritional needs met. People were complimentary about the food and were given choice and variety. However, people who remained in their rooms were not always supported to drink outside of mealtimes.
The home had a registered manager. 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 an area manager.
People were complimentary about the registered manager. However, there was not adequate leadership on the individual units which resulted in poor communication and confusion over delegated tasks between nursing and care staff. This put people at risk of not receiving their care in a safe, effective or responsive way.
We have made a recommendation about leadership.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.