Brookfield Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment we assessed all quality statements from this key question and the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People’s experience of care and support had improved as the provider listened to concerns and addressed these promptly. Communication within the staff group had improved, which drove forward improvements in consistency and accuracy of record keeping and overall monitoring of changes in people’s care. The provider had systems in place to continually identify concerns, ensure these were investigated and learnt from, to help reduce the risk of them from happening again. For example, the provider shared lessons learnt from across the team and implemented these promptly within the home to embed good practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People had reviews with external health and social care professionals to ensure their overall healthcare needs were being met. Staff understood people’s individual risks and were able to share their knowledge and understanding of this with health care professionals who were involved in people’s care. For example, staff could contact the GP surgery using a specific phoneline when someone was unwell, and they needed advice and support.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The provider shared concerns quickly and appropriately.

All people we spoke with told us they felt safe and supported by the staff. One person told us, “I do feel safe here, cared for and well looked after.” While another person said, “Staff are very good to me and that make me feel safe.”

Staff received training on how to recognise and report abuse and knew the processes to follow to keep people safe. All staff felt confident to raise concerns with the management team. All staff were confident any issues raised with the management team, or the provider, would be fully investigated to make sure people were protected. The manager understood their responsibilities regarding the action to take to protect people from harm, we saw examples where action had been taken to protect people where required.

During the visit we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. Where the provider had deemed people were being deprived of their liberty, applications had been sent to the local authority for authorisation. They kept track of application processes, to ensure key dates were met. The provider met their legal requirement to notify the CQC where a person had been legally deprived of their liberty.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and where appropriate, their relatives were involved in managing their individual risks to ensure they remained safe. One person told us, “The staff walk with me. Staff help me. They help me out of the chair. I feel safe because they are doing it properly.” Staff recognised risks to people and were consistent in their knowledge as to how they supported people to mitigate risk in the least restrictive way. People were supported to do the things they wanted to do, and staff helped them to do this safely. We saw staff supporting people safely around the home and in activities. Staff were patient and supported people at their own pace. People’s care plans and risk assessments were personalised to them. Details held within the records we looked at showed a good understanding of the person’s needs and how to meet these. Incidents and accidents were reported to the management team in a timely way, so that prompt reviews of their care could be taken. In addition to this, regular reviews were also completed to ensure care plans and risk assessments remained relevant and up to date.

At the last inspection we found the provider was failing to ensure the premises and equipment was clean, secure, suitable for the purpose they were being used, and properly maintained.

At this visit the environment of the home appeared safe however, there were areas that required maintenance. For example, the window restrictor on 1 window continued to be a risk. Some of these issues were a breach at the last inspection, they did not impact quality of care or safety of people. We raised these concerns with the manager as several areas had improved. They sent us their plan for maintenance and improvements with dates. Some of these issues have been rectified since the visit. For example, we found staff did not routinely record water temperatures of in bathrooms and bedrooms for water safety. The manager has sent us records they have put in place to monitor water safety.

The provider mostly detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. At the last visit equipment and items were not stored properly, we found this had been rectified.

People did not express any concern in relation to the safety of the environment. Relatives also felt the environment of the home was safe. People had access to a secure garden area and a choice of communal areas to sit in throughout the day.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People did not raise concerns about staffing levels. One person said, “Yes there are enough staff because I never have a long wait.” Relatives felt there were enough staff on duty to meet their family member's needs. One relative said, "There are enough [staff] after lunch things are quietening down.” All people and relatives felt staff had the right skills and experience to support them with the care needs. Staff told us their training had benefited them to provide safer care.

Staff told us there were enough staff to meet people's needs and keep people safe. Staff were attentive to people's needs and requests and supported people at their own pace. A dependency tool was used to determine staffing levels based on people’s dependency requirements. The management team completed supervisions and spot checks to test staff's knowledge and observe if they applied this in practice or whether further training and support was needed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

At the last inspection we found mattresses and hoists with slings were stored in bedrooms, bathrooms and the dining area. Slings were shared between service users, which increases risk of transmission of infection. Slings were stored hung over hoists. At this visit we found these risks had been mitigated and people had their own slings if needed and these were kept in their rooms.

All people we spoke with told us the home was always clean and tidy. One person said, “I have no complaints it is all very clean, always somebody around cleaning, nice and clean everywhere.” People were protected from the risk of infection as staff were following safe infection prevention and control practice. Staff had access to personal protective equipment (PPE). Cleaning staff told us they had enough cleaning equipment to support them to carry out their roles effectively. The home appeared clean and clutter free. Regular audits were undertaken to ensure the areas of the home were maintained to a good standard.

However, we found several areas such as scale on taps, stained bath seat and toilet brushes this was a potential infection control issue. The manager told us they have implemented changes in the cleaning, amended the audits and spoken with the cleaning staff to make the necessary improvements.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

All people we spoke with had no concerns around the management of their medicines. One person said, “Very careful with the medication. They [staff] bring it in, give it to us and they also wait until we have taken it.” People also felt supported with management of pain. One person said, “If I have pain staff give me painkillers.”

Staff told us they had sufficient time to administer medicine, and the medicines were well organised with sufficient stock. Medicine record keeping was mostly clear and accurate. However, staff did not always follow safe practice when administering medicine to people. For example, we saw 2 examples of where a cream had been put into white pots with lids from its original container. When we raised these concerns with the manager, they told us this practice had stopped.

At the last inspection there was concern regarding the lack of information and management of medicines for individuals. At this visit this had improved. Each person had appropriate protocols in place for regular medicines and those which were given ‘as required’.

There were concerns about the labels on bottles of liquid medicine being unreadable, staff could not be assured they were giving the correct dose or giving it to the correct person. The manager has since spoken with the staff and their local dispensing chemist about the labelling and the potential risks to see if there is an alternative. They are purchasing an extra controlled drugs cupboard for storing no longer needed medicines to give more space for medicines in use.

The process of receiving, storing, and returning medicines was good. There were medicine audits in place, which included spot checks of staff’s practice, record keeping and medicine counts. Where shortfalls were identified, further training and support was given.