Brockworth House Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

People were considered in how the service planned and delivered care. Health and care needs were understood, and care was planned in a way which met those needs although several relatives had raised concerns about the care their relative received. There were no barriers for people in accessing the correct care and treatment. Access to care documentation was easily accessible for staff. People were supported to understand their care needs, and feedback was sought to ensure care was appropriate and to drive improvements. There was partnership working with the community. Links were established with a variety of local groups which meant people were integrated and felt part of the local neighbourhood.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people and their relatives. People told us the staff were kind and caring. One person told us “The nurses are lovely, no doubt about it, you couldn’t meet nicer nurses than what I’ve got.” We saw evidence the service utilises Robotic Pets, which are life-like animatronic animals which appear to ‘breathe’, and this has helped to calm people who have dementia and have a history of pet ownership. Some relatives told us they were happy with the care provided; one relative told us “[I] had a wonderful feeling to know [person] would be cared for.” Other relatives told us they had negative experiences with person-centred care and raised concerns staff were over-worked and didn’t have any time to spend with people. Several relatives told us they felt the staff lacked consideration for their loved ones.

Staff told us about the systems to monitor people’s needs and were aware of what to do if they found any gaps in the delivery of people’s care, such as assisting people with drinks or repositioning. The manager told us they have oversight of people’s care records and if there were any gaps in recording health needs, they would complete an internal investigation. The manager shared an example where it was noticed a staff member was not completing the correct care documentation and they addressed this with them.

We observed interactions between staff and people were mostly positive. During lunchtime we observed one interaction during lunch time which was not person centred and brought this to the manager’s attention. The manager promptly addressed the issue with the individual staff member involved. We saw people were sometimes distressed and crying, but staff were kind to them and showed compassion. We saw staff engaging in activities with people and at lunch time we saw staff helping people to make meal choices by physically showing them the options available to them. We observed people accessing the gardens on the day of the inspection.

We received mixed feedback from people and their relatives. People told us they could always ask a nurse about anything health related and could see a GP whenever they wanted. People told us about the Chaplain and how much they enjoyed having access to them. Relatives told us they felt concerned people’s changing needs were not followed up in a timely manner. Some relatives felt their views and opinions were not always sought in relation to decisions about people’s care needs and treatment. One relative told us they felt they had not been spoken with when medicine changes were considered for their family member. Relatives told us they were not always aware of who the key worker was for their relative. Relatives were concerned agency nurses did not always know important information about their loved ones.

Staff were able to tell us about how they worked with health professionals. One staff member told us about a recent visit by a podiatrist and told us “We were told in handover in the morning about their visit, and when they arrived, I was asked to show them to [person’s] room. [Person] was upset and anxious, so I stayed with them.” The manager told us about a person who was having a high number of falls, and how the staff needed to monitor them for their safety. The manager told us it took several months to secure additional funding for the person to have one to one support and once this was in place, their falls dramatically reduced.

Partners we spoke with were satisfied with the communication from the service. One health professional we spoke with described the staff as caring and committed. Another health professional observed the service had made improvements and were more person-centred than in previous visits.

We saw evidence of the arrangements in place, from pre-admission onwards, which ensured people’s needs were identified and their wishes and preferences were considered when planning and delivering care. We saw evidence of feedback being sought from health professionals, before people were admitted and afterwards, to ensure the care service was the right environment for their needs. We saw evidence new people were offered the chance to attend lunches and afternoon teas in the service before they moved in to see if they liked the atmosphere and to meet the staff. We saw all new admissions to the service were allocated a Key Worker, which was in line with the provider’s policy.

People told us they did not always receive appropriate information. People told us they didn’t remember if staff had told them about appointments but did feel they were kept informed about social activities happening. Relatives told us Relative Meetings rarely happened and there was a lack of consistency in notifying relatives of meetings. One relative told us they were concerned agency nurses forgot to share information in handover, and this had led to a delay in treatment being sought. Relatives unanimously told us they were not satisfied with the communication from the manager.

Staff told us they had staff meetings and were able to share information in an effective way. The manager told us they were planning on holding a Relatives Meeting very soon as they had recently started in post and wanted to introduce themselves. The manager explained they had an open-door policy so families could come in at any time and ask questions or receive updates. Staff told us they read people’s body language to help them understand how people were feeling. The manager told us they were ordering picture cards to help people to communicate.

There was an Activity Calendar telling people about the social activities taking place, and there were posters in the service informing people about how to make a complaint and raise a safeguarding concern. We saw Welcome Packs which were given to people when they moved in. We saw evidence of relatives and staff meetings having recently taken place.

We received mixed feedback from people and their relatives. People told us staff listened to them daily when they interacted with them, but often found they were lonely when they chose to stay in their bedrooms. People told us they felt lonely and wanted more activities. Some relatives told us they felt involved in decisions made about their relative’s care and the planning of their care and others told us they did not feel involved or listened to. Some relatives told us they have attempted to convey messages to the management team on several occasions and were not listened to. Relatives told us staff were unaware of people’s preferences.

Staff told us they often spent time with people, sitting and talking and playing games with them. Staff told us they did not feel rushed, and they were encouraged to listen to people. The manager told us they were changing their procedure to incorporate the Key Worker system, so the Key Worker will now be involved in people’s monthly care reviews.

We saw evidence the provider had an audit schedule in place which was overseen by the Area Manager. We saw evidence the provider had a complaints policy and were aware of several complaints which had been made and had been investigated. We saw evidence the provider had a continuous improvement plan in place which staff were encouraged to contribute to. We saw evidence of new initiatives to support staff learning and engagement with people living at the service which are scheduled to begin soon called ‘Key to Me’. This was a one-page profile completed about a person’s likes, preferences and history and included picture cards as well as a larger booklet with more details about the person. We saw the service employed a music therapist who rotates over the course of several weeks in different services run by the provider to enhance people’s wellbeing through music therapy.

We received mixed feedback from people and their relatives. People told us they did not have any concerns with their access to health professionals. People told us they could always speak to a nurse on duty. Some relatives told us they had good access to other health professionals and had no concerns. Some relatives felt the provider did not always work jointly with them around involving health and social care professionals in their relative’s care.

Staff told us they felt confident to speak up on behalf of the people they supported. Staff told us they would not have any issues with challenging treatment plans with health professionals if they felt they did not benefit the person. The manager told us they would promote the care and wellbeing of people if they felt people were not being given equitable access to the support they required. The manager told us how they supported reasonable adjustments and enabled a person to move from an upstairs room to a downstairs room.

Health and social care professionals confirmed the service made timely contact with them to review people's care and support needs.

We reviewed people’s care documentation which showed health professionals had been liaised with and appropriate referrals had been made. We saw evidence of provider policies on supporting referrals and working with health professionals. We saw evidence of completed audits which included the provision for people to have access to health professionals when appropriate. For example, access to dentists were noted on an audit as an area which required improvement.

People told us they did not always receive equitable experiences. For example, one person and their relative told us during one activity where refreshments were offered to people in communal areas, they were missed due to being in their bedroom. When this was brought to staff’s attention, they did offer refreshments to the person and their relative. Relatives told us they felt some staff didn’t come to see their loved ones if they were being cared for in their bedrooms. Relatives were concerned with the service’s practice of having all of the doors to people’s bedrooms closed and locked from the outside. Relatives told us this practice led to their loved ones feeling isolated and lonely. We reviewed with the provider the reasons for this practice and were assured all staff had keys and could unlock doors as needed. We tested the doors, and they were easily opened from inside the room and were not locked from inside the room. We found all staff had a key to the doors so they could quickly be unlocked if needed.

Staff told us they treated everyone equitably and did not feel they treated anyone differently due to their needs or abilities. Staff told us they liked to move between the different floors so they could get to know people as individuals. The manager told us they walked around the service every day and spoke to people to ask how they were and if they needed anything. The manager told us they reviewed people’s care needs and had daily meetings with the nurses. This helped to ensure oversight of all clinical needs and referrals which promoted equitable access to resources and improved people’s outcomes. We spoke to the manager and area manager about the practice of having all doors fitted with a locking mechanism which locked doors when they closed, but only from the outside, meaning staff would need to unlock the doors from the outside to gain access. The area manager told us this has been the normal practice at the service for many years and is in place to prevent people walking with purpose from going into other people’s rooms and disturbing them or their belongings. The area manager assured us anyone with capacity could choose to have their own key for their door. We discussed with the manager and area manager the concerns we had regarding restrictive practice, and they stated they were going to undertake a review of this practice and gain people’s views on whether it was beneficial or not to continue. The manager told us they were going to tighten up their documentation around evidencing consent for keeping peoples doors locked.

Processes and systems to review people’s care needs and support were in place. Risk assessments including steps taken to mitigate concerns were accessible and used by staff. For example, staff documented people’s mood and presentation when undertaking different activities. This meant staff could offer similar activities or different experiences, based upon people’s interests and not presumed preferences. This helped to improve outcomes for people. We saw evidence the manager had an action plan which showed where there were identified shortfalls and timescales for achieving improvement.

During the inspection people and relatives did not want to have conversations about planning for the future. People told us there was a Chaplain who held regular services, which people felt was a supportive experience. People told us the Chaplain was kind and they could speak to them if they wanted. Relatives did not share any concerns about planning for the future and we did not receive any feedback from people whose relatives had passed away.

The service employed a Chaplain. They told us “I often will lead a chat with bereaved relatives of all faiths. There is one person here who is not Methodist, and they are supported by a relative who helps them pray, but if they did not, I would contact a relevant person within their religious community and sort this out for them. We have visits from a Catholic deacon who supports Catholic residents … I conduct both religious and non-religious funerals and keep in contact with families after a person has died. If the funeral is far away, we do a memorial about the person for the staff as they like to remember them as well. We do a celebration of staff service, and all relatives are invited to the local Methodist church. We have little hearts we put on our tree of life, and there are tea and cakes in the church, it’s very supportive.” Staff told us the Chaplain delivers training. One staff member told us “I think that [providing training] is very considerate, she speaks to the staff and really supports the staff to prepare for when people die, because it is a profound thing. She has also explained what happens after someone dies.”

We saw evidence the service had promoted a positive experience for relatives of people nearing the end of their life. We saw the service had implemented ‘comfort boxes’ for relatives with toiletries, a card for the family including and a handwritten note from the area manager. The area manager told us "It's our last gift" and explained the boxes were given to family members when someone was approaching the end of their lives and the relative wanted to stay with their loved one at the service. We saw evidence of the manager communicating with other health professionals when people began to show signs of deterioration. We saw evidence the provider had a protocol for end of life which included having correct medicines in place and people’s relatives were encouraged to stay at the service. The manager had recently obtained a fold up bed for relatives to use if they wanted to stay in their loved one’s room with them. We saw evidence the Chaplain provided in-house training called ‘Final Lap’ which incorporated understanding of different faiths and end of life care.