We carried out this unannounced inspection on 5 September 2018.

Brooklyn House Nursing Home is a nursing home which provides accommodation and nursing support to older people and those living with dementia. The service can accommodate a maximum of 38 people. On the day of our inspection there were 32 people using the service and two of those people were in hospital.

Following our last inspection of 4 July 2017, we rated the service as requiring improvement overall. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had failed to identify risks to the health and safety of people living in the home. The service had not ensured there were enough staff deployed to meet people’s needs. Not all of the systems in place to monitor the service were effective at identifying and improving the quality and safety of the care provided. Not everyone received personalised care that met their individual needs.

In the key questions for safe, effective, caring, responsive and well-led, we rated the service as ‘requires improvement’. This resulted in the overall rating of the service for that inspection being ‘requires improvement’.

At this inspection of 5 September 2018, we noted there had been improvements and there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service ‘good’ in all key lines of enquiry and therefore the overall rating of the service was ‘good.’

The service had a registered manager in post. 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 used a dependency tool to identify the number of staff required to be on duty to meet the assessed needs of the people using the service. There were sufficient numbers of qualified nurses and care staff to meet people’s identified needs. Nursing staff, with the support of the team leaders, organised the care to be provided to each person by the staff team.

Staff received training in safeguarding and were aware of what actions they should take to safeguard people from potential, or actual, abuse and knew what actions to take to promote people’s safety and well-being.

There was a robust staff recruitment policy and procedure in place. This was operated to ensure only suitable staff were employed. Once employed staff were supported by an induction process and regular supervision and a yearly appraisal. Training was organised to develop and maintain staff skills, including the nursing staff who had all revalidated their qualification.

There were suitable arrangements for the safe storage, management and disposal of medicines. There was a process and procedure in place for the recording of topical creams and lotions. All of the staff administering medicines had received on-going training in the administration of medicines.

Care and support was delivered in line with the assessed needs and choices of the people living at the service.

People had their nutrition and hydration needs met through effective planning and delivery of nutritious menus. Menus were varied and took into account people’s dietary preferences.

The service had built up an effective and supportive relationship with the general practitioner service.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the local authority to support people who used the service with regard to the MCA

The inspection took place on 4 and 5 July 2017 and was unannounced. At the previous inspection of this home we rated it as Good in each domain. At this inspection we have rated it as Requires Improvement in each domain.

Brooklyn House Nursing Home is registered to provide residential and nursing care for up to 38 people. At the time of the inspection 38 people were living at the home. The home supports older people who have nursing needs, some of whom are living with dementia.

There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

Some risks to people’s safety had not been managed well. The provider had not ensured that the number of staff they said they needed to keep people safe and to meet their needs, were consistently working in the home.

Staff had received training but not regular supervision. Staff practice was variable. Some staff were kind, caring and compassionate and treated people with dignity and respect. However, other staff demonstrated poor care practice. They did not always ask people for their consent before performing a task. Staff did not always interact with people in a meaningful way and restricted some people when they became upset and distressed.

The systems the provider had in place to monitor the quality and safety of the care provided were not all effective. They had not assessed some areas of risk to people’s safety and had not ensured staff had been regularly checked to ensure they were competent at performing their role.

People received their medicines when they needed them and systems were in place to reduce the risk of people experiencing abuse. Any incidents or accidents that had taken place had been investigated and actions taken to reduce the risk of them re-occurring in the future.

People received enough food and drink to meet their needs. Staff supported them to maintain their health. Advice was sought from other healthcare professionals when needed and staff followed their guidance.

People had access to a variety of activities to provide them with stimulation. The staff encouraged visitors and relatives into the home. However, staff did not have much time to spend with people in their rooms to reduce the risk of them becoming socially isolated.

People were supported with their cultural and diverse needs and their complaints and concerns were encouraged and listened to. Action was taken in response to people’s feedback and they were involved in the development of the service.

During our inspection of 4 June 2014, we found that the provider had not ensured there were enough staff to safeguard people’s health, safety and welfare.

Following the inspection, the provider wrote to us to tell us what improvements they would make to meet this standard. We returned to check that the required improvements had been made.

A single inspector carried out this inspection. The focus of the inspection was to answer two key questions; is the service safe and is it responsive? During the inspection we spoke with twelve people who lived at the service, five visiting relatives/friends, nine staff, the regional manager and another manager who represented the provider.

Below is a summary of what we found. The summary describes what people who lived at the service, and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is it safe?

The service was not safe. On the day of our inspection, some people who lived at the service, their relatives and the majority of staff we spoke with told us there were not always enough staff to provide them with the care they needed. The provider had calculated how many staff were required to meet people’s needs. However, the number of staff needed during the day and night had not been met on a regular basis. This meant that not all people who used the service received care when they needed it.

Is the service responsive?

The service was not responsive. We found that nine people had not received personal care from staff such as washing and dressing by 11.45am. Two people who could give us their feedback told us that they were not happy about this. Some relatives also expressed concern to us regarding this. Some people did not receive adequate drink to meet their needs and were not being re-positioned regularly to reduce the risk of them developing a pressure ulcer.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People said that they liked living at Brooklyn House Nursing Home. They told us that they often had to wait for help because the staff were busy. We saw that call-bells rang for between ten and fifteen minutes before staff were free to answer them. Improvements were needed to ensure that there were sufficient numbers of staff on duty to meet the needs of the people living at the home.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Policies and procedures were held. There had been no reason to submit a DoLS application. Staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application.

Is the service effective?

People’s health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the nursing care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the nursing care and support needs of each person. One person told us. “This is a nice home and the staff will do anything to help you.” Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that the staff were sometimes busy but did not rush them. Our observations confirmed this. A visitor told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Care and risk assessments had been completed but not all had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person’s plans of care. A record was held of people’s preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities that they said they enjoyed.

Is the service well led?

Staff spoken with had an understanding of the ethos of the home and quality assurance processes were in place. Relatives told us that they were asked for their feedback on the service their family member received. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the manager was approachable.

During our visit to Brooklyn house, we met the newly appointed manager who was in the process of completing the “registered manager’s application” for submission to CQC.

People that we spoke to told us they were happy living at Brooklyn house. We observed that people were relaxed and contented in their surroundings. People were appropriately dressed and looked well groomed. Several people were in the process of having their hair done. We observed people being served their lunch and drinks. Most people appeared to enjoy their food and told us they usually had a choice of food, and drinks, and were supported to eat and drink whenever they wanted.

We reviewed care records and found that overall people had been asked for their consent in relation to their care treatment and support. However the provider may wish to note that in some of the files we reviewed there was no written consent.

We noted people had care plans and risk assessments in place. The manager was in the process of arranging supervision and appraisals for staff; this was being arranged over the coming weeks.

Quality monitoring and feedback was obtained via an annual survey. However the latest survey had a very poor response and therefore the results were not evaluated. However, a new survey was being developed and was due to be sent out to all stakeholders in December 2013. The provider had not always notified the CQC about “incidents and deaths” relating to people who used the service.

During our inspection on 7 February 2013, we spoke with the manager, staff and people who use the service. All the people we spoke to were complimentary about the care that was provided and told us the staff were good. We were told and saw staff always explaining to people what was going to happen and encouraging them to do things for themselves where possible.

We observed and talked with staff who were very knowledgeable about the people who lived at Brooklyn House and were able to understand their needs. Care records and the training offered by the provider enabled staff to meet people’s health and care needs.

All the people we spoke with told us they felt safe living at the home.

There was an effective complaints procedure in place.

We spoke with a number of people in the lounge and with some who preferred to stay in their rooms. Everyone was complimentary about the care provided. They told us that they liked their room, that the staff were good and now a manager had been in post for six months they were beginning to see consistency. They felt the staff team were kind and had the skills to do their job. We were told “The home is clean and tidy and my laundry is always returned neatly ironed later the same day.”

We were told that people felt safe living in Brooklyn House. “I trust the staff team and they look after me well” was just one of a number of positive comments.

No one appeared rushed, people were smiling and plenty of positive interaction between staff and the people living in the home was noted.

This inspection took place on 28 and 29 April 2015 and was unannounced. Brooklyn House Nursing Home is a residential care home providing personal and nursing care and support for up to 38 older people, some of whom may live with dementia.

The home had a manager who has been in post since December 2014. The manager had submitted an application to us to become the 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.

At the last inspection in December 2014, we asked the provider to take action to make improvements to the care people received, the care records, how much people were given to eat and drink and to staffing levels, and most of this action has been completed.

People told us they felt safe and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and they knew how to report concerns to the relevant agencies.

Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There had been improvements to the number of staff members available and there were usually enough staff available to meet people’s needs. However, there were still times when people had to wait for care.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so.

Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received support from the manager, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager had acted on the requirements of the safeguards to ensure that people were protected.

Staff members understood the MCA and presumed people had the capacity to make decisions first. However, where someone lacked capacity, best interest decisions to guide staff about who else could make the decision or how to support the person to be able to make the decision were available.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans contained enough information to support individual people with their needs. Records that supported the care given were completed properly.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or their relatives could speak with her at any time.

The home monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible.