About the service:

Brookhaven is an open mental health rehabilitation and recovery service, which provides personal and nursing care for up to 22 adults. The person led model of care is designed to fully support people and enable their own recovery pathway in the next stage of their journey. At the time of our inspection there were 18 people who lived at Brookhaven.

People’s experience of using this service:

Support plans were very detailed person-centred documents. They reflected people's assessed needs extremely well and had been consistently reviewed. Any changes in need had been clearly recorded. People who lived at the home planned their own recovery journey, by using the ‘Recovery Star’ model, which is designed to enable people to take control of their own programme, so that goals are achievable and can be met. A wide range of evidence was available to demonstrate how people had significantly improved whilst using their own personalised ‘Recovery Star’ programme. Daily activities were tailored to suit each person on an individual basis and these were clearly highlighted and monitored by the management team through a digital computerised system.

A resident representative had been appointed, who attended internal and external meetings to actively discussed issues, particularly around mental health awareness. This helped to ensure the voices of those who lived at Brookhaven were heard by a wider audience.

The home had introduced an effective innovative system of the ‘Champion Model’, which was designed, in accordance with the five key questions used by the Care Quality Commission. Each area had a designated lead, supported by an enthusiastic team of staff and people who lived at the home. Each team was selected on the basis of individual strengths. Milestones were set and celebrated when achieved. This helped to ensure the voices of those who lived at the home were heard and people were involved in making decisions and improvements to their home and the service.

Everyone we spoke with provided us with extremely positive comments about the quality of service and the standard of the staff team. People who lived at the home were safe. Systems to act on allegations of abuse were in place. A wide range of risk assessments had been developed and potential risks were being managed well. A system was in place for the reporting and recording of accidents and incidents. Staff were recruited safely. Staff had received training in medication awareness and relevant guidance was available.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's needs and choices were assessed and their care and support was delivered to achieve effective outcomes. Staff engaged with people well. We saw some lovely interactions between staff and those who lived at the home. We were told and our observations confirmed care workers were kind and caring.

New staff received an in-depth induction programme and a broad range of training had been completed by all staff, who were regularly supervised and observed at work. People told us that staff were competent to do their jobs.

Detailed policies and robust systems were in place for the management of complaints. Audits had taken place and feedback was regularly obtained from those who used the service and their relatives. Regular team meetings had been conducted and staff members felt able to approach the managers with any concerns, should they need to do so. Meetings were also conducted for those who lived at the home and their relatives.

Rating at last inspection: Good (16 September 2016)

Why we inspected: This was a scheduled inspection.

Follow up: The service will be re-inspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive

We carried out an inspection of Brookhaven on 22 and 23 August 2016. The first day was unannounced.

Brookhaven provides accommodation and nursing care for up to 22 people with mental health needs. The aim of the service is to provide people with care and support through a recovery and rehabilitation programme. The service is based in a residential setting within walking distance of local amenities. Accommodation is provided on two floors in single bedrooms. At the time of our inspection there were 14 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 on 22 and 23 June 2015, we asked the provider to ensure the environment was clean, ensure appropriate risk assessments were carried out, ensure people received safe care and treatment and ensure people were treated with dignity and respect. Following the inspection the provider sent us an action plan which set out what action they intended to take to improve the service. During this inspection, we found the necessary improvements had been made in order to meet the regulations.

People living in the home said they felt safe and staff treated them well. There were enough staff on duty and deployed in the home to meet people's care and support needs. Safeguarding adults’ procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care and support needs and had been involved in the support planning process. Support plans and risk assessments provided guidance for staff on how to meet people’s needs. People were given the opportunity to participate in group and individual therapy sessions to help them with their rehabilitation and recovery. People were able to express their views and were confident any complaints would be fully investigated and action taken if necessary.

All people and staff told us the home was well managed and operated smoothly. The registered manager took into account the views of people about the quality of care provided through consultation, meetings and surveys. The registered manager used the feedback to make on-going improvements to the service.

We asked if medicines were handled safely. We found that suitable arrangements were in place for handling medicines. Regular medicines audits were completed and prompt action was taken should any shortfalls be identified. We found that supporting information about people’s individual medicine’s needs was not always clearly recorded within their care plan or risk assessments to help ensure that all staff were aware of how individual people’s medicines need are best met.

We asked if medicines were handled safely. We found that appropriate arrangements were in place for recording and administering medicines. The home manager completed regular audits of medicines handling to help ensure that should any shortfalls arise, they can be promptly addressed.

However, care plans and risk assessments had not been completed where people needed additional assistance with taking their medicines, or to ensure that people’s medicines needs were best met when away from the home.

Additionally, we found that an incident report had not been completed when prescribed creams were out of stock for one person for several days. This meant the incident was not investigated to try and reduce the risk of reoccurrence.

We set out to answer two of our key questions; Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with three staff and three people who use the service and looking in detail at the medicines for six people.

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

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with use and management of medicines.

People did not receive their medicines at the times they needed them and in a safe way. Medicines were not administered and recorded properly.

Is the service well led?

We saw that audit systems for checking medicines were in place but none had been completed in the last six months so errors and concerns about the way medicines were handled had not been identified or managed appropriately.

People told us they were involved in planning their support and the provider's staff sought their consent to care and treatment. People told us how they were encouraged to make choices and develop life skills and it was their decision how they spent their time.

People explained they were happy with the care and support they received and they enjoyed living at Brookhaven. There were a variety of activities available and people were supported to go out into the community.

People were very complimentary about the staff and were pleased that their views and opinions were sought and acted on by the provider. The provider used this as part of their comprehensive quality assurance process which helped them ensure that care and support was being delivered to a high standard.

We found the premises to be clean and orderly. The provider ensured staff undertook the relevant training on infection control and appropriate personal protective equipment was made available for staff.

We spoke with four people living at Brookhaven. They told us they were involved in decisions about their care and were encouraged to make choices and decisions about how they spent their time. People also told us they were encouraged to express their views and opinions of the service and were able to influence changes in the home.

People told us they were happy with the care and support they received. Comments included, "I know about my care plan and I'm involved in meetings and discussions about what I need", "It's the best place; there is nowhere better", "I sit down with staff and we talk about what I would like to do and how it can be organised" and "I feel better doing things for myself; it's good to be independent".

Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People living at the home said, "I don't have any problems with any of the staff here", "I get on well with all the staff" and "I feel safe here; I don't have any problems".

People made positive comments about the staff team. They said, "I can have a laugh and a joke with the staff" and "Staff are great". Staff told us, "We have a good team" and "The care is very good".

We carried out an inspection of Brookhaven on 22 and 23 June 2015. The first day of the inspection was unannounced.

Brookhaven provides accommodation and nursing care for up to 22 people with mental health needs. The aim of the service is to provide people with care and support through a recovery and rehabilitation programme. The service is based in a residential setting within walking distance of local amenities. Accommodation is provided on two floors in single bedrooms. At the time of our inspection there were 17 people living in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected this service on 4 December 2014 and found it to be meeting the regulations in force at the time. This inspection focussed on the management of medication in the home.

During this inspection we found the provider needed to improve the cleanliness of the building, ensure all risks to people’s health and safety were assessed, ensure people received safe care and treatment in respect of their healthcare needs and ensure people were treated with dignity and respect. You can see what action we told the provider to take at the back of the full version of this report.

We also made recommendations about the implementation of the Mental Capacity Act 2005 and making care plans more meaningful to people using the service.

People living in the home made positive comments about the home and told us they felt safe and looked after.

On arrival, we found some parts of the home had a poor level of cleanliness. Prompt action was taken to clean these areas. However, we also noted one person’s bedroom only contained a bed and had no heating or soft furnishings. Whilst there were mitigating factors, this situation had not been risk assessed in order to manage the risks to the person.

Staff knew about safeguarding people from harm and we saw they had received appropriate training on these issues.

We found the arrangements for managing medicines were safe and all records seen were complete and up to date.

We found staff recruitment to be thorough and all relevant checks had been completed before a member of staff started to work in the home. Staff had completed relevant training for their role and they were well supported by the management team.

Whilst people had access to healthcare services, we found there had been a delay in obtaining a medical diagnosis for one person and specialist advice and support had not been sought for another person.

People told us the staff were kind and supportive. However, we noted some practices which did not promote the dignity of people living in the home. For example, there were locks on all external doors and some internal doors and many of the staff had a bunch of keys on a strap attached to their clothing. Although some people had a fob to get out the front door other people had to ask staff every time they wished to go out for fresh air or smoke a cigarette.

The unit manager had made two applications to the local authority for Deprivation of Liberty Safeguards (DoLS). However, we found there was no information in one of the people’s care plan about the DoLS application.

We noted from looking at people’s personal files each person had an individual care plan. However, apart from one person, people were not aware of their care and recovery plan.

People were able to express their views about the service at weekly “Have your say” meetings and they had also been given the opportunity to complete a satisfaction questionnaire.

We saw there were systems in place to monitor the quality of the service, including audits. The registered manager had also devised a detailed operational development plan, which included an action plan to improve the service.