This inspection took place on 4 April 2017 and was announced. At our last inspection in December 2015, we found the provider was not meeting a number of regulations. We therefore asked the provider to take action in relation to upkeep of the environment, staff training and support, quality assurance systems, notification of reportable events and record keeping. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations.

Brigstock House is a care home registered for eight adults with a learning disability, autism or mental health needs. There were six people using the service at the time of our inspection. Two people used the service for short stay breaks from time to time.

The registered manager in post at the time of our previous inspection left employment shortly afterwards and a replacement manager was appointed in April 2016. This manager left and another new manager was appointed in October 2016. They were in process of applying to register and were already registered for a second location owned by the registered provider. 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.

Since our last inspection essential repairs and redecoration to the environment had been carried out. The home was clean, comfortably furnished and bedrooms were personalised according to people’s needs and interests.

Staff had undertaken further training to support them in their role and meet people’s individual needs. The manager had improved the arrangements for staff supervision and to check and monitor that staff had the skills to support people effectively.

We previously found that incidents and accidents were not always reviewed or investigated and those which were reportable to CQC had not been shared. We found improvements at this inspection.

Further quality assurance arrangements had been introduced to check that people were well cared for and safe. New audits and checks were in place although further work was required to embed and sustain consistent practice. We have not changed the rating for the well led question from requires improvement because to do so requires consistent good practice over time.

There were adequate numbers of staff who had been safely recruited. Staff were available to provide people with one to one support when needed.

People felt safe and the staff took action to assess and minimise risks to people’s health and well-being. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse.

People spoke positively about the home and the staff team. Staff understood the needs of the people who used the service and how they liked to be supported. We found that staff communicated well with people and with each other.

Staff respected people’s privacy and treated individuals with kindness and patience. Staff made sure people’s dignity was upheld and their rights protected. 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 support this practice.

Care and support was planned in partnership with people so their plans reflected their views and wishes. Care plans were reviewed on a regular basis to ensure people were getting the right support.

People maintained relationships with those who were important to them. Staff worked flexibly to support people with their preferred interests, activities and hobbies.

People were involved in the planning and preparation of their meals which met their dietary needs and choices. People received the support and care they needed to maintain thei

This inspection took place on 7 and 11 December 2015 and was unannounced. At our last inspection in October 2013 the provider met the regulations we inspected.

Brigstock House is a care home registered for eight adults with a learning disability, autism or mental health needs. There were six people using the service at the time of our inspection. Two people used the service for short stay breaks from time to time.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were not living in a well maintained environment because parts of the premises were in need of redecoration or repair.

There were adequate numbers of staff who had been safely recruited. Although staff were familiar with people's needs, they had not received regular training to keep their knowledge and practice up to date. We were also not assured that staff had the most up to date skills and expertise to support people’s specific needs.

There were arrangements to monitor service provision and to check that people were well cared for and safe. However, the provider’s systems were not always used effectively to develop the service and make improvements. We also found that incidents and accidents were not always reviewed or investigated to check that appropriate action had been taken and those which were reportable to CQC had not been shared. We were therefore not assured that important events which affect individuals’ health, safety and welfare were being appropriately reported to us.

People using this service experienced responsive care and support that was person centred and appropriate to their needs. For some however, care records did not reflect the most recent information staff needed to support people in ways that suited them best and kept them safe.

Staff respected people’s privacy and treated individuals with kindness and patience. Staff made sure people’s dignity was upheld and their rights protected. The manager understood their responsibilities where people lacked capacity to consent or make decisions. Appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made where required. Staff were knowledgeable about the risks of abuse and procedures for reporting any concerns.

Staff understood how to protect people from harm and provide safe care. Risks to people’s health and safety were managed and the service encouraged people to take positive risks. Medicines were managed appropriately and people had their medicines at the times they needed them.

People were supported to maintain good health and had access to healthcare services they required. The service had made timely referrals for health and social care support when they identified concerns in people’s wellbeing. People were encouraged and supported to eat a nutritional diet that met their needs and recognised their choices.

People were able to take part in activities of their choice and were supported to maintain relationships with family and friends who were important to them.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. People, their relatives and staff were provided with opportunities to make their wishes known and to have their voice heard. Staff received regular supervision and spoke positively about how the manager worked with them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the training provided to staff, the systems for monitoring the quality of service provision, notification of reportable events and record keeping. You can see what action we told the provider to take at the back of the full

At the time of our inspection there were six people residing at Brigstock House.

On the day of our inspection we met with all six people using the service and observed how staff supported and cared for individuals. We saw that the registered manager and staff respected people's privacy and dignity and people were asked for their consent in relation to their care and support which the provider acted in accordance with their wishes.

We spoke with three people living at the home in some detail. One person told us “I have lived here a long time. This is my home and I like it very much”. Another person told us “The staff are all very nice. They help me to go out. I like going to the activities centre every day”. We saw that people were supported to undertake a range of activities in the community and had varied and individual routines.

We spoke with two family members of people who use the service. One person told us “I am extremely happy with the care and support that is provided. All the staff are lovely and very supportive”. Another person told us “Communication with the home and staff is good. If I had any concerns or problems I know who to speak with and how to make a complaint”.

People had consented to their care and treatment. Where people did not have the capacity to consent, decisions would be made in their best interest and with people’s family members fully involved. People's needs were assessed and their food and drink choices met their religious, cultural and specialist nutritional needs.

The home had an appropriate and safe system in place for the recruitment of staff. All staff received regular training and supervision. Staff had completed training on the safeguarding of vulnerable adults and knew how to report any concerns and were familiar with the safeguarding processes in place within the home.

We spoke with five people using the service. They told us they felt safe and care staff were kind and helpful. Their comments included "I like it here, I’ve got my things in my room and I can go out when I want to” and "the staff know what I need and they always help when I need them.” People also told us they were involved in making decisions. One person said "I like the food and there’s always a choice.” Another person said "I can eat where I like and if I don't like what's on the menu, the staff will help me cook something else."

We saw that staff supported people in a professional and friendly way. People using the service were offered choices about their daily activities and the food provided at meal times.

We spoke with three people working at Brigstock House, including the home's manager. Staff told us how they respected people’s privacy and gave them choices throughout the day. They also told us they felt supported and well trained. One staff member said "it’s a good home, I’ve done all the training I need to do my job.” The staff we spoke with were aware of the risk of abuse and gave appropriate answers when we asked about how they would respond if they had concerns about a person using the service.

We saw that the provider had arrangements in place to make sure people using the service were cared for safely, appropriate checks were carried out before new staff were appointed and any complaints were investigated and where possible resolved.

Please see main report for this information.