The inspection visit took place on 9 January 2017 and was unannounced.

Brockshill Woodlands is a residential care home providing accommodation for up to 30 older people who live with dementia, physical disability and mental health needs and who require personal or nursing care. The home has 23 bedrooms, 10 of which have ensuite facilities. There are toilets and bathrooms on each of the two floors. There are two communal lounges and a dining room. At the time of our inspection 19 people were using the service.

The service did not have a registered manager at the time of our inspection. 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 time of our inspection the service was managed by a manager who was in the process of applying to be registered manager.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures designed to ensure that people suited to work at the service were employed. Staff understood their responsibilities for protecting people from abuse and avoidable harm.

People’s care plans included risk assessments of activities associated with their care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

There were sufficient numbers of suitably skilled and knowledgeable staff deployed to meet the needs of the people using the service. Staffing levels were decided according to the needs of people using the service. Care workers duties included kitchen duties which meant a care worker was diverted from directly supporting people for up to three hours a day.

People were supported to receive the medicines by staff that were trained in medicines management.

Care workers were supported through supervision and training.

The manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at Brockshill Woodlands who were being cared for under the Deprivation of Liberty Safeguards of the MCA.

People’s lunchtime meals were delivered ready made from the provider’s ‘central kitchens’ service based at another residential home service run by the provider. Some people told us they enjoyed their meals, others told us they did not. People who required support with eating were supported.

People using the service were supported people to access health services when they needed them.

Where they were able to be, people were involved in decisions about their care and support. They and their relatives received the information they needed about the service and about their care and support. However, on the day of our inspection people were not provided with enough information to make an informed choice about their lunch-time meal.

We observed staff treating people with dignity and respect when they supported them apart from on two occasions.

People and their relatives contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider.

People were supported to participate in activities. These included social and individual activities. We have made a recommendation about activities for people living with dementia.

The provider had arrangements for monitoring the quality of the service. These arrangements included asking for peopl

An unannounced inspection took place on 4 April 2016. We returned to the service on 15 April after giving four hour's notice because we wanted to be sure the registered manager would be there.

Brockshill Woodlands is a residential care home that provides care and support for up to 30 older people living with dementia, physical disability and mental health needs. The home has 23 bedrooms, 10 of which have ensuite facilities. There are toilets and bathrooms on each of the two floors. There are two communal lounges and a dining room. At the time of our inspection 15 people were using the service.

The service has a 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.

People using the service were protected from abuse and avoidable harm. Staff understood and practised their responsibilities for keeping people safe. People’s care plans included risk assessments which included information for staff about how to support people safely.

There were enough care workers to meet the needs of people using the service. However, care workers were particularly busy in the period from 11.45am to 1.30pm. During that period they served lunches, supported people to have their meals then cleaned the dining room, kitchen and washed cutlery and china. They had much less time to attend to people’s needs during that time.

People were supported to have their medicines at the right times. The arrangements for the storage of medicines were safe.

People were supported by staff with the right skills and knowledge. Staff were supported through training and supervision. Staff were aware of their responsibilities under the Mental Capacity Act 2005.

Lunchtime meals are delivered from another home run by the provider. Choice of meals was limited and people were not given an accurate description of the meals that were available. Meals were not served in a way that made them look appetising. A food hygiene inspection by the local authority two weeks before out inspection downgraded the food hygiene rating from `5’ to `3’.

People were supported to access health services when they needed those services.

Staff were kind and caring. We saw staff being attentive to people’s needs and ensuring their comfort. Staff supported people with their privacy and dignity. We also saw examples of staff being well intentioned but not as skilful as other staff. We brought this to the attention of the registered manager who supported the staff to understand how they could improve.

People were involved in decisions about their care and were provided with information about the service and independent advocacy.

People received care that was personalised because the staff understood people’s needs and preferences. People were provided with social activities at the home and outside. The registered manager was introducing new and fresh activities for people, including for those living with dementia.

People knew how to make a complaint and raise a concern. They had opportunities to contribute suggestions and ideas at residents meetings. If people wanted to they participated in reviews of their care plans.

The registered manager had a clear aim about what they wanted to achieve for the people using the service. Their aims were supported by staff. People using the service and their relatives expressed confidence in the registered manager.

The registered manager regularly monitored the quality of the service and sought the views of people using the service to identify improvements. Their monitoring activity was verified by the regional director who carried out their own checks and reported findings to the provider’s board of directors.

A refurbishment of the premises was ex

When we inspected the service in December 2013 we found improvements were required to the environment. We received information from the provider as to the improvements they planned to undertake, which included increasing the number of accessible bathing and showering facilities and the undertaking of identified repairs.

When we returned to inspect the service in January 2014 to review the improvements made we found two walk in shower facilities ‘wet rooms’ had been installed and additional equipment had been provided to an existing bathroom to increase is accessibility for people with mobility difficulties. We found repairs had been undertaken to areas within the service which had been identified as requiring improvement.

The senior carer in charge of the service on the day of our visit told us that people who used the service had benefited from the installation of the shower facilities. They told us staff were now able to provide a choice to people as to whether they wanted a bath or shower as the facilities were now accessible to those with mobility difficulties.

We spoke with people who used the service who told us they were happy with the service they received. We spoke with three visitors, one person told us they had expressed concerns about the quality of care their relative had received in the past, which had been addressed by the registered manager. Two visitors told us they were happy with the care and support their relatives received. Visitor’s comments included: “My …. has been here for six months, we along with a social worker chose this home, all in all we are happy with the service and if we had any concerns we would be happy to raise them.” A second visitor told us: “My … has been here for nine months, I’m happy with the care and they are working with a number of professionals to help address the underlying mental health issues which are impacting on her physical health with regards to food and drink. I would be confident to raise concerns should I have any.”

During our visit we observed staff encourage people to take part in individual or group activities which included throwing a ball and a game or skittles. We noted some people were actively watching the television whilst two people sat reading the daily newspaper. One member of staff sat with one person and looked at a book with them. The television was turned on in one lounge whilst in the other lounge music was being played. In the afternoon a number of people went out on the mini-bus for a drive into the countryside and stopped for a drink.

We looked at four people’s care plans with regards to eating and drinking and their involvement in care planning including their consent to care. We found people’s care plans in these areas had been regularly reviewed and either the person themselves and / or their relative had signed their care plan. We found where people did not have capacity to make an informed choice the registered manager had liaised with health and social care professionals and people’s relatives to ensure people’s rights were promoted and protected. We found care plans had been regularly reviewed and showed where necessary appropriate health care referrals had been made to ensure people’s health and welfare was monitored and supported.

Records showed that gas systems had been checked by external contractors as to their safety. We toured the premises and found that the services communal sitting and dining facilities were well maintained and met people’s individual and collective needs. We found the service required improvement in some aspects of maintenance, which included the number of accessible bathing and showering facilities to meet people’s individual and collective needs. Improvements were also identified as requiring attention in individual bedrooms. The provider has provided us with information as to what action they will be taking to address the issues identified.

The provider had a procedure for people to raise concerns or make a complaint. We noted a recent complaint had been recorded and the action taken, including the response to the complainant.

People told that they felt safe and well cared for. They also told us the staff treated them with respect and observed their rights and dignity at all times.

We spoke to people in the home, who commented, “the staff are OK, they are helpful”. They went on to talk about the food and meals and stated “I enjoy the soup and puddings.” Other comments made included, “I am able to go out and visit the local park and see (my friend) in a nearby home.”

We spoke to staff that were aware of the needs of individual people, and were able to explain the different levels of intervention and support people required.

Because many people who live at Brockshill Woodlands have cognitive disability or communication difficulties, we were unable to ask people directly about their experiences, we spent time with people in the lounge areas and saw that people on in the sun lounge appeared relaxed and interacted with staff members in a positive way.