About the service: Brockwell Court is a residential care home which provides people with nursing and personal care. The home can accommodate up to 75 people. At the time of our inspection there were 61 people using the service.

People’s experience of using this service: Records held in the service to describe people’s care needs and provide guidance to staff were not always accurate and up to date.

Information was provided to kitchen staff about people’s dietary needs. This was not always accurate and information used by kitchen staff to serve people’s meals in one area of the home contained errors.

Checks had been carried out to ensure people lived in a safe environment. There were however gaps, in some of these checks. Actions were agreed with the regional manager and the registered manager with the fire service to reduce potential risks in the home.

The service had failed to assure themselves agency staff who worked in the service had the necessary background to deliver people’s care needs. Pre-employment checks were carried out on permanent staff to ensure they were suitable to work in the home. People told us they had experienced insufficient staff being on duty.

People who used the service were not always treated with dignity and respect. We made a recommendation about the provider finding ways to improve this area of practice.

People’s personal risks were not identified or actions put in place to reduce the risks of harm to people. Where accidents and incidents had occurred, the registered manager had monitored them to see if they could have been prevented.

Staff had access to gloves and aprons to support them in their duties. Cleaning was ongoing in the home to reduce the risk of cross infection. However, there were areas of the home which required further cleaning.

The care provided fluctuated in different parts of the home. Whilst people and their relatives spoke positively about staff, people who lived in the Allensford area of the home lived in poor conditions. The fabric of their part of the home required attention. Following our site visits the registered manager told us the flooring problems had further deteriorated and the provider had taken the decision to close the unit.

Induction, training and supervision was provided to educate and support staff carry out their roles. Staff felt supported by the registered manager and were complimentary about their management skills.

People were supported with their health by staff who had regular contact with other healthcare professionals to discuss people’s conditions and seek advice. Information from other professionals had not always been incorporated into people’s care plans.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were given choices and their decisions were respected.

Staff spoke to people with kindness. People felt staff acted in a kind manner. There were examples of staff supporting people to be more independent.

People had the opportunity to give their views about the service and a complaints procedure was available. Complaints had been thoroughly investigated. Relatives were invited to meetings to give their views and hear news about the service.

Activities were provided in the service. An activities co-ordinator was supported by staff to engage people in meaningful activities during our inspection.

People’s preferences for their end of life care had been discussed with them and their wishes were noted. Arrangements were in place for people who did not wish to be resuscitated.

More information is in the 'Detailed Findings' section below. For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection: At our last inspection in January 2018 this service was rated as requires improvement. (Report published 13 March 2018)

Why we inspected: This was a scheduled inspe

This inspection took place on 11, 12 and 15 January 2018 and was unannounced. Following our last inspection in October 2015 we rated the service as overall ‘Good’ and there were no regulatory breaches.

During this inspection we found breaches of Regulations 10, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff were not aware of people’s needs and how to keep them safe. The provider had not done all that was reasonably practicable to mitigate risks to people including the safe administration of people’s topical medicines and the cleanliness in the home. The premises in certain parts of the home were unsafe. The audits carried out to monitor the service had failed to identify these issues and records were not always up to date and accurate.

Brockwell Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate up to 75 people. At the time of our inspection there were 70 people using the service. The home was divided into four areas – Allensford, Blanchland, Corbridge and Derwentside. Each area had a different emphasis on meeting people’s care needs.. For example Allensford focussed on people with dementia whilst the Derwentside focussed on people with nursing care needs. People can transfer between the areas.

There was a registered manager in post 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.

The local infection and prevention control team had visited the home and carried out an audit in August 2017. They returned in January 2018 and found not all of the actions had been carried out. We found the Allensford area of the home was odorous and lacking in cleanliness.

We found the administration of people’s medicines varied in the home. There were arrangements in place for the ordering, receipt, administration and disposal in the home. However we found in Allensford some topical medicines (creams applied to the skin) in people’s bedrooms which were out of date. These were removed by staff during our inspection.

Relatives told us there were not enough staff on duty. We looked at people’s needs and the demands place upon staff and found more staff were required to provide the necessary support to people. The deputy manager told us new staff were being employed in the home.

Regular maintenance checks were being carried out to ensure people were protected from fire and water hazards. However we found areas of the home to be unsafe. For example we found some emergency pull cords were tied up and out of reach of people who may have fallen to the floor.

We saw that the physical environment in Allensford did not reflect best practice in dementia care. Adaptations were not in place to support people to remain independent. We also found some care practices did not always promote the dignity of people living with dementia. The regional manager brought a dementia care specialist into the home who agreed to support the home make improvements.

Checks were carried out on staff before they started working in the service to ensure they were suitable to provide care to vulnerable people. After being appointed, staff underwent an induction process and were supported through supervision and appraisal. However we found not all staff had received the four supervision meetings with their supervisor in 2017 and annual appraisals.

Other professionals had been consulted regarding people’s health care needs and advice sought. We found the guidance and

In this report the name of one of the registered manager's appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection (SOFI), speaking with people using the service, and the staff supporting them and from looking at records.

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

Is the service safe?

People told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about an application that had been submitted. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager set the staff rotas, they told us they took people’s care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People’s health and care needs were not fully assessed with them, and they or their representatives were not fully involved in writing their plans of care. We made a compliance action to make sure this issue was addressed by the provider.

Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments. We saw improvements had commenced to extend the dementia care unit and a landscaped sensory garden was almost completed for people to use.

People who used the service confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good. They put me at my ease,” “This is a good place to live. They look after me very well, there is wonderful food. It’s nice here. We all have a nice time,” “I have a bell in my room. When I pull it the staff come quickly” and “They are good the staff. They would get the doctor quickly if I was unwell.”

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, we saw these had generally been addressed by the provider.

People’s preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People we spoke with knew how to make a complaint if they were unhappy.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

During our visit we spoke with 10 people who used the service and spoke with seven visiting Relatives.

All of the people we spoke with were full of their praise for the care and attention they were receiving.

One lady said “I have no complaints. The staff show me a lot of respect and are very kind." Other comments included: “If you want something you only need to ask and they will get it for you.” Another person said "I was a Cook prior to my retirement and the food is like how I made it at home."

One relative told us “My husband was in two homes before he came here and this is the best. I could not fault the care for my husband who spends a lot of time in bed. I have nothing but praise for the staff. They are very kind and patient. It is like a family here.”

Several relatives commented on the great improvements since there had been a change of management in the home. One relative said "The staff are really working as a team now. There is a change in the atmosphere and everyone seems to be keen to help each other even more than before.”

Another relative said “My grandfather is very happy here. The staff are fantastic and always on the go. They thought they might be slightly understaffed sometimes. She said her grandfather was always very smartly dressed every time she came in to see him. He likes his food and he is well fed here."

All the people that we spoke with said they were happy at Brockwell Court. One person said "It’s tip top. I can honestly say that I have no concerns at all."

People also said they were involved in their care, with their preferences taken into consideration.

People told us they were happy with the care and treatment they were receiving. One person said "I have a nice girl (key worker) who looks after my personal care and she does all my shopping for me. She talks to me all the time about things, and she makes sure that I get everything that I need.” Another said "They look after me very well here."

A relative said the care and support provided to their relative was excellent and that they were kept informed and fully consulted about their relatives care.

All the people that we spoke with told us they felt safe at Brockwell Court. One person said "I feel very safe and secure living here" and other people confirmed they didn't feel at risk within the home.

We spoke with people who told us they were happy with the staff at Brockwell Court and the care they provided. One person said, "The staff are very good, lovely people."

Another person told us, "They all do a good job and the new manager has made a big difference, I think things are better since he came."

This section was not completed for this inspection. More information about what we found during the inspection is available in the report below.

This inspection took place on 19 & 21October 2015 and was unannounced. This meant the provider did not know we were inspecting the home at that time.

We last inspected Brockwell Court on 18 July 2014 and found it was compliant with our regulations.

Brockwell Court is registered with the Care Quality Commission to provide care for up to 75 elderly people. The home also provides nursing care. At the time of our inspection there were 62 people living in the home.

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. During our inspection we found the previous registered manager had left the service and a new registered manager had been appointed. On the day of our inspection the new registered manager had been in post since January 2015.

We found staffing levels at the home were appropriate for the number of people living there.

We found people’s medicines were well managed.

We saw the home had in place personal emergency evacuation plans displayed close to the main entrance and accessible to emergency rescue services. The fire brigade had carried out a training session at the home two weeks before our inspection visit. The fire officer told the registered manager that the PEEPs file was extremely detailed, however in an emergency situation; he and his officers would not have the time to go through each person’s profile. He suggested a one page

Spreadsheet with bedroom numbers and a coloured code to indicate the assistance people required. We saw that the registered manager had commenced the implementation of this.

We found the home had robust cleaning schedules in place to prevent the spread of infection.

The provider had worked within the Mental Capacity Act 2005. We saw that all people using the had Mental Capacity Act assessments to identify if they had capacity to consent to their care. We also saw Deprivation of Liberty Safeguards were in place.

We observed staff speaking with people in kind, respectful and reassuring ways.

People told us they felt their dignity and privacy were respected by staff.

We saw a notice board on which was displayed information about the activities for that week. During our inspection we found lots of various activities taking place. It also displayed information about how to access an independent advocate who could assist people to make decisions that were important to them.

We found the provider had audits in place to measure and monitor the quality of the service, including those for the prevention of infection control.

We saw the provider had in place a complaints policy in place and this was clearly displayed for people to see.