Brockworth House Care Centre 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. Brockworth House Care Centre accommodates up to 55 people in one building. At the time of our inspection there were 47 people living at the care home.

At our previous inspection in October 2015 the service was rated "Good". At this inspection we found the service remained "Good".

Brockworth House Care Centre 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.

Following our previous inspection recruitment practices had been improved and records showed the required pre-employment checks had been completed. Improvements had also been made to ensure people’s medicines would be available when needed and people continued to receive their medicines as prescribed.

We heard positive comments from people using the service at Brockworth House Care Centre such as, “I would recommend Brockworth House to people and have done” and “The home nowadays has a good reputation amongst the local population and clinicians are happy to go there.”

The personalised care people received were exceptional and the service was outstandingly responsive to the changing needs of people living with dementia. Digital systems were used creatively to enable people to access material that they enjoyed and held meaning for them. Activities available to people were highly personalised and staff went out of their way to ensure people had a stimulating and enjoyable day.

People were protected from harm and abuse through the knowledge of staff and management. Risks in respect of people's daily lives or their specific health needs were assessed and appropriately managed with plans in place to reduce or eliminate those risks. Sufficient staff were deployed. The care home was clean and had been well maintained.

Staff were supported to maintain their skills and knowledge to support people. People were assisted 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 were consulted about meal preferences and enjoyed a varied diet. People's health care needs were met through on-going guidance and liaison with healthcare professionals.

People received support from caring staff who respected their privacy, dignity and the importance of their independence. People were supported to maintain contact with those important to them.

People and their representatives could be assured that complaints would be thoroughly investigated. Care was provided for people at the end of their life.

Effective quality monitoring systems were in operation. The registered manager was approachable to people using the service, their representatives and staff.

Further information is in the detailed findings below.

This inspection took place on 30 June, 1 and 2 July 2016 and was unannounced.

The care home specialised in the care of people who lived with dementia or mental health needs. Some people had become more frail and their predominant needs were now of a physical nature. The care home could care for up to 55 people and at the time of our inspection there were 50 people living there. Nursing care was provided by nurses who were on duty at all times. People’s care was delivered across two floors and areas were separated into units. Each unit had its own communal area, bedrooms and bathrooms. People could visit other units but they tended to remain on their own. There were extensive grounds outside to be enjoyed and a safe enclosed garden meant people could enjoy the outside safely and independently if they chose to.

The care home did not have a registered manager in post but a new home manager had been recruited and was due to start in August 2016. It was planned that this manager would apply to the Care Quality Commission (CQC) to become the new registered manager. A registered manager is a person who has registered with the 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.

During this inspection we followed up breaches of the regulations which were identified in our last inspection; that inspection had been on 30 June, 1 and 2 July 2015. The provider had been asked to take action and address these breaches. These had included unsafe care delivery, a lack of personalised care, people not being treated with respect and dignity and staff not providing understanding and compassion. It also included care records not being sufficiently maintained in order for safe and consistent care to be delivered. The provider wrote to us with their action plan on how they would address these shortfalls and by when. During this inspection we found these actions had been taken and the shortfalls addressed.

We did however find people were at risk of not being cared for by staff who were suitable because some recruitment checks had not been fully completed. However, the two examples we identified were addressed at the time of the inspection and just after the inspection. The forms used by the provider had not prompted staff to explore these areas and this was going to be addressed. Arrangements to ensure people were fully assessed and their moving and handling needs were met safely had been implemented. Staff were now consistently ensuring people were supported to move safely. People’s dependency levels had been reviewed and had continued to be reviewed and there were enough staff to meet people’s needs.

The care home had problems in ensuring people’s medicines were available when needed. This was a problem with the way the Pharmacy received prescriptions and managed these. The care home had put strategies in place to try and reduce the risks arising from this to people. The care home’s arrangements for medicines were likely to change because of this. Safe practices were in place in the care home for the administration and storage of people’s medicines once they arrived.

We received information prior to the inspection that the management staff had confused staff over what constituted abuse. We explored this with the management staff who after the last inspection had reminded staff that in forcing people to do something they did not want to do or to move them in a way they had not been assessed to be moved constituted abuse. The staff we spoke with were very clear about what abuse was, what this looked like and what they would do about this if they witnessed or suspected it had taken place. They were very clear about the fact people could not be forced to receive care they did not consent to but, in order to deliver the care people needed and to

We were not able to talk to anyone who used the service because of their advanced stage of dementia. We did observe how staff interacted and communicated with people who used the service. We spoke to their relatives and to staff and looked at documents held by the provider. We specifically looked at the care files of six people who used the service.

Where possible staff encouraged people who used the service to make choices about their care. We observed staff asking people which activity they wanted to take part in or what they wanted for lunch. Each person had individual support plans (care plans) that had been reviewed each month. This meant people were receiving up to date care based on their individual needs. Systems were in place for the safe administration of medicines and this was carried out by trained staff. We also saw systems in place to monitor the quality of the service provided within the home.

The relatives told us “it’s a very nice home”. “I can’t speak highly enough about it, very friendly”. “They care for my mother very well and make her feel comfortable”. “Our mother has deteriorated, but the staff have adapted the care accordingly and are very aware of her needs”. “The staff always have time for our mother and we are reassured she is getting good care”.

Brockworth House provides accommodation for people with dementia. Although we spoke with a number of people we did not obtain feedback about the service people received. We spent time observing people during our visit. A person commented that they enjoyed their meal.

We observed people taking part in activities such as a sing along, listening to music or a film show. People were reading daily newspapers. We also saw relatives and friends visiting people throughout the day. Relatives told us, "its the next best place to home".

Relatives told us, "they look after ........ well. I can't fault them". Relatives said "we attend relatives meetings each month","the manager's door is always open and any problems are dealt with as they arise, not that there are any".

Surveys from last year noted the following comments from relatives: "Staff are very friendly and helpful", ".... speaks very highly of all staff" and "standard of care and compassion from all staff together with the quality of care provided itself is of the highest standards".

The inspection took place on 30 June, 1 July and 2 July 2015 and was unannounced.

The service cared for people who lived with dementia and who had mental health needs. It could accommodate up to 52 people and at the time of the inspection 51people in total were cared for.

The service’s manager had been registered with the Care Quality Commission since December 2013. 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.

We found the provider was not meeting the legal requirements in the following areas: care was not always provided safely, care was not provided in a way that met people’s individual needs, people were not always treated with respect and dignity, care was not always delivered in a caring and compassionate way and care records were not always kept up to date and accurate. You can see what action we told the provider to take at the back of the full version of the report.

We also made three recommendations; to review the staffing numbers to ensure people’s needs could be met in a personalised way, review the effectiveness of the staff training and implement any necessary improvements around training required for the support of people with specialist needs such as dementia.

We found people’s needs were not always met because staff skills, knowledge and practices varied. Staff had been provided with training but, at times, this learning was not applied in practice. The need to recruit new staff had been the registered manager’s main challenge since the new year. This had resulted in the employment of several new staff who needed additional support. Existing staff did not always have the skills to support new staff. Recent appointments had been made to secure a senior management team within the service. This would provide the registered manager with the support she needed.

There were mixed views about whether there were enough staff to meet people’s needs. The registered manager confirmed the recruitment process now meant the home was fully staffed with the appropriate numbers of care staff. Additional recruiting was taking place to make it easier to cover staff annual leave and sick leave. Staffing numbers were continually reviewed by the registered manager who considered there to be enough staff in number to meet people’s needs. We found people’s needs were met but not necessarily when people wanted them met or when they needed to be met. Care was delivered in a task oriented way and not in a personalised way with little time in-between tasks. People had access to activities but there were several people left for long periods of time without meaningful interaction despite the involvement of activity staff and volunteers.

There were times when people were not treated with dignity or respect. People were always provided with the privacy they required. People’s medicines were managed safely and people were protected against the inappropriate use of medicines that can sedate. Staff were provided with guidance on how to deliver people’s care but this was not always up to date. People had access to health and social care professionals and to specialists when required. People were supported to have a balanced diet and to receive enough drinks. People’s relatives predominantly spoke on their behalf and they were involved in the planning of their relative’s care. People who lacked mental capacity were appropriately assessed and decisions, which were made on their behalf, were made in their best interests.

Environmental risks were managed and good maintenance arrangements were in place. Other regulators visited to check on food safety standards and fire safety for example. Requirements and recommendations from these agencies were addressed. Accidents and incidents were monitored and action taken to avoid these happening or to avoid reoccurrences.

The provider had arrangements in place to support the registered manager and to monitor the overall performance of the home. This process had not successfully identified some of the issues we found during the inspection. A new senior management team was now in place to address the shortfalls in the service. The service was also advertising for a permanent administrator who would provide further support.