About the service: Brook House Residential Home is a residential care home that was providing care to 30 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• Significant improvements had been made in all areas of the service since our previous inspection. However, further work was needed to ensure these improvements were sustained. Improvements were also needed to ensure people's care records were updated in a timely manner to show the care they received.

• The management of people’s medicines had improved, although some staff continued to not sign for medicine they had given.

• Risks associated with people’s care and the environment were identified and managed.

• Staff had received training in and understood how to protect people from harm and abuse.

• People were supported by staff who knew them well and had good relationships with them.

• Staff obtained people’s consent prior to supporting them and respected their decisions and preferences.

• People were supported to eat and drink enough and enjoyed the food they received.

• People were treated with dignity and respect by staff.

• People and their relatives were involved in the planning of their care and people were supported in line with their preferences.

• Complaints systems were in place, which people and relatives knew how to use.

• People were happy with the care and support they received and gave positive comments about the staff at the home.

The service met the characteristics of Good in most areas; more information is in the full report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report was published 13 June 2018).

At our previous comprehensive inspection in April 2018, we had found four breaches in regulation because the provider had not ensured decisions made on behalf of people were made in their best interest, or that people’s medicines and risks were managed safely. Also, the provider’s systems for checking the quality of the service were not effective and they had failed to notify us of significant events.

After the inspection, we had served a Warning Notice to the provider to be compliant with the Regulations by 1 August 2018. The provider also wrote to us with an action plan, to say what they would do to meet the legal requirements.

At this inspection, improvements had been made and the regulations were met. However, some further improvements were still needed in the key question of Well-Led.

Why we inspected: This was a planned inspection to check the provider had made improvements since our previous inspection.

Follow up: We will continue to monitor the service through the information we receive.

This inspection took place on the 5 and 10 April 2018 and was unannounced on the first day and announced on the second day.

Brook House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Brook House Residential Home is registered to provide accommodation with personal care for up to a maximum 32 people. The accommodation was split across two floors, each of which have separate adapted facilities. At the time of our inspection, there were 28 people living at the home, two of whom were staying there on a temporary basis. Some people were living with dementia.

There was a registered manager in post who was present during 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 our last inspection in March 2016, we rated the service at Good. At this inspection we found significant failings at the service and breaches of the Regulations. We gave the service an overall rating of Requires Improvement.

Risks associated with people’s needs were not always accurately assessed and managed. Where people were at high risk of falls, it was not always clear what if any action had been taken to prevent reoccurrence, this left people at risk of serious injury. The provider had not assessed the risk of entrapment to people in relation to bed rails and ill-fitting mattresses. People’s medicines were not always managed safely. Infection prevention and control measures required improvement to prevent the risk of infection. The provider had not ensured a safe and hazard free environment and people were exposed to the potential risk of avoidable harm.

There was a lack of effective leadership and governance which impacted on the effectiveness of the care provided to people. The checks the provider had in place to monitor the quality and safety of the service were not effective in identifying shortfalls and driving the required improvements.

The principles of the Mental Capacity Act were not always fully understood and implemented and we were not assured decisions made on people’s behalf were made in their best interest. Staff sought people’s consent before supporting them and explained things to people in a way they understood to enable them to make decisions for themselves wherever possible.

While people had access to a range of activities suited to their needs and interest, staff had limited time to sit and chat with them.

Staff received training relevant to their role and to support their development. Staff felt well supported by the registered manager and their colleagues.

People were protected from the risk of abuse and discrimination by staff who had the knowledge to identify the signs of abuse and who knew how to report concerns

People enjoyed the food and were supported to eat and drink enough. Staff monitored people’s health and supported them to access healthcare professionals as required.

People found staff to be kind and considerate and were involved in decisions about their care. Staff treated people with dignity and respect and supported then to remain as independent as possible.

Although people had not had cause to raise concerns they felt comfortable and able to approach staff or management should the need arise.

The provider sought people’s view on the quality of the service and people found the registered manager friendly and approachable.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection was carried out on 17 March 2016 and was unannounced.

Brook House Residential Home is registered to provide accommodation with personal care for up to a maximum of 32 older people. There were 28 people living at the home on the day of our inspection.

There was a registered manager in post who was present during the 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.

People felt safe living at the home as there were enough staff to meet their needs. Staff had received training on how to keep people safe, they knew how to identify signs of abuse and who to report concerns to. Staff had access to detailed care plans and risk assessments and were aware of how to protect people from harm. Risks were managed appropriately whilst promoting people’s choice and independence.

Staff knew how to deal with accidents or incidents and these were overseen by the registered manager who took appropriate action to reduce the risk of reoccurrence. Checks were completed to ensure new staff were suitable to work with people living at the home before they started work there.

People received their medicines safely and accurate records were maintained. People were supported to see health care professionals as required. Staff followed guidance provided by health professionals to promote people’s health and wellbeing.

People received support from staff who had received training to meet their individual needs. Staff were knowledgeable and highly motivated to deliver good quality care.

Staff sought people’s consent before supporting them and respected their choice. Where people were unable to make decisions for themselves best interest meetings were held to ensure their rights were protected.

People enjoyed the food and had a choice of what they wanted to eat and drink. People’s nutritional needs were assessed and monitored. Where required people were supported to eat and drink.

People were actively encouraged to make choices about how their care and treatment was provided. Care plans were tailored to people’s individual needs and kept under regular review.

People were treated with kindness and respect. Staff had developed positive relationships with people and their relatives. Staff promoted people’s dignity and supported them to remain as independent as possible.

People were able to spend their time as they wished. There was a range of activities and outings that people could choose to partake in. Staff knew people well and responded promptly to any changes in their needs.

There was a warm and friendly atmosphere at the home. People and staff found the registered manager approachable and easy to talk to. Staff were positive about their caring role and felt valued.

The provider encouraged feedback from people and their relatives and completed a range of checks to monitor the quality of the service. They used the information gathered to drive improvements in the service.

We carried out this inspection in response to concerns we had received about Brook House Residential Home. It had been alleged that insufficient staffing levels in the evening and at night put people’s health and wellbeing at risk. It was also alleged that moving and handling practices were not always safe and in line with current guidelines.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three people who used the service, five staff and the Registered Manager. We also reviewed records relating to people's care, staff rotas and maintenance records.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

We were told by one person who used the service that, “This is definitely a safe place to live”. Staffing levels were appropriate for meeting the needs of people.

We saw records and staff confirmed that equipment such as hoists were regularly maintained to ensure they were in good condition and safe to use. Staff confirmed that they had received moving and handling training and they were confident in the appropriate use of moving and handling equipment and techniques.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no application had needed to be submitted at the time of our visit, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

Is the service caring?

One person told us that staff were, “Very caring and very good”. We were told that staff were particularly sensitive when assisting people with personal care. People told us that they felt respected by staff. Staff were caring and compassionate.

Is the service responsive?

People told us that staff were responsive to their needs. One person told us, “I can’t praise them enough. I had a fall recently and they were there immediately”.

Is the service well-led?

The home had an experienced Registered Manager in post. Staff told us that they felt part of a good team and felt well supported. Good training opportunities were available to staff.

During our inspection we spoke with six people who used the service, three relatives, four staff, a visiting health care professional, the registered manager and the provider. People using the service all made positive comments that included, "Staff are very kind to me" and "I have no complaints, I am not shy at coming forward and would say if things were not right". A relative said, "The staff show complete respect to me and my relative".

We found that people using the service received their planned care in a professional and safe way from staff who were well trained and knowledgeable about their needs.

We saw that people had a positive dining experience and that suitable nutritious food and drinks were available at all times with assistance from staff if needed.

There was a system in place to ensure that people were protected against the risks associated with medicines. We found that people received medicines safely and as prescribed.

We found that there had been adequate numbers of suitably trained and experienced staff to meet people's needs. Two people using the service told us that they felt there had been sufficient staff on duty at all times.

We found that people using the service and staff had the opportunity to give their views about the service provided. We saw that changes had been made to the service in response to people's views and the findings of audits. Appropriate systems were in place to monitor the quality of service.

We spoke with eight people who used the service. We also spoke with the provider, the manager and five staff. There were 28 people living at Brook House on the day of the inspection.

People were very satisfied with the care and support they received at Brook House. They were involved and consulted about the way that care and support was given and reviewed. People were supported to retain their independence as much as possible. Staff and the service were described as, "Marvellous" and "Excellent". One person said it was "Like being at home here". Another person told us that "You couldn't get a better place to look after you".

Care plans contained clear guidance for staff on people's needs and how these should be met. This was done in a way that reflected people's individuality and preferences.

People confirmed that their consent was sought by staff over all aspects of their lives at Brook House. This included decisions about health and medical matters.

Measures were in place to reduce the risk of people acquiring healthcare associated infections.

Systems were in place to make sure that checks were made when new staff started working at the home to make sure that they were suitable. Staff felt very well supported by the management team.

The service supplied people with information about how to raise any concerns and complaints.

There were 30 people living at the home on the day of the visit.We spoke with the registered manager, five members of staff and seven people who live at Brook House.

People were encouraged to visit the home before they decided to move in and an assessment of their needs was undertaken to make that Brook House was the right place for them .

All of the people who were able to talk to us spoke very positively about their life at Brook House and the care they receive from staff. People were pleased with the quality of the food and the range of activities available. On the day of our visit we saw people being supported sensitively and discreetly. Staff were mindful about respecting people's dignity and privacy and were seen to be involving people fully in relation to all decisions made.

The home was clean, tidy and free from odours. The home was well maintained and all the necessary aids, adaptions and equipment were provided. People were able to personalise their rooms and their choices and lifestyle was respected.

Care plans contained good detail about people's life history, health and social care needs and their likes and dislikes. Care plans gave clear guidance and information for staff on how people's needs should be met and the importance of supporting people to retain life skills and independence.

Polices, procedures and training were in place to make sure that people who use the agency were kept safe and the risk of abuse was known and minimised.

Staff were very knowledgeable about what constituted abuse and poor practice and were clear about how to report this should it occur. Staff felt that they had the training they needed to do their job well and were well supported by senior staff and management.

Staff were provided with training, supervision and support by the manager and were confident that they were able to provide the care and support to people who live at the home.

Quality assurance systems were in place to monitor and review the quality of the service provided. Health and safety systems were in place to make sure that people who live and work in the home were safe.