This inspection took place on 28 and 29 March 2017. It was an unannounced visit to the service.

We previously inspected the service on 27 and 28 January 2016. The service was meeting the requirements of the regulations at that time. However, we made three recommendations to improve practice at the service.

Brook House is a care home providing nursing care for up to 35 older people. Thirty three people were living at the service at the time of our visit.

The service 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.

We received positive feedback about the service. A relative told us “I see a lot of what goes on here as I am here most days and it’s a good standard of care.” Relatives told us their family members received appropriate healthcare support. One said their family member’s mobility had improved since they had been at the home. People spoke positively about the meals provided for them. Typical comments included “Plenty to eat and I have no complaints” and “The food is really good here.” People told us staff were kind and caring. For example, “The staff are very kind and caring” and “The staff are very nice to me.”

When we visited the service in January 2016, we made three recommendations to improve the quality of people’s care. These were in relation to promoting people's dignity when assisting them with moving and handling, following good practice in involving people in decision-making processes about their care and improving people's links with the local and wider communities. We found improvements had been made in each of these areas.

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 supported this practice.

There were enough staff to meet people’s needs. Recruitment procedures were thorough to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction, regular supervision and an annual appraisal of their performance. Staff undertook training to meet the needs of the people they cared for.

People’s needs were recorded in care plans. These were detailed and had been kept under review. Work had started to find out more about people’s backgrounds and personal histories through involving relatives. This helped staff to better understand the lives of the people they supported and what was important to them.

Refurbishment was taking place. At the time of the inspection, the provider was working through a planned refurbishment programme of the home. The refurbishment plan had begun in January 2016. It would include areas of the home which now looked worn, including older parts of the building.

We saw electrical cables had been left plugged into the wall and trailed onto the floor after staff had disconnected the equipment or appliances they belonged to. We acknowledge the registered manager took action straight away once this was brought to their attention. The registered manager was able to show us staff were made aware of health and safety concerns as and when they arose. We have made a recommendation about electrical safety.

There were various systems to monitor the quality of care, such as surveys, audits and visits by the provider.

This inspection took place on 27 and 28 January 2016. It was an unannounced visit to the service.

We previously inspected the service on 20 February 2014. The service was meeting the requirements of the regulations at that time.

Brook House is a care home providing nursing care for up to 35 older people. Thirty one people were living at the service at the time of our visit.

The service 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.

We received positive feedback about the service. Comments included “I am very happy here, everyone is kind and cheerful and nothing I can say would improve it,” and “It’s like home from home; I would recommend it to family.” Other comments included “It’s lovely here” and “I like the way I’m looked after.” A relative said “We genuinely believe that they are caring, it’s a lovely atmosphere and because they care, everything is right. It feels like a lovely home.” One of the staff we spoke with told us “I’m proud to be a nurse in this nursing home.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. People’s medicines were handled safely and given to them in accordance with their prescriptions.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through regular supervision and staff meetings There was an on-going training programme to provide and update staff on safe ways of working.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs. People were supported to take part in activities. Staff referred people to external healthcare professionals as necessary, to help keep them healthy and well.

People knew how to raise any concerns and were relaxed when speaking with staff and the registered manager. We saw complaints were dealt with appropriately.

The building complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

The service was managed well. The provider regularly checked quality of care at the service through visits and audits. There were clear visions and values for how the service should operate and staff promoted these. For example, people told us they were treated with dignity and respect and we saw they were given choices. Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We have made recommendations about promoting people’s dignity when assisting them with moving and handling, ensuring people are involved in decision-making processes about their care and improving people’s links with the local and wider communities.

Brook House currently supports 28 people to live in the home. We talked with people who lived there, with staff and with a visiting relative.

People told us the care was very good. One person said “It’s really first class”.

We found people’s needs were assessed and that care was provided in line with their care plan.

There were policies and processes to prevent abuse and to alert managers and the local authority if there were concerns.

Staffing numbers were adequate and staff were supported to do their jobs.

The provider regularly sought people’s views on the service and took account of those when planning future services.

Records were kept and were clear and reviewed regularly.

The people we talked with expressed a high level of satisfaction with the service. One person told us their health had improved since admission and they were now more independent, able to walk around the garden and participate in their own care. At the same time they valued having support available when needed. Another person said it was a “Very nice” service. They were happy with their care and also appreciated being able to visit their children and grandchildren. The relatives we talked with expressed satisfaction and confidence in the service. They were able to be involved in their mother’s care. They said their mother was treated with dignity and respect. Their mother had told them the food was good. Another relative told us their mother was treated with respect by staff, the care was good, and staff informed them of relevant matters. A visiting GP expressed confidence in the service. The GP said the staff had good knowledge of people’s needs, were alert to problems people might be having, maintained good communications with the surgery, and maintained good clinical practice.

We found people’s needs were assessed and care was provided in line with their care plan. People were protected from the risk of inadequate nutrition. People were protected against the risk of abuse. There were sufficient staff to meet people's needs. Staff were supported in providing care and support to people. The organisation had arrangements for monitoring the quality of the service.

The people we spoke to were very satisfied with the home. One person described it as very good. The person found it friendly and said the staff were "very good".

Another also said it was a very good home. The person found the staff attentive and said that they were always available to help. Another person said that "Overall, (the home is) very good" and that her relative had improved since moving to the home from hospital.