The inspection took place on 29 August and 7 September 2017. The first inspection visit was unannounced. We told the registered manager when we would return for our second visit.

Brooke House provides accommodation and support for up to 35 people who may be living with dementia, mental health support needs or with physical disabilities. At the time of this inspection there were 33 people living in the home. The service has an older unit in the main house, arranged over two floors with lift access between. The Brookefields unit is adjacent to the main home, is purpose built and on one floor.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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. The registered manager was recently registered with CQC, completing the process in April 2017.

At our last inspection in August 2016. we did not identify any breaches of regulations. However, the safety and effectiveness of the service needed to improve. This included improvements in the way some medicines were managed, monitoring of pressure areas and in the timely completion of staff training. This included training for staff to understand their legal obligations when supporting people who might not be able to make specific, informed decisions.

At this inspection, we found that improvements had been made in the areas we highlighted last time. Some further improvement was needed to ensure the service people received was always as safe as it should be.

There was a new, electronic system for managing medicines. This tracked who had administered medicines, when, and provided a system for auditing, with daily reports. The registered manager could show they took prompt action to address any anomalies identified in the daily reports. The system was still bedding in but indicated improvements in the safe management of medicines. A concern was raised with us before our inspection, that sometimes people were without medicines because staff had not ordered it in a timely way. We found that the new system alerted staff to the need to reorder items and that people were unlikely to be left without essential medicines.

There were enough staff to support people safely. Robust recruitment processes and checks continued to protect people from the employment of staff not suitable to work in care. Staff were clear about their obligations to report any concerns should they suspect that people might be at risk of harm or abuse and people said they felt well treated by staff. However, a recent visit by the safeguarding and quality assurance team, highlighted two situations of concern. They considered that the registered manager should have shared these concerns with the local authority safeguarding team. The management team had taken action in relation to the safeguarding and quality assurance visit both to investigate and learn from the feedback they received.

During our inspection, we found a further example of an incident that should have triggered prompt discussion with the safeguarding team and further exploration. Between our two inspection visits, the management team acted on the concern that we raised. The registered manager and deputy manager had enrolled on further training specifically for the management of safeguarding concerns and possible abuse. They anticipated this would improve their awareness of issues that might indicate concern and require advice from safeguarding specialists.

Risks to people's safety and welfare were assessed and staff had guidance about minimising these. They were able to tell us what they did to promote people's safety and about their training to understand their obligations. The registered manager had made improvements to the timeliness

The inspection took place on 22 and 25 August 2016 and was unannounced.

Brooke House provides accommodation and support for up to 35 people who may be living with dementia, with mental health support needs or with physical disabilities. At the time of this inspection there were 34 people living in the home. The service is comprised of an older unit in the main house, arranged over two floors with lift access between. The Brookefields unit is adjacent to the main home, purpose built and on one floor.

There was a registered manager in post as required. 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.

Some improvements were needed to the safety of the service. Increased clarity was needed to the way that risks to people's skin integrity were managed and mitigated to promote people's safety. This included improving the application of external creams and lotions to protect and maintain the health of people's skin. The provider had already identified this as an issue. Staff were very busy and sometimes stretched to respond to people promptly. The registered manager was seeking an appropriate tool to use for assessing people's dependency levels to ensure that staffing levels remained safe as people's needs changed. Staff understood the importance of their role in contributing to protecting people from the risk of harm or abuse and of reporting any concerns they had. Recruitment practices contributed to people's safety.

There were some gaps in staff training which the manager was trying to address, chasing staff to complete some of their learning in a more timely manner. We found that there were also gaps in training for them to understand their legal obligations when they were supporting people who may not be able to make informed decisions about their care. This area needed to improve and the provider was aware of this. However, staff did understand the principles of trying to gain people's consent and cooperation. The registered manager understood what action they needed to take to ensure people's liberty was not unreasonably restricted in the interests of maintaining their safety.

People had enough to eat and drink to meet their needs. However, the quality of their mealtime experiences varied. There was not always a calm and conducive atmosphere for people to enjoy their meals. Where there were concerns about people's diet or other aspects of their health, staff made sure that they sought appropriate advice from health professionals.

Staff had developed warm and caring relationships with people using the service. They took action to offer reassurance and comfort when people became anxious or distressed. They also treated people with respect for their dignity and privacy and spoke with them politely. They offered people opportunities to make choices about their care. Staff considered how people communicated and how they could adapt what they did to ensure people were able to understand what was happening and make choices.

Staff had also developed a good understanding of people's backgrounds and histories so they knew what was important to them. They took these and people's interests into account in people's opportunities to pursue activities and hobbies as well as in the way that they delivered their care.

People were supported to express their views about their care so that improvements and changes in the service were made if it was needed. They were confident that, if they had concerns or complaints, the management team would listen to them and take their concerns seriously. Staff were also supported to express their views and found both the registered manager and deputy manager supportive if they had issues or suggestions to make.

The r

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

As part of this inspection we spoke with five people who used the service, the registered manager, a senior manager who represented the provider, and three members of staff. We also reviewed records relating to the management of the service which included four care plans, daily records, staff records and quality assurance monitoring records.

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

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

This is a summary of what we found:

Is the service safe?

People told us they felt safe living at Brooke House and would be able to speak with a staff member if they were concerned about anything. The service had guidance for staff in protecting people from abuse and we found that staff members had a clear understanding of their responsibilities in this area.

Risk assessments for care needs were completed and provided appropriate actions for the identified risk to be reduced. Applications had been appropriately made in regard to Deprivation of Liberty Safeguards for people whose liberty was restricted. Staff members and the manager showed they had appropriate knowledge regarding recent guidance.

People using the service said there were enough staff available to meet their needs. Information from staff members, the manager and records shows that there were enough staff available with the skills and training to care for people appropriately.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with. They told us that they were satisfied with the care they received. Care records provided clear and detailed information about people's care needs and preferences. We found that staff members had a good understanding of people’s care needs and of current good practice in dementia care.

Health needs were responded to and people had access to health care professionals if they needed this. Care records contained information and guidance from the health care professionals involved with people's care.

Is the service caring?

People said that staff members were polite and kind; they respected people's privacy and dignity, and involved them in their care. Staff members knew people's care needs and their personal preferences when we spoke with them.

We observed interactions between people and staff members and we found that the members of staff were patient and understanding of people’s individual needs. There was a warm, friendly atmosphere at the home. Staff members spent time with people and ensured they had the care and attention they needed. They spent time with people during activities and made sure that those who were less able to participate easily were provided with a positive experience.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and planned for. Their individual choices and preferences regarding their support and care were valued and respected.

Is the service well led?

There had been an annual survey to gather the views of people using the service a year ago and a further survey was due to be sent out. Responses from the last survey were positive, but actions were identified for suggests that had been made. There were other systems in place to monitor and assess the quality of the service provided, and the service had analysed this information for any trends or themes resulting from complaints, accidents or incidents.

During our inspection, we spoke with five people who used the service and asked them about the care and treatment they received. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The people we spoke with told us that they were well looked after.

One person said, "They (the staff) look after me really well." Another person we spoke with said, "The food here is really nice, we always have a choice at lunchtimes and the staff are so helpful." A further person we spoke with told us, "I really like it here, there is so much space and the gardens outside are lovely."

We looked at a range of records including care records, staff recruitment and training records, maintenance records and medication records. These records were stored securely, readily available, accurate and fit for purpose and provided us with evidence that the service was maintaining the information we required.

Staff received appropriate support and training to carry out their duties.

During the inspection we spoke with five people who used the service and with three members of the care staff.

People who used the service told us that the care and support they received was good. One person told us that they were very, "Happy and had nothing to complain about." Another person told us that staff made sure that they, "Have my newspaper to read everyday."

People who used the service were all living with dementia and did not therefore comment on their care plans. We observed staff during the inspection. They treated people with respect, played games with them and spoke in appropriate terms.

We spoke with six people who live in the home. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that they always treated them with respect and that their privacy was respected. They told us that there were enough staff on duty to assist them and that they felt safe living in the home. They also told us that the environment was comfortable and clean and that they were provided with good quality meals and daily activities.