This inspection took place on 26 July and 7 August 2017 and was unannounced. This meant the provider and staff did not know we would be visiting.

Brookfield Care Home can accommodate up to 30 people. The home is situated in the village of Lazenby which is close to the coastal town of Redcar. The home has two units. The ground floor accommodates people living with a dementia. The first floor accommodates people requiring personal care. There are enclosed gardens which people who used the service can use. At the time of our inspection 29 people were using the service.

At the last inspection on 15 and 16 December 2015 the service was rated Good. At this inspection we found the service remained Good. At the December 2015 inspection we also identified two breaches of our regulations in relation to care plans for people with complex mental health conditions and activity provision. We took action by requiring the provider to send us action plans setting out how they would address these issues. When we returned on our latest inspection we saw improvements had been made. However, we identified that further and sustained improvements were needed.

There was a registered manager in place. 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.

Activities were available but were not always appropriate for people with physical support needs and people living with a dementia. We made a recommendation about activities for people living with a dementia and physical support needs.

Most of the care plans we looked at contained evidence of personalised care planning. However, we saw that further and sustained improvement was needed in care plans for people with complex mental health conditions or who were living with a dementia.

Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Accidents and incidents were monitored to see if improvements could be made to keep people safe. People’s medicines were managed safely. Policies and procedures were in place to safeguard people from the types of abuse that can occur in care settings. Staffing levels were monitored to ensure they were sufficient to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received mandatory training in a number of areas to support people effectively. Staff were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 (MCA) were protected and promoted. People were supported to maintain a healthy diet. Health and social care professionals were involved in people’s care to enable them to maintain good health.

People and their relatives spoke positively about the support they received and described staff as kind, caring and friendly. A caring culture was noticeable throughout the service, with staff at ease with people and any relatives or health professionals visiting the service. We saw numerous examples of kind and caring support being provided during our visit. Processes were in place to support people to access advocacy services and end of life care. Procedures were in place to investigate and respond to complaints.

Staff spoke positively about the culture and values of the service and said they were supported by the manager. The manager was a visible presence around the service, and clearly knew the people living there well. The provider and manager carried out a number of quality assurance audits to monitor and improve standards at the service. Feedback was sought from people who used the service and their relatives. The registered manager had informed CQC of significant events in a timely way by submitting

Brookfield Care Home can currently accommodate 26 people although an extension is close to completion. The home is situated in the village of Lazenby which is close to the coastal town of Redcar. The home has two units. The home accommodates people living with a dementia and people requiring personal care. There are enclosed gardens which people who use the service can use.

Our inspection team was made up of an inspector and this helped answer our five 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, speaking with people using the service, their relatives, 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 were treated with respect and dignity by the staff. People told us they felt safe. One visitor told us they felt there was not enough staff, but that they were happy with the staff who worked at the home and felt the care provided was good. Systems were in place to make sure that managers and staff learnt 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 policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and appropriate applications had been submitted and records held accordingly. We discussed the implication of a recent court judgement in relation to Deprivation of Liberty Safeguards and advised the manager to seek advice from the local authority into its relevance for Brookfield residents. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected.

Is the service effective? - People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that people had been involved in writing them and they reflected their current needs. Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring? - People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented that the staff; “Were all lovely” and “The care here is very good”. People using the service, their relatives, friends and other professionals involved with the service were asked for their views through meetings and surveys. Where shortfalls or concerns were raised these were addressed. People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. The manager had that day received a letter from a relative whose family member had recently passed away. The letter was a very moving thanks to the manager and all the staff at the service for the; “Love and care my mother was always shown by everyone and praise for the; “Professionalism, support and advice of the manager."

Is the service responsive? – At our last inspection we found that there were not always enough staff to meet the needs of the people using the service. The service provided us with an action plan and have carried out a full staffing review used a dependency tool to assess the needs of each person so staffing could be set accordingly. They also said they would change the day staff shift times so someone started at 7am to help support the night staff. On this visit we saw that all these changes had been put in place and the home was also recruiting for bank staff. This showed the service listened and responded to the Care Quality Commission. The service also regularly sought views of people using the service and visitors via questionnaires and meetings. The home had a complaints policy and procedure that was accessible and people and visitors to the home told us they could raise any issue with the managers or staff.

Is the service well-led? - The manager and deputy manager had clear roles along with senior care staff. Together they met regularly to plan how the service should be managed. The service has a quality assurance system; records we saw showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke with people who lived at the service, two relatives and three members of staff as well as the manager and deputy manager. One visitor told us he felt there was not enough staff but said “The girls are very caring and I feel my wife is safe here”. We discussed the gentleman’s concerns over staffing with the manager so that the manager could take this issue further. Another relative we spoke to whose husband had recently been admitted to the home said; “They look after him well and me and my daughter are quite happy”. She also told us the home maintained her husband’s appearance well saying; “He is a stickler for presentation and looking smart and they have him looking good." One person living at the home told us; “I used to visit my husband here so I knew everyone before I came in. The girls are wonderful and I can talk to Chris and Martin (the manager and deputy) if I have any problems”. She also told us; “You can go to bed and get up whenever you like and you can have a cup of tea whenever you want one."

We spoke with two members of staff who were working on the first floor of the service. They told us they felt there was enough members of staff and one staff member said; “There is good training and I feel supported here."

During our last inspection of Brookfield Care Home we identified some concerns with the standard of record keeping. We carried out a follow up inspection on 16 October 2013 to make sure that there had been improvements to people’s care records.

We found that improvements had been made. Risk assessments took place and were reviewed regularly, as were care plans. Records contained meaningful, personalised and up to date information about people, thus protecting them from receiving unsafe or inappropriate care.

People who used the service told us they were treated with respect by staff and their dignity was preserved. They also stated that staff knew how to care for and support them without causing embarrassment or harm.

We observed that on the whole staff maintained confidentiality and privacy but there was room for improvement.

Staff were aware of the care and welfare needs of people and were knowledgeable about people’s likes and dislikes. We found that they supported people in a safe and positive way most of the time.

People told us they felt safe and had no concerns about staff. Staff were aware of their responsibilities in relation to safeguarding vulnerable adults; had undergone training; and had access to policies to support them. There were systems in place to ensure that people were protected from the risk of financial abuse.

Staff received regular training and supervision. They told us they were well supported by the managers within the service. If they had concerns they were confident that action would be taken to resolve them.

The service had a quality assurance system in place and the manager was aware of their responsibilities in checking quality and ensuring they provided a high quality service.

Records were in need of improvement. Some care plans and risk assessments were unavailable; some had not been reviewed regularly; and in some, inappropriate terminology had been used. Although records were stored securely, some information had been misfiled.

This inspection took place on 15 December 2015 and was unannounced. This meant that the provider did not know we would be visiting. A second day of inspection took place on 16 December, and was announced. The service was previously inspected on 12 May 2014 and was meeting the regulations we inspected.

Brookfield Care Home can accommodate up to 30 people. The home is situated in the village of Lazenby which is close to the coastal town of Redcar. The home has two units. The ground floor accommodates people living with a dementia. The first floor accommodates people requiring personal care. There are enclosed gardens which people who used the service can use. At the time of the inspection 27 people were using the service, 19 of whom were living with dementia.

There was a registered manager in place. 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.

Care plans were not always responsive for people who had complex and specific mental health conditions. People did not have access to a wide range of activities, which meant that they could be at risk of social isolation. This prevented them from maintaining relationships and links with their community. These were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

The building was clean and appropriately maintained. However, items were inappropriately stored in communal areas and cupboards in a potentially hazardous way. This also meant that some areas did not look homely for people living at the service.

Risks to people using the service were assessed and care plans were designed to minimise them. Risks arising from the premises were also monitored and addressed. Staff understood safeguarding issues, and the service operated procedures to deal with any incidents that occurred.

The service had policies and procedures in place to ensure that medicines were handled safely. Accurate records were kept to show when medicines had been administered. Some information was missing from people’s medicine identification records, but we told the staff about this and it was remedied during the inspection.

People were supported by staff who had been appropriately recruited and inducted as pre-employment checks were carried out.

Staff received suitable training to ensure that they could appropriately support people. Staff said they received sufficient training to do their jobs, and felt confident to raise any professional development needs at their regular supervisions and appraisals.

Staff understood and applied the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure that people received care that they consented to or was in their best interests.

People received suitable support with food and nutrition and were able to maintain a balanced diet. Mealtimes were enjoyable for people using the service, and they were offered drinks and snacks throughout the day.

The service worked with external professionals to support and maintain people’s health. The professionals we spoke with had no concerns about the service.

Staff treated people with dignity, respect and kindness and were knowledgeable about people’s needs, likes, interests and preferences. People had access to advocacy services.

Care plans for people without complex and specific mental health conditions were person-centred and reflected the care and support that they wanted. People’s preferences and needs were reflected in the support they received.

The service had a clear complaints policy, but this was not always applied when issues were raised informally.

The registered manager used audits to monitor and improve standards. Staff felt supported and included in the service by the registered manager and the provider. People and their relatives were invited to meetings to give feedback, but attendance was low and there was no other formal system for asking people what they thought of the service. The registered manager said they felt supported by the provider.