This inspection took place on the 9 and 16 January 2019 and was unannounced. At our last inspection on the 4 June 2018 we rated the service as ‘inadequate’ and identified nine breaches of regulation. These breaches related to person centred care, meeting people's nutritional needs, management of risk including medicines, staffing arrangements, support to staff, safeguarding people from abuse, consent to care, maintenance of premises and governance of the service. We also found the provider had not notified CQC about some significant events.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and were ongoing. This service is no longer rated as inadequate overall, or in any of the key questions. Therefore, this service is now out of Special Measures.

Brookfield provides care for up to three people who have learning disabilities. At the time of inspection there were two people using the service. People in care homes receive accommodation and personal care as a single care package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service had a manager in place who had started working at the service six weeks prior to the inspection but they had not registered to manage this service yet. They told us they were planning to submit their application by the end of January 2019. It is a legal requirement that this service has 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 found the manager, regional support manager and staff had worked hard to make improvements in the areas of concern found at the last inspection. At this inspection, we found improvements in all areas. However, we discussed with the manager and regional support manager more work was needed to ensure a robust and sustained service moving forward. The management team agreed with this and told us they had been focusing on ensuring the home was safe and people received the right support.

Regular health and safety meetings took place between the staff responsible for maintenance and the manager. Action plans were created following the meetings and it was clear when actions were to be completed by and by whom. However, we noted the temperature of the kitchen tap was extremely hot. Although this had been identified on maintenance checks no action had been taken and it had not been picked up at the health and safety meetings. The manager and regional support manager immediately took steps to make the temperature safe and ensured a thermostatic mixing valve was fitted. We made a recommendation that the maintenance checks were reviewed at the health and safety meetings to ensure action is taken where necessary.

Robust procedures were in place to protect people from financial abuse. Staff knew who to report any concerns to both within the organisation and to external agencies, such as the CQC. We found medicines were managed safely and in a person-centred way. People received their medicines as prescribed. There were PRN protocols in place and clear guidelines what to do if a person refused their medicines.

Improvements had been made to risk management. Personal Emergency Evacuation Plans and the Herbert protocol were fully completed. The Herbert Protocol is a national scheme introduced by the police in partnership with other agencies to compile useful information which could be used in the event of a vulnerable person g

This inspection took place on 4 June 2018. At the last inspection in January 2018 we found the provider was in breach of two regulations which related to staff training and governance arrangements. The provider sent us a plan which told us they would not complete all their actions and meet the regulations until November 2018. At this inspection, five months after the previous inspection we saw the service had significantly deteriorated. They had made some progress in relation to basic staff training but new staff were still not receiving an appropriate induction. There were still significant issues with the governance arrangements. We also found there were issues around person centred care, meeting people’s nutritional needs, management of risk including medicines, staffing arrangements, support to staff, safeguarding people from abuse, consent to care and maintenance of premises. We found they had not notified CQC about some significant events.

Brookfield provides care for up to three people who have learning disabilities. At the time of this inspection two people were using the service. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

The service did not have a registered manager. 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. A manager had been appointed to manage Brookfield and two of the provider’s sister services; they had been in post six weeks.

The service was not safe because risks were not assessed or well managed. We identified issues around fire safety and infection control. Accidents and incidents were not investigated. The service did not learn from incidents and prevent events from reoccurring. Medicines were not managed safely. People were not safeguarded from abuse. Staff were not appropriately supported and supervised. Only one member of staff was on duty for most of the time which resulted in people having limited opportunities to engage in person centred activities; one person was funded for one to one staffing but they did not receive this.

Support plans were not always accurate and did not reflect people’s current needs. People had not been involved in the support planning process. People’s health needs were not met because they did not always receive health checks and support from health professionals. People’s nutritional needs were not met. Food records showed meals were not varied or balanced. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

We observed friendly interactions during the inspection. A member of the night staff was finishing their shift when we arrived and one member of staff was on shift during the day. People were comfortable with the staff who supported them.

There were widespread and significant shortfalls in the way the service was led. Some important records could not be located. Staff and resident meetings had not been held so people did not have opportunities to share their views. The provider did not have effective systems to assess, monitor and manage the service. They did not have processes to learn lessons and drive improvement. The provider did not respond to external reports.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014, which related to person centred care, meeting people’s nutritional needs, management of risk including medicines and infection control, staffing, safeguarding people from abuse, consent to care, maintaining premises and governance arrangements. We also found a breac

The inspection took place on 15 and 16 January 2018 and was announced. Brookfield is a ‘care home’ without nursing. The service is registered to provide accommodation for up to three people younger people with learning disabilities. 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. Brookfield accommodates up to three people in a semi detached house on a residential street.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has a registered manager. 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.

Premises were appropriately maintained to ensure people’s safety.

The provider ensured appropriate recruitment checks were completed. The provider’s recruitment policy stated satisfactory references must be obtained before staff start work. This was not adhered to for one member of staff, although they shadowed until references were received. We made a recommendation that the provider ensures they follow their own policies.

We observed there were sufficient staff to meet people’s needs. We made a recommendation the provider ensured a named member of staff was allocated on the rota to provide 1:1 hours.

Staff were provided with appropriate support to ensure the safe administration of medicines. They had undertaken training in medicines management and their competency was assessed.

The home was clean and tidy although some areas did require maintenance and updating. Staff used appropriate Personal Protective Equipment (PPE). A cleaning schedule was being introduced which including tasks for night staff.

Although staff received an induction they did not receive appropriate training as is necessary to enable them to carry out the duties they are employed to perform. We concluded this demonstrated a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

People were supported to plan their meals and buy their food. People had access to other healthcare professionals.

People’s care records were up to date and recorded what support people required. People’s activity planners were detailed and provided a good picture about each individual.

People were involved in the running of their home through resident meetings.

Staff told us how they respected people’s privacy and dignity. For example, by listening to people, knocking on doors and asking permission if they wanted to enter their room. We observed one incident which impacted on a person’s dignity when they left their home with large stains on the front of their top.

Staff were passionate about encouraging people to be as independent as possible. For example, ensuring they were involved in cleaning, preparing meals and choosing activities.

The provider had a complaints policy and procedure in place. The home had not received any complaints.

Audits were completed in areas such as, medicines, finances, and infection control. The registered manager or deputy completed a monthly report log looking at incident records. The report logs did not analysis patterns and trends and what action

This inspection took place on 19 August 2015 and was announced. This was because Brookfield was a very small service and we needed to make sure that the service would be open on the day of our inspection.Brookfield provides accommodation for up to three young adults living with a learning disability. At the time of our inspection there were 2 people living in the service. The service is a house in a residential street, which offers people who use services a ‘family home’.

There was 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.’

The registered manager was registered to oversee three locations owned and managed by Care Worldwide (Carlton) Limited. The registered manager was supported by deputy managers across all locations

People told us they felt safe living in the service. The provider reported safeguarding concerns appropriately and took the necessary action to safeguard people from harm.

The registered provider recognised and promoted the rights of the people who use services and supported them to live as independently as possible, whilst encouraging them to achieve their goals.

The service created a family home environment, which was welcoming and relaxed, and the people who use services were happy to be in.

People and their families told us they were treated with kindness and respect, that staff were warm, friendly and caring.

People had a regular team of staff caring for them, and the staff were skilled and knowledgeable.

The service provided high quality person centred care which met the needs of the people who use services.

The care plans were extremely detailed and individual, which meant that staff knew the people who use services really well and were able to meet their needs effectively.

Staff understood the needs of the people they cared for, what was important to them, their abilities to make informed choices and the support they needed to be able to do this.

Families of people who used the service told us their loved one received high quality care and they have had no concerns about the service which was being provided to their family member, they were very happy with the care which was provided and felt confident that their relatives were being well cared for.

Staff told us that they received regular refresher training, and that they felt well supported by the management of the service. mary of findings