About the service:

Brookfield is a residential care home that provides accommodation for up to 14 people with mental health needs who require support with personal care. There were 14 people living at Brookfield at the time of the inspection.

People’s experience of using this service:

The environment remained well maintained and a calm and relaxed atmosphere was still prominent. A visiting professional told us, “I was amazed at the standards of accommodation for people with high profile needs; other people don’t get the standard of accommodation as here.”

The staff provided effective care for people because detailed person-centred care plans were in place. People were involved in regular reviews of their care plans. One person said, “They always involve me in care planning and I discuss this with staff”.

Staff showed a genuine motivation to deliver care in a person-centred way based on people's preferences and likes. People were observed to have good relationships with the staff team.

We saw complaints and concerns were minimal. The service had one complaint logged by a person using the service and the registered manager had acted on this. The service demonstrated they had investigated and responded to this in line with their policy. However, we recommend that the service records the action taken and any lessons learnt more robustly. The registered manager agreed to address this feedback immediately following our inspection.

Accidents and incidents were minimal and continued to be appropriately managed and recorded. Trends were spotted by reviewing each accident or incident. We recommend that an analysis process is used to identify trends, if the number of events increased.

People were involved in their day to day lives through being empowered to make their own choices about what they do with their time. People participated in activities that met their individual choices and preferences. People’s independence was promoted. One person said, “Staff promote my independence and I can do what I want. I can choose when I get up and go to bed; I like to get up early and I choose my own food.”

The service kept people informed and tried to reach out to people’s families and friends. We recommend that the service uses tools such as newsletters to keep people, families and friends informed. The provider confirmed they had implemented newsletters the day after the site inspection.

People's health and well- being were well managed as staff maintained positive links with health professionals. Upon arrival on the first day of the site inspection, the registered manager had taken people to attend their health appointments. This showed the registered manager continued to play an active role in supporting people to manage their health and meet their needs.

Medication administration records (MAR) were provided to support people’s hospital admissions. We recommend that the service uses tools such as health passports (a piece of documentation that details people’s health needs and contains other useful information) to support people when accessing other services. The provider issued evidence of the tools they intended to use the day after the site visit.

Equality and diversity was promoted. We observed people eating different foods in line with their cultural and religious needs. We also saw people dressed in specific items of clothing to meet their religious requirements.

Staff worked in partnership with the community, other services and organisations. We saw multi-disciplinary team meetings were scheduled to discuss people’s needs and wishes. People had links with other organisations to access services, such as adult learning courses. People were also supported to take upon voluntary work. One person said, “I complete voluntary work in an environment that is important to me.”

The service continued to meet the characteristics of Good in all areas; more information is in the full report.

Rating at last inspection:

Good (rep

This was an unannounced inspection, which took place on 20 and 28 April 2016. We had previously carried out an inspection on 12 March 2015 when we found two breaches in the regulations relating to good governance and maintenance of the property. At this inspection, we found that both breaches in the regulations had been met.

Brookfield provides accommodation for up to fourteen people with mental health needs who require support with personal care. Fourteen people were living at Brookfield time of our visit.

The service had a manager who was registered with us. 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 and associated Regulations about how the service is run.

All the people we spoke with who used the service told us they felt safe in Brookfield. People said, “I feel safe. Yes I do because it is wonderful here,” “It is calm here,” “It’s quiet. That’s important” and “I feel safe because there are no bullies here. They are alright with me. I have got friends here.”

Recruitment processes in the service were sufficiently robust to ensure the protection of people from the risks of unsuitable staff being recruited. We found staffing levels were appropriate to meet the needs of people who used the service.

The service’s infection control systems had been assessed by the local health protection nurse with a good outcome. There were appropriate systems in place for the administration of medicines.

Significant improvements had been made to the property since the new owner took over the service with ongoing improvements planned. One person said, “[New owner] has made this place look a lot better.”

A person who had moved into the home recently told us, “I had good support from my social worker. They brought me to look round first and then I started to visit and stay overnight. Gradually increasing until I moved in.”

The people who used the service we spoke with were confident that the staff knew what they were doing. One person said, “The staff here are wonderful. [Staff] is number one for support and [the registered manager] is the number one manager.” One relative stated in a returned questionnaire, “The management and staff of the home do their job and duties to 110%.We are very pleased with all the care, time and attention they give to people.”

During our inspection, we observed the atmosphere in the service was calm, relaxed and friendly. People who used the service told us, “Its lovely here everyone gets on well together I am happier than I was a year ago when we spoke. My room is lovely. I can sit here see the trees and like watching birds fly in and out of the bird box. It is quiet here and that is important to me. I get a good night’s sleep” and “It’s quiet here. We are all the same age and we interact well together.”

A community based professional commented in a quality assurance questionnaire, “The care is excellent. All the staff are very caring and treat patients with dignity.” A relative commented, “Management and staff give full and thorough updates regarding our [relatives] wellbeing and we are very happy and our [relative] is doing amazing at Brookfield. That means everything to us, peace of mind is a great thing.”

People were supported to maintain their independence and the majority of people were involved in activities that met with their personal preferences. People were encouraged to maintain contact with their family and friends were appropriate. One person commented, “I see my family and that is important to me. My children are happy and if they are happy, I am happy.”

People who used the service and staff spoke highly of the registered manager and the new owner. They told us that the registered manager was always approachable and supportive and that the new owner had made c

This was an unannounced inspection which took place on 12 March 2015. We had previously carried out an inspection on 18 September 2013 when we found the service had complied with all the regulations we reviewed except supporting workers and staff training. We revisited the home on 25 Mach 2014 and found that Brookfield Residential Care Home Limited had complied with the requirement to improve in those areas.

Brookfield provides accommodation for up to fourteen people with mental health needs who require support with personal care. Fourteen people were living at Brookfield time of our visit.

The service had a manager who was registered with us. 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 and associated Regulations about how the service is run.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The home was tired in appearance both inside and out and malodours were detected in communal toilets, and liquid hand wash and paper towels were not always available to use. Systems for assessing and monitoring the service would benefit from being improved.

You can see what action we asked the provider to take at the back of the full version of this report.

All the people we spoke with who used the service told us they felt safe in Brookfield. Staff had received training in safeguarding vulnerable adults and children’s procedures. They were able to tell us what action they would need to take if they had any concerns about the care people received in Brookfield. The staff we spoke with were confident any concerns they might raise with the registered manager would be taken seriously and acted upon.

Recruitment processes in the service were not sufficiently robust to ensure the protection of people from the risks of unsuitable staff being recruited. We found staffing levels were appropriate to meet the needs of people who used the service.

There were appropriate systems in place for the administration of medicines.

Staff told us they enjoyed working at Brookfield and considered they received the training and support they needed to safely carry out their role. Training records showed that staff had received the basic training they needed.

The registered manager demonstrated their knowledge about the process to follow should it be necessary to place any restrictions on a person who used the service in their best interests. At the time of our inspection we were told that there were no restrictions to people’s liberty.

People who used the service told us they enjoyed the food that was available and we saw that they were offered food and drink frequently throughout the day.

All the people we spoke with gave positive feedback about the staff in Brookfield. During the inspection we observed frequent and friendly interactions between staff and people who used the service. The atmosphere at the home was calm and relaxed.

People were supported to maintain their independence and the majority of people were involved in activities that met with their personal preferences.

All the people we spoke with told us the registered manager of the service was very approachable and would always listen and respond if any concerns were raised.

At our inspection in September 2013 we found that some new staff members had not received all the basic training they needed to support people living at the home safely and effectively. Established staff had not received updated or refresher training in some areas for a number of years.

We asked the provider to tell us what they were going to do to make improvements. We received an action plan that informed us finances had been made available to ensure that training could be undertaken by staff and this would be completed by the end of December 2013.

We visited the home at this inspection to check what action had been undertaken. We found that some of the training had been completed and other training was either planned or the provider was waiting for dates from a training company.

There were 13 people living at Brookfield at the time of our visit. We spoke with three people who had recently moved into the home. People told us they had been made to feel welcome by the existing group, all of whom had lived at the home for a long time. A person said “I am happy here and we have everything we need”. Another person told us “I wanted to move here. It is really great” and “I feel looked after”.

People told us “the food here is better than the last place” “the food is alright” and “we get a big meal at teatime”. Some people said that they were looking forward to the takeaway meal on Thursday. They said they could have what they liked.

There were systems in place to reduce the risk and spread of infection.

Most people had large and spacious bedrooms and had lots of personal belongings in their bedrooms including televisions and music equipment. People spoke positively about their bedrooms. We saw that some people had arranged their bedrooms around their hobbies and interests. A person said “I really like my room and I like to spend most of my time here.” People told us they were able to access television channels they liked to watch, for example sport and music.

Staff had not received all the training they needed to support people safely and effectively.

People we spoke with told us they all got on well together. They also said that they could do what they wanted when they wanted to.

Interactions between people living at the home were seen to be relaxed and friendly.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Before our visit we contacted the local authority to ask if they had any concerns about Brookfield. They confirmed with us that they did not. We had not received any complaints or concerns about the service.

People we spoke with told us that if they had any concerns or worries they could speak to the manager. They said that they were confident that the manager would listen to them and take action to sort the problem out.

Two people living at the home were being supported to move on into more independent living. One person told us that the manager and staff had been ‘very helpful’.

We were told that people’s religious and cultural needs were respected for example at prayer times and in relation to their Halal diet. One person told us that they went out regularly with family members. Another person spoken with had enjoyed a shopping trip with staff and was very pleased with the items they had purchased.

People spoken with confirmed they were involved in meetings about their care and support. One person told us that they ‘trusted the manager’ and that they ‘felt safe’.

Another person told us that they ‘get on with the staff and other residents’ and the manager was ‘very helpful’. They also said they had ‘no concerns or worries’.

The visiting health professional spoke highly about the service provided at Brookfield. They told us that the manager of the home was ‘well thought of’, ‘approachable’ and ‘listened’. They also said that Brookfield was ‘a rare service’ and ‘5 star’ and that the home had an ‘excellent relationship’ with the hospital care team and consultants. They told us that they regularly visited the home and were very happy with the support provided. They said staff ‘look for early signs’ of changes in peoples health and that they ‘knew people well’.

Staff commented positively about the manager of the home. They felt that he was ‘very approachable and supportive’, ‘listens and acts on things when needed’ and ‘was very understandable’.