The inspection took place on the 1 and 7 February 2018. It was unannounced on the first day and announced on the second.

Brookfield is a 'care home'. 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 28 people in one adapted building. On the day of the inspection there were 24 people living at the home.

Brookfield is a three storey property with a range of communal areas and a large conservatory. It is located in the village of Lymm and is close to the local amenities.

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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good. The service is rated Good as it met all the requirements of the fundamental standards.

Everyone we talked to without exception spoke positively about the staff and management team. They described feeling safe living at Brookfield and being supported by well trained and caring staff.

People living at the home had many opportunities to engage in activities of their choice and the management team had developed excellent relationships with organisations within the local community.

Brookfield was well maintained and all equipment was regularly serviced. All required health and safety checks and documentation were in place.

Safe recruitment practices were evidenced and sufficient numbers of staff were available to meet people's assessed needs. All staff had completed a comprehensive induction. Staff completed refresher training and were supported through regular supervision and an annual appraisal. Team meetings were held regularly.

Care plans and risk assessments were person centred and held sufficient information to give clear guidance to staff to support people safely. People's preferences were included and people told us they were offered choice and their independence was promoted. All documentation was reviewed regularly and updated following any changes to a person’s assessed needs.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

Staff had all received safeguarding training and were clear about the procedures they would need to follow if they had any concerns.

Medicines were managed safely in accordance with best practice guidelines. All staff that had received medication training and had their competency assessed.

Staff had developed good relationships with people who lived at the service and were very attentive to their individual needs. People told us their privacy and dignity was respected at all times. We observed many positive interactions between staff and people living at the service throughout the inspection.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). It was clear from discussions with people and from their care records that their consent was always sought in relation to care and treatment.

The registered provider had a comprehensive range of policies and procedures available for staff to offer them guidance. These were regularly reviewed and updated.

Effective governance processes were in place that included a range of audits undertaken by the registered manager and registered provider. The audit information was analysed and used to further improve and develop the service.

We carried out an unannounced inspection of this service on 30 July 2015.

Brookfield provides accommodation for up to 31 people who need support with their personal care. Accommodation is arranged over two floors; there is a passenger lift to assist people to get to the upper floor, although access to some bedrooms is via a few stairs. The dining room and communal areas are situated on the ground floor. On the day of our visit 26 people were living in the home.

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. We found the registered manager accessible and approachable. Staff, people living in the home and relatives told us that they felt able to speak with the manager for guidance or to raise concerns.

At our last inspection on 5 August 2014 we found that further development was required for staff regarding their understanding of the Mental Capacity Act 2005 (MCA). We found the home needed further development in training their staff in the Mental Capacity Act 2005 (MCA). We also identified issues around their understanding of how to support people when they lacked capacity; including the implementation of DNACPR (do not attempt resuscitation orders). Records lacked evidence that people living at the home or their representatives had signed to consent with the orders in place which had been signed by the GP. After the comprehensive inspection the provider sent us an action plan telling us what action they would take. In addition to this we have also received further clarification from external professionals working in end of life care regarding the completion of DNACPR’s who state that the decision is a medical one and relatives should not be asked to sign DNACPR documents although it should be documented with whom the GP discussed the matter.

We saw that people’s needs had been assessed and care plans provided staff with information of how peoples care and support should be met. We found that risk assessments supported people to maintain a level of independence. Staff knew the people they were supporting and provided personalised support.

People were treated with kindness and compassion, staff spent time speaking with the people they were supporting and the atmosphere in the home was relaxed and jovial.

This inspection took place on 5 August 2014 and was unannounced. At our last inspection in August 2013 the service was meeting the regulations inspected.

The home has a registered manager with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

Brookfield Residential Care Home provides personal care and accommodation for 31 older people. The service is owned by Barchester Healthcare. It is a three storey property comprising of 25 single bedrooms and three double rooms. It is located in the village of Lymm close to local amenities. There is a range of communal space’s and a large conservatory. Toilet and bathroom facilities are dispersed throughout the building. There is a car park provided for visitors.

We found the service needed further development in training their staff and in understanding of supporting people when they lacked capacity, including the requirements of the Deprivation of Liberty Safeguards and in obtaining consent when supporting people with ‘Do not attempt resuscitation’ orders. We noted that support was needed for staff to fully support people who lacked capacity to make decisions for themselves.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found care plans to be detailed and focused on the individual person. They contained guidance to enable staff to know how to meet service users’ needs and how they wished to be supported. Staff had a good understanding and knowledge of people’s individual care needs. We noted that two people cared for in their bedrooms did not have access to their call bell system as staff had forgotten to ensure they had access to it. The registered manager advised they would review access to call bell systems on a regular basis so that everyone had access whenever they needed to call for staff.

People living at the home, relatives and staff were very positive about staff however we received mixed opinions in regard to the staffing levels. The majority of people thought the service needed more staff, yet two relative’s thought the staffing levels were fine.

We observed how staff spoke and interacted with people and found that they were supported with dignity and respect.

We noted the service had a complaints procedure and complaints that had been made were

recorded with actions taken. People were confident that they could raise their opinions and discuss any issues with senior staff.

The service operated safe staff recruitment and ensured that staff employed were suitable to work with vulnerable people. Appropriate pre-employment checks were being carried out and application forms were robust to enable the management of the home to have adequate information before employing staff.

Staff had not always received regular formal supervision and training to assist them in their job roles and in their personal development.

Various audits at the service were carried out and some that needed further improvements had action plans developed by the registered manager and registered provider to help ensure that adequate standards were maintained throughout the service. This meant that that improvement could be made and an audit trail could be followed to ensure all actions were met.

Most people we talked to told us the care was good and they were positive about the staff. People told us they attended ‘residents meetings’ where they raised their opinions and comments on behalf of others living at the service. They told us they were involved with their care plan and felt the staff listened to them to help them with their care.

Staff were friendly and respectful to the people they were supporting. We heard staff speaking quietly and chatting and joking to individual people sat in the lounge and hallway. People living at Brookfield were offered various choices and staff respectfully listened and helped people with their care and requests.

We had contacted the local authority contracts and monitoring team for Warrington Social services before we visited the service. They are due to visit the service as part of their quality monitoring checks.

We used a number of different methods to help us understand the experiences of people using the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing support to help us understand the experience of people who could not talk with us. People living at the service looked content, happy and comfortable with the staff supporting them. We heard staff speaking quietly and politely to people living at Brookfield and in an unhurried manner.

Most of the people we talked with who lived at the service told us they liked the food and made various comments such as: “Food is lovely”; “We had a residents meeting to discuss the food and since then we have had a lot more variety and we have seen an improvement, the food is very good” and “The food is good here.”

People living at the service were mainly positive about the care and support provided and one person told us, “The staff are very attentive and kind, we couldn’t want for anything else.”

Some people indicated an easy going atmosphere at the service which was also noted during our visit. One person living at the service described the atmosphere being in place almost daily and staff told us it was often commented on by visitors to the service.

We had also contacted the local authority contracts and monitoring team for Warrington Social services before we visited the service. Up to completing this report we did not have an update from their department.