This inspection took place on the 13 September 2018 and was unannounced. Brookfields is a ‘nursing 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’s is registered for six people with learning difficulties and physical disabilities. On the day of our inspection, six people were living at the service.

At the last inspection on 20 January 2016 this service was rated good in all five key questions, and before that the home has a history of compliance with legal requirements. At this inspection we found the service remained Good.

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. People living at Brookfields could live a life as fully as they were able in a domestic styled homely environment that had been created to meet their needs.

On the day of our inspection visit 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 was run.

The service was well led. There was a person-centred ethos which meant that people were empowered to have some choice and control over their lives. The registered manager provided stable leadership and clear direction to the staff team and staff felt supported.

There were effective systems to monitor the quality and safety of the service provided that placed an emphasis on the quality of people’s lives. These systems were used to continue to drive improvements in the service and the care people received.

Brookfield’s provided person-centred care. We saw that people and relatives were treated with kindness by a staff team. Staff supported people with dignity, and had developed some positive relationships with people that were based on respect and trust.

People could maintain relationships with people who were important to them. Relatives we spoke with felt their views and opinions about their loved one’s care were listened to so that they felt involved in their loved one’s care.

Staff sought consent from people before caring for them and they clearly understood and followed the principles of the Mental Capacity Act, 2005 (MCA). Where people were deprived of their liberty, processes had been followed to ensure that this was done lawfully. Where medicines were given covertly the best interests processes hadn’t been followed. Staff understood people’s unique communication styles and ensured that the views of people with communication difficulties were listened to and acted upon.

People were protected from the risk of harm because there were robust processes to ensure their safety. Staff all knew and understood their responsibilities in relation to protecting people from abuse and had received the training they needed to do this. People were protected from harm because the risks to their safety were clearly identified and measures in place to reduce these risks.

People were supported by enough well trained and competent staff who knew people well. The registered manager followed robust recruitment checks to ensure that staff employed were suitable to support people using the service with all aspects of their care. People’s medicines were managed safely and people were protected from the risk of infection.

People were supported to have enough to eat and drink, to manage their health needs and saw health profess

Our inspection was unannounced and took place on 7 December 2015.

At our last inspection in July 2013 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver nursing and personal care to six people who lived with a learning disability and/or an associated need. Six people lived at the home at the time of our inspection.

The manager was registered with us as is required by law. 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.

Where people received support from staff with taking prescribed medicines records were up to date and accurate to confirm that they had been given to people as they had been prescribed.

Staff knew the procedures that they should follow to ensure the risk of harm and/or abuse was reduced.

Kind and caring staff in sufficient numbers were available to meet people’s individual needs.

Staff received induction training and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff felt that they were trained and supported to enable them to care for people in the way that they preferred.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were enabled and encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

Systems were in place for people and their relatives to raise their concerns or complaints.

People and their relatives felt that the quality of service was good. The management of the service was stable. The registered manager and provider undertook regular audits and took action where changes or improvements were needed.

There were five people living at the home on the day of our inspection. No one knew we would be visiting.

Because some of the people living at the home had complex needs, not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people, which included observation.

We spoke with three people who lived at the home although communication with some people was very limited. One person said, “I do like it here. I like the staff”. Another person said, “Yes it is good here”. We also spoke with two relatives. One relative said, “You will not find a better home than this one. I have no worries at all”. The other relative said, “It is a wonderful place. They have improved so much since they have been here”.

We saw that people's needs had been assessed by a range of health professionals including; specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met.

We found that people were offered varied and nutritious food. Where concerns had been identified referrals had been made to health care professionals to prevent malnutrition.

We found that although some work was to be completed, the premises were safe and maintained which made the home a pleasant place for people to live in.

We determined that staffing levels were mostly adequate but in need of frequent assessment. Frequent assessment of staffing levels against needs would make sure that people were not being placed at risk of harm through inadequate supervision and care provision.

We saw that complaints processes were in place and were accessible to people to use if they were not happy with the service provided.

In May 2012 during our inspection of this home we found non-compliance with essential outcome 10, ‘safety and suitability of premises’ as the standard of the upkeep of general decoration, basic refurbishment and the maintenance of the rear garden was not adequate.

We carried out this inspection to find out if improvements had been made and found that they had. Our observations showed that there was a marked improvement in the overall decoration inside the home and the garden had received the attention it required. During our inspection we spoke to two staff. These staff confirmed our findings from our observations that improvements had been made. One staff member said, “The redecoration has made the home look much better”.

Since our May 2012 inspection we had been made aware of concerns regarding the care provided to one person using the service. During this inspection we looked at this issue and found that the situation had been dealt with and any concern had decreased.

There were six people living at the home on the day of our visit. No one knew we would be visiting. We spoke with one person who lived at the home, three members of staff and the acting manager.

Because the people living at this home had complex needs only one person was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of other people these included observation, speaking with staff and looking at records. We spent time sitting in the dining room and observed the care that people received. We saw good interactions between the staff and people who live at the home and we saw that people were given choices.

One person living at the home told us “I like living here, they look after me and I like the staff”.

We found that the atmosphere of the home was relaxed and friendly. Our observations showed that people were at ease with the staff. We saw that staff treated people with respect and dignity and understood how to communicate with them.

Staff we spoke with were able to tell us about people’s needs so that they receive care in a way that they want to.

We saw that the management of medication had improved since our previous inspection which prevents people being placed at risk through unsafe medication systems.

We saw that the environment is in need of redecoration and that the garden needs better maintenance. Adequate decoration and the garden being maintained will make the home a brighter and more pleasant place for people to live in.

Staff received a range of training so that they have up to date knowledge and skills in order to support the people who lived there.

There were systems in place to monitor how the home is run to ensure people receive a quality service. The acting manager told us ”The new operations manager is very good, they visit often and they are getting work done to make the home more attractive and safe”.

The location is registered to provide accommodation and personal care to a maximum of six people who have a learning disability. At the time of our visit there were five people living at the location. There was one vacancy.

We arrived at the location early and were fortunate in that we were able to meet all five people.

We spent the day observing people, their routines and interactions with staff. Due to limited communication we only spoke with one person living at the location. This person indicated that they were happy living at the location.

Below are a few examples of what they said to us;

“I like it here”.

“The staff are good to me and look after me”.

“I like to go out and they take me out”.

We found that the atmosphere at this location was positive. The staff team were happy in their work and were committed to provide a good service to the people who live at this location. Staff told us;

“I like it here”.

“People are safe and looked after”.

We found some shortfalls that could place people at risk. For example, medication systems are not as robust and safe as they should be. Not all care plans were current and up to date and risk assessments were not available for some high risk needs. More robust processes should be put into place to monitor the quality of the service to prevent shortfalls occurring like those we identified during our inspection.