The inspection took place on 3 and 4 September 2018 and was unannounced on the first day. At the last inspection in August 2017, we rated the service Requires Improvement. We found breaches in regulations which related to information in care plans, consent and overall governance of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led to at least good. Whilst we found some improvements in all areas at this inspection, there were some continued concerns in the way care plans were recorded. At this inspection, we have rated the service as Requires Improvement again.

Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive and we found systems in place to ensure improvements were made and sustained were not fully effective. As this is the third time in a row the service has been rated Requires Improvement, we will meet with the provider to discuss their action plan for improvements.

Brooklands Care Home accommodates up to 63 people. The building is purpose built with lift and stair access to the first floor. Accommodation consists of single occupancy rooms situated in three units over two floors. At the time of our inspection there were 57 people using the service.

Brooklands Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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.

There were inconsistencies with people’s care plans. Some people had care plans, which contained good information and guidance for staff in how to meet their needs; these had improved since the last inspection. However, other people’s care plans lacked important information which meant there was the possibility of care being overlooked. This was a continued regulatory breach in relation to person-centred care. You can see what action we told the provider to take regarding the above areas at the back of the full version of the report.

The provider's systems to assess, monitor and improve the quality of the service provided had been effective in driving improvements in relation to risk management and consent, but required strengthening to sustain the improvements with care plan records. A new deputy manager had been recruited to support the registered manager to sustain the required improvements.

Staff were recruited safely. Improvements had been made to the number and deployment of staff. The registered manager used a tool to calculate staffing numbers and monitored this to ensure the levels remained safe. They had recently requested from the senior management team additional staffing hours during the day to provide a ‘staff float’, who would work across the units to provide additional support and cover for staff breaks.

Medicines were managed safely and people who used the service received them as prescribed. There were safe systems in place to manage risks to people’s health and safety. Staff had received training in how to safeguard people from the risk of abuse. Staff knew what to do if they had concerns.

The environment was clean and tidy and staff had access to personal protective equipment to help prevent the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; t

Brooklands Care Home provides nursing and personal care for a maximum of 63 people, some of whom may be living with dementia. Accommodation consists of single occupancy rooms situated in four units over two floors. At the time of our inspection 46 people were using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 undertook this unannounced inspection on the 1 and 2 August 2017. The last full inspection took place on 20 and 21 June 2016 and although no breaches in regulations were identified we rated the service ‘Requires Improvement’ for two of the five key questions and rated the service ‘Requires Improvement’ overall.

During this inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls not identified through the audit programme or when shortfalls were identified, timely action had not been taken to address these. Examples included gaps in care plans, supplementary charts for recording food and fluid intake and records to support consent to care.

There was some inconsistency with the application of mental capacity legislation. Some people had assessments of capacity and records about the restrictions they had in place, but this was not consistent throughout the service. One person was subject to low level physical interventions which had not been agreed or assessed as being in their best interest.

People had care plans in place, however, we found these were not always person-centred and missed important information regarding how staff were to care for them. This meant that important care could be missed.

You can see what action we told the provider to take regarding the above three areas at the back of the full version of the report.

The CQC had not received a notification of an incident which affected the welfare of a person who used the service. On this occasion we are writing to the provider to address this shortfall.

We received a mixed response from people who used the service, staff and visiting relatives with regards to staffing levels at the home. There were occasions when people were not supervised appropriately and staff reported being over stretched at times during shifts and unable to spend time with people. Some relatives considered staff were not visible enough and some people felt they had to wait at times for care. We have made a recommendation that the provider reviews the number and deployment of staff on shifts.

Staff were recruited safely which ensured employment checks were in place prior to new staff starting work. Staff had received training in how to protect people from the risk of harm and abuse. There were also policies and procedures for additional guidance. Staff knew what to do if they had concerns but some staff were not aware of the external agencies they could raise these with.

Generally, there were safe systems in place to manage risks to people’s health and safety although the area director took action during the inspection to ensure one person’s risk of falling was reviewed and action was taken to better protect their safety.

People had access to community health professionals for advice and treatment. Staff knew when to consult these professionals although the guidance provided was not always followed consistently.

Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required. We saw the menus provided people with a choice of nutritious meals. People told us they liked the meals provided for them and staff were flexible if they wanted an alternative to the main menu choices each day. During the day, we observe

Brooklands Care Home is a purpose built care home providing accommodation for people who require nursing or personal care for up to 63 people. Accommodation consists of single occupancy rooms situated over two floors. There are three separate units within the main facility which provide care for people with needs associated with dementia and physical disabilities. At the time of our inspection 51 people were using the service.

This inspection was carried out by an adult social care inspector on 20 and 21 June 2016. The service was last inspected in January 2014 and was found to be compliant with all of the regulations that we assessed at that time.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 recently been recruited but had not commenced working within the service at the time of our inspection. A registered manager from another of the registered provider’s services had worked in the service three days a week since January 2016. We have called them the 'supporting manager' throughout this report.

During the inspection people who used the service and staff raised concerns regarding staffing levels and we recorded periods were people were not supervised by staff. The assistant operations director confirmed that staffing levels would be assessed and changes made as required. Internal auditing highlighted amongst other things, issues with the recording of when medication had been administered. However, this had been monitored internally and improvements had been made.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Accidents and incidents were investigated and action was taken to prevent their future reoccurrence. Staff had been recruited safely and relevant checks were completed before they commenced working within the service.

We completed a tour of the service we found most areas to be clean and in a good state of repair. However, some area’s such as two communal toilets required refurbishment. We highlighted this to the supporting manager and assistant operations director who took immediate action to ensure people were cared for in a clean and hygienic environment.

We saw that historical internal auditing had highlighted concerns regarding the safe administration of medicines, although action had been taken and the more recent audits evidenced an improvement in this area we found some issues persisted, such as not completing medication administration records accurately. The temperatures in both medication rooms exceeded the medicines manufactures advice in relation to appropriate storage. However, portable air conditioning units were purchased during the inspection to rectify this issue.

People were supported by staff who had the skills and experience to carry out their roles effectively. Staff received effective levels of support, supervision and mentorship. People who used the service were supported to make their own decisions about aspects of their daily lives. The supporting manager followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made. People were encouraged to maintain a healthy lifestyle and eat a balanced diet. People’s needs were met by a range of healthcare professionals.

People who used the service told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. People were treated with dignity and respect througho

Brooklands Care Home is a care home for older people in Grimsby with good access to local transport and amenities. At the time of our inspection 47 people were living at the home. During our visit we spoke with eight people who used the service, one relative and eight members of staff.

The home provides care and support to older people and has a separate unit specifically designed to support people with dementia. The home is located in a residential area with parking to the front of the property. Accommodation is on two floors and there are two passenger lifts.

Mental capacity statements and best interest assessments were in place where required, for people who were unable to make decisions for themselves. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) is law protecting people who do not have mental capacity, which means they may not be able to make some decisions for themselves.

Each person’s care plan had a personal profile which described their personal preferences in relation to religion, food, drink, and daily routines. We saw this had been reviewed monthly. This allowed staff to pick up on changes in people’s behaviours which may indicate anxiety, pain or distress.

The care plans we reviewed showed people’s individual health care needs were addressed. Each person was registered with a GP and had an allocated member of staff who coordinated their care. Each care plan we viewed had been signed by the person it concerned which confirmed their involvement in their care.

The eight members of staff we spoke with demonstrated a good understanding of people’s care and support needs and clearly knew people well.

We looked around the home and identified a number of concerns regarding the condition of some of the bathroom areas which were in poor state of décor and repair. The inspection team felt that we would not wish any of our relatives to use these bathrooms. The loose floor seals and damaged plasterwork meant there was an infection control risk as it was not possible to clean these areas effectively.

We also identified seven bathrooms/toilets that had no lock. Five of the doors without locks had holes through the door where the locks had once been. This meant people could be observed whilst going to the toilet. This meant people’s privacy and dignity was compromised.

Following our observations of these bathrooms we have decided to issue a Compliance Action as we consider there has been a breach of Regulation 15 of the Health and Social Care Act (2008). Further information about this Compliance Action can be found at the end of this report.

We saw adequate leadership at all levels. At the time of our visit the service had a registered manager in place. The registered manager was supported by two senior care assistants. Since the home provided nursing care a total of 13 registered nurses were used on the staff rota. The registered manager promoted a positive culture that was person centred, open, honest and inclusive.

At the scheduled inspection on 5 September 2013 we identified shortfalls in relation to aspects of the care records. We found care plans to support people’s needs in relation to pressure damage had not been developed. This meant there was a risk people may not receive all the support they needed and in the way they preferred.

We re-visited the service to check that the necessary improvements had been made. We found improvements had been made to the care plan records; people’s needs in all areas had been properly assessed and detailed care plans were in place to direct staff on the care support required.

People who used the service told us they were satisfied with the care support they received. One person told us, “The staff look after us all very well, no complaints at all.” Relatives we spoke with told us, “Mum has been in two other homes before moving here, she’s really happy and has settled very well. She’s well looked after.”

We used a number of different methods to help us understand the experiences of people that used the service including observing care practices. Some people had complex needs and were therefore not able to verbally communicate their views and experiences to us. However, throughout our visit we saw staff providing care and support with kindness and warmth and with consideration for people's needs.

We found gaps in some people’s care plan records which put their health, safety and welfare at risk. However people who used the service, relatives and health care professionals we spoke with were complimentary about the care provided. Comments included: “I'm very happy with all aspects of the support” and "You can’t fault the staff; excellent care without a doubt.”

We observed staff interacting with people who used the service and this was carried out in a sensitive way. We observed lunch time and staff assisted those who needed help, this was done at their pace. People we spoke with told us the food was very good and they had plenty of choice.

People told us they were satisfied with the facilities however we found areas of the home required renewal and refurbishment.

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

People told us the staff worked very hard. One person said, "They are marvellous, all of them." However, they also said the staff were over stretched at times and they needed more staff. Comments included: “They (the staff) don’t stop, always on the go; they don’t have so much time to spend with us these days” and “Staff try their best, we have to wait for help sometimes, but not often.”

People were made aware of the complaints system. Those we spoke with said they had no complaints but would feel comfortable raising any concerns with the staff.