We carried out an unannounced comprehensive inspection of this service on 7 February 2017. After that inspection we received concerns in relation to an incident which indicated potential concerns about the management of risk associated with the administration of people’s medicines. As a result, we undertook a focused inspection on 25 and 26 June 2018 to consider those concerns. We announced the second day of the inspection visit. This report only covers our findings in relation to the Key Questions of Safe and Well led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brooklands on our website at www.cqc.org.uk”

At our last unannounced comprehensive inspection on 7 February 2017, the overall rating was 'Good'. At this inspection the rating has changed to ‘Requires Improvement.’

Brooklands 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.

Brooklands accommodates up to nine people in one adapted building. There were six people living at the home at the time of our inspection.

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.” Registering the Right Support CQC policy

At the time of our inspection visits, the registered manager was currently on leave of absence. The registered provider had arranged for a registered manager from one of their other homes to provide temporary management support in their absence. 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.

People’s medicines were made available and people received these as prescribed. However, the management arrangements to ensure medicines were administered in line with the registered provider’s procedures were not always effective and required improvement. The acting manager was acting to ensure improvements were made including staff training.

People’s records to support risk management had not consistently been reviewed at the stated intervals. Some people’s care plans lacked information about how to use of distraction techniques to consistently and safely meet people’s behavioural needs.

The registered provider’s quality checks did not consistently identify shortfalls in risk management plans and medicine management. There was also a lack of oversight in the managements procedures, so the registered provider could be fully assured staff continued to provide care which mitigated risks to people’s safety and welfare. The registered provider had missed opportunities to analyse accidents and incidents on a regular basis, so trends could be identified and to support the reduction of similar events happening.

People told us they felt safe living at the home. Staff understood their responsibilities in reporting abuse and the action they should take if they were concerned a person was at risk of harm.

People had developed positive relationships with staff who knew people’s needs well.

There were sufficient staff to meet people's needs. The registered provider ensured pre-employment checks had been completed before staff started work to make sure, as far as possible, they were safe to work with the people who lived there.

Staff enjoyed working at the home and felt supported by the registered manager and acting manager. Staff felt able to make suggestions about the m

We undertook an inspection on 7 February 2017. This was an unannounced inspection. Brooklands provides accommodation and personal care for up to nine people with a learning disability. On the day of our inspection there were six people living at the home.

At the last inspection on December 2015, we asked the provider to take action to make improvements to ensure Dol applications were made when required, at this inspection we found this action has been completed.

There was a registered manager for this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People we spoke with said they had support from regular staff who knew them well, and they felt safe at the home. Relatives told us their family members were cared for in a safe way. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns. Staff were knowledgeable about how to manage people’s individual risks, while remaining focussed on supporting people to be as independent as possible. People were supported to receive their medicines by staff who were trained to do so and knew about the potential risks associated with people’s medicines.

Staff had up to date knowledge and training to support people living at the home. Staff always ensured people agreed to the support they received. The registered manager ensured people were supported in the least restrictive way and were supported to make their own decisions where possible. People told us they enjoyed the food at the home and were encouraged to make their own meal choices. They explained that they were supported to make their own decisions and be as independent as they could. People and their relatives told us staff would access health professionals as soon as they were needed.

People said the staff and the registered manager were caring and always treated them with dignity and respect. Relatives told us they were involved as part of the team to support their family member. Staff understood people’s human rights and adapted their communication skills to ensure people understood them. People had access to the wider community and said their cultural needs were met.

The staff team were adaptable to changes in peoples’ needs and knew people well to recognise when additional support was needed. All the people we spoke with and the feedback collected by the registered manager and provider said how happy people were to be living at the home. People and their relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and appropriate action taken. Staff were involved in regular meetings and one to one time with the registered manager to share their views and concerns about the quality of the service.

The registered manager and the provider had systems in place to monitor the quality of care provided. The registered manager ensured there was a culture of openness and inclusion for people using the service and staff.

Brooklands provides accommodation and personal care for people with a learning disability, for nine people. On the day of our inspection there were seven people living at the home.

The inspection took place on the 9 December 2015 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People and their relatives said they were happy about the care people living at the home received. They told us staff were caring and promoted people’s independence. We saw people were able to maintain important relationships with family and friends. People had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. Staff knew the people who lived at the home well and were able to support them to eat and drink. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and relatives told us they had access to health professionals as soon as they were needed.

People felt involved in decisions about their care. Where support was identified as being needed, best interest decisions were made, involving family and health care professionals. However, we found that some people may have been deprived of their liberty unlawfully. The registered manager and the provider did not have systems in place to ensure applications were made to the Local Authority to check that people were only deprived in a least restrictive, best interest and lawful way. The registered manager had booked on training to support her with this process and had sort advice. The registered manager and the provider needed to ensure any decisions to restrict somebody’s liberty were made by people who had suitable authority to do so.

Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns. People living at the home saw their friends and relatives as they wanted. People and their relatives knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. Staff and the registered manager knew people well and were aware if people were unhappy. The registered manager had arrangements in place to ensure people were listened to and action taken if required.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and were focussed on each person as an individual.

The registered manager promoted an inclusive approach to providing care for people living at the home. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The provider and registered manager had systems in place to monitor how the service was provided, to ensure people received quality care.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks of infection as the provider had arrangements in place for keeping the home clean. The registered manager regularly checked the cleanliness of the home to help ensure the risk of infection was reduced.

Staff employed by the home had been recruited effectively. The provider demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. Staff had been trained to understand when an application should be made and no current applications were in place. The provider might find it useful to note that there were no policies and procedures in place for staff to follow should a referral be required.

Is the service effective?

People were involved in identifying their own health and care needs. The provider had also considered information and involvement from relatives, other health professionals and staff.

The provider had been able to demonstrate that they had cooperated with other providers to ensure people received the care and treatment that met their needs. For example, we saw that people were supported with having dental checks and sight tests.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions.

Is the service responsive?

People regularly completed a range of activities in and outside the service and staff supported them in arranging and attending these activities.

We saw the home had been responsive to people’s changing needs and had listened to professional advice that had been provided. For example, we saw the home had requested an occupational therapist assessment and had obtained the required equipment to meet the change in needs.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions. One person we spoke with told us: “I have asked for new curtains”. We saw that this had been recorded and was in the process of being completed.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home provided a good quality of service and people were well cared for. They also told us they felt the home had continued to improve for the benefit of people who lived there. They told us that they felt supported in their role and knew where to find information when needed. For example, there was information in each person’s care plans and a record of the care provided.

We inspected Brooklands and spoke with three of the people who lived at the home and with two of the staff on duty. We also spoke with the manager and the provider. We spent some time in communal areas and observed the interaction between staff and people who used the service.

We looked at care records for two people and other supporting documents for the service. Staff told us they: “Always ask people if they are happy with me giving care before I give it”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs. People told us they were: “Happy” with the staff who worked at the home. We saw that staff were kind and caring in their approach to people who lived in the home.

We saw that people were protected from the risk of harm and abuse because staff had received training in how to safeguard vulnerable people. Staff had a clear understanding of their roles and responsibilities for keeping people safe.

The staffing levels for the home were sufficient to meet the needs of the people who lived at the home. We found people received the care and support when they needed it.

There was a complaints procedure in place at the home. We found people knew how to make a complaint and felt supported in that process.

During this inspection we spoke with two people who used the service and three staff. We also looked at how staff cared for the people who used the service. We observed that people were receiving care that was meeting their heath and welfare needs.

One of the people we spoke with said, "I get looked after, it's really nice". Another said that, "The care is good".

However there were times when the people living there were not doing any meaningful activities. The provider told us that they will now increase the opportunities for activities.

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said, "I feel well supported in my job". This meant that staff had the support and knowledge to meet

the care and welfare needs of people who lived there.

There were regular meetings for people who used the service and staff. The views of families and professionals were sought by the provider. The provider also did regular checks including medicines and cleanliness. This meant that the provider was able to review the quality of the service and to ensure appropriate care was being provided.

People living at Brooklands told us that they liked living there and the people they lived with. We were shown around the service by one person and they told us about some of the improvements that had been made to the communal areas and how they had been involved in choosing the decoration, colour schemes and furniture.

Three people living at the service were happy to show us their bedrooms and told us that they had their own personal belongings and choice of decoration. The manager told us that two people had recently moved rooms. This meant that for one person their new room had an en-suite added and had direct access to a secure outside area.