This inspection took place on the 19 and 20 July 2018 and was unannounced.

Our inspections in May 2016 and June 2017 found breaches of regulation and were rated Requires Improvement. This was because they had not sustained the necessary improvements needed to meet the breaches of regulation. We received an action plan from the provider that told us they would meet the breaches of regulations by June 2018.

Brooklands Nursing Home 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 Nursing Home is located close to the village of Forest Row and backs on to the Ashdown Forest. The service provides nursing care and support for up to 29 people most of whom have limited mobility, are physically frail with health problems such as heart disease, diabetes and stroke. There were people at the service living with dementia and some people were receiving palliative care. At the time of our inspection there were 23 people living at the home, two of whom were in hospital.

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 is run.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check the provider had followed their action plan and confirm the service now met legal requirements. We found improvements had been made in the required areas.

The overall rating for Brooklands Nursing Home has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made.

The quality assurance system had been reviewed and areas for change had been identified and prioritised to drive improvement. Nurses were responsible for reviewing the care plans, risk assessments and daily records and, although most of these were up to date with clear guidance for staff in how to deliver safe, effective and responsive care, we also found some information that was not clear or had not been updated. This included changes to people’s risk assessments when their nutritional needs had changed and food and fluid charts not being consistently recorded. Staff were aware records were not consistently up to date and the changes in the care planning process would take time to be embedded into day to day practice.

People were relaxed and comfortable with staff. They said they felt safe and there were sufficient staff to support them. One person said, “I feel safe, the staff are kind and look after me.” A relative said, “I really don’t think we could have found a better place, we looked at a lot of homes. Here it is always clean and never smells, my relative is kept nicely and able to do what she wants. She phoned me at 10 last night, which shows the kind of freedom she has, she uses the phone a lot.” When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems that ensured medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire or emergency situat

We carried out an unannounced comprehensive inspection at Brooklands Nursing Home on the 11 and 12 May 2016 where we rated the service as requires improvement. To follow up on whether required actions had been taken we completed this inspection on 6 and 8 June 2017. Although we found some improvements we also found new areas which required improvement and breached regulation.

Brooklands Nursing Home is located close to the village of Forest Row and backs on to the Ashdown Forest. The service provides nursing care and support for up to 29 people. At the time of our inspection there were 28 people living at the home, most of whom have limited mobility, are physically frail with health problems such as heart disease, diabetes and stroke. There were people at the service living with dementia and some people were receiving palliative care.

Accommodation is provided from the original building and a purpose built extension connected to this. The two floors were accessible via a lift between the ground floor and upper level.

A registered manager was 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 and associated Regulations about how the service is run. The registered manager was supported by a deputy manager.

We found a number of areas that required improvement, despite positive comments from people, relatives and health care professionals regarding the good quality of care provided.

The provider had failed to take timely action to address identified shortfalls in regard to the environment, risk and forward planning. For example, both a fire risk assessment and an electrical wiring report had actions and recommendations which had not been fully addressed. This lack of cohesive business and continuity planning meant that the provider was not proactively planning but reactively managing the service.

We found areas of the home which required attention to ensure they did not present a health and safety or infection control risk. The registered manager took steps during and immediately following our inspection to resolve these shortfalls.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure medicines had been stored, administered, audited and reviewed appropriately. People received their correct medicine in a timely manner.

Staff received training and had an understanding of the MCA and were seen to act in accordance with its principles. Staff were heard to ask people for consent and senior staff had taken action to ensure decisions made on people’s behalf was done within the legal framework.

There were sufficient number of staff working at Brooklands Nursing Home with the appropriate skills and experience. Robust recruitment checks had taken place prior to staff working at the home.

People’s needs had been assessed and personalised care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People received the care they required, and staff members were clear on people’s individual needs.

Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised appropriately with healthcare professionals for advice and guidance.

Staff had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of food and drink which met their identified needs.

There were two breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection at Brooklands Nursing Home on the 16 and 19 December 2014. A breach of Regulation was found. As a result we undertook an inspection on 11 and 12 May 2016 to follow up on whether the required actions had been taken to address the breach identified. Although we found improvements had been made there remained some areas that required improvement.

Brooklands Nursing Home is located close to the village of Forest Row and backs on to the Ashdown Forest. The service provides nursing care and support for up to 29 people. At the time of our inspection there were 26 people living at the home, most of whom have limited mobility, are physically frail with health problems such as heart disease, diabetes and stroke. There were people at the service living with dementia and some people were receiving palliative care.

Accommodation is provided from the original main building and a purpose built extension connected to this. The two floors were accessible via a lift between the ground floor and upper level.

A registered manager was 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 and associated Regulations about how the service is run.

People and their relatives spoke highly of the service provided at Brooklands Nursing Home. Comments included, “I’m am well looked after and happy living here.” However, we identified a number of areas that required improvement.

Although people told us they felt safe we found kitchen staff had not consistently followed basic food hygiene principles in relation to the storage of food. The provider could not be assured one person’s skin integrity was being protected as specialist mattress equipment was not working effectively.

Staff received training and had an understanding of the MCA and were seen to act in accordance with its principles; however care documentation did not clearly identify how people who lacked capacity for specific decision had been supported to reach best interest decisions.

The provider had systems in place to monitor and drive improvements in the performance of the service; however we found some shortfalls with care plan and accident auditing which meant not all areas had senior staff oversight.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure medicines had been stored, administered, audited and reviewed appropriately. People received their correct medicine in a timely manner.

People’s needs had been assessed and personalised care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

It was clear staff and the registered manager had spent time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of food and drink; meals offered ensured people had their nutritional needs met.

There were sufficient number of staff working at Brooklands Nursing Home with the appropriate skills and experience. Robust recruitment checks had taken place prior to staff working at the home.

We spoke with five people and three relatives who told us that people were treated as individuals and that they were given information and choices in relation to their care. One person said that ‘they look after me really well and I have a nice room’. Another said the staff are very nice and caring’. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations. A visitor told us ‘the home is just lovely and the matron is always available to talk to us’.

We spoke with five members of staff who told us they all enjoyed caring for people and worked well as a team. During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided that day before doing so.

We were shown examples of person centred care records which had been developed with each individual with a relative assistance where necessary. They documented their wishes and preferences in relation to how their care was provided. This provided clarity for staff. Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.

We spoke with three people who used the service and the relatives of five people. For the most part, people and their relatives were happy with the home and the staff. People and their relatives described the service as "Brilliant" and "Homely ." People felt that staff treated them with kindness and respect. One person said, "They're very good to me."

We found that people's care was planned and delivered in line with their needs and preferences. People's needs were assessed with the input of people and their relatives. People's care records were up to date and reflected people's most current needs.

People told us they felt safe living at Brooklands. We found that the home maintained people's safety and that safeguarding concerns were responded to appropriately.

We also spoke with three members of staff. Staff told us that the home cared for people to a good standard. One member of staff said, "I would recommend it." Staff also told us that they received appropriate training and support in their roles. Staff expressed high job satisfaction and felt there was good teamwork and communication amongst their colleagues. We found that staff training had been refreshed on a yearly basis.

We found that the provider responded appropriately to complaints and suggestions about the service. People and staff understood how to raise a complaint and felt comfortable to do so.

We inspected Brooklands Nursing Home on the 16 and 19 December 2014. Brooklands Nursing Home provides nursing care and support for up to 29 people. On the day of our inspection 19 people were living at the home. The home provided nursing care and support to people living with long term healthcare needs, this included heart failure and some people living with dementia.

A registered manager was 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 and associated Regulations about how the service is run.

Through the duration of our inspection, people spoke highly of the home. Comments included, “Really lovely place to live” and, Very happy with the home.” However, we identified a number of areas that required improvement. These had not been identified by the registered manager through auditing or quality assurance.

People received their correct medicine in a timely manner however the home did not have effective systems in place for the disposal of medicines.

People’s needs had been assessed and individual care plans developed, these contained appropriate risk assessments. However, a process to determine whether people’s Mental Capacity required assessing had not been completed on admission to the home. Care plans did not always contain personal ‘life histories’ of people.

Staff received training that enabled them to support people living at Brooklands Nursing Home. However, the staff’s understanding of the Mental Capacity Act (MCA) 2005 and its key principles was limited and training schedules identified a high proportion of staff had not received training in this area.

The provider had not submitted all statutory notifications to the Care Quality Commission, as required. Under the Health and Social Care Act 2008, providers are required by law to submit notifications. We have asked the provider to make improvements in this area.

There were some quality assurance procedures in place to improve the quality of the service but some areas had not been considered. There were no effective systems to capture people’s views and opinions. Satisfaction surveys of people or their relatives had been undertaken since 2010.

Staff interaction with people was kind, caring and genuine. People spoke highly of the care they received. Comments included, “Very kind, all of the staff.” People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

There were sufficient numbers of staff to care for people. People told us they felt safe living at Brooklands Nursing Home. Staff had completed safeguarding training and knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff had a clear understanding of the vision of the home and they spoke enthusiastically about working for Brooklands Nursing Home. Staff were supported and could approach management with any concerns.

We found a breach in a Regulation. You can see what action we told the provider to take at the back of the full version of this report.