The inspection took place on 5 June 2017 and was unannounced.

Brooklodge provides residential care for up to 3 older people. The provider’s representative and registered manager live on site. At the time of this inspection there were 3 people living in the home. Accommodation is over a single story and all those that use the service have their own rooms. A number of communal areas and gardens are available to those living at Brooklodge.

At our last inspection carried out in December 2014, the service was rated as good. At this inspection, carried out in June 2017, the service is again rated as good. However, in order to further improve the service delivered and in order to sustain those improvements, we have made recommendations. These recommendations relate to the management of medicines, adherence to the MCA and care planning.

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.

The staff members that the provider employed had all undergone checks to reduce the risk of employing people not suitable to work with those who used the service. Staff had received training, told us they felt supported and there were enough of them to meet people’s needs in a prompt and person centred manner.

Staff worked well together and, as there were so few of them, communicated effectively to achieve a shared aim. The culture of the home was based on building relationships and meeting people’s needs in a person centred and individualistic manner. Staff demonstrated respect, compassion and humour when engaging with those that used the service. People’s dignity and privacy was maintained and they received support to make choices.

The risks to those that used the service had been identified and managed although not consistently or robustly recorded. However, staff knew those that used the service exceptionally well and mitigated the risks in the support they provided. Staff had received training in safeguarding vulnerable adults.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service understood how to support people to make choices and involved others in making best interests decisions. However, the service lacked records in relation to MCA assessments and best interests decisions.

People received dedicated and individual care that met their personal preferences, likes and dislikes. Staff knew people exceptionally well and delivered care and support that was based on relationship development and getting to know people as individuals. People, and their relatives, were involved in the planning of their care.

Nutritional needs were met and people received enough to eat and drink. The service referred people to healthcare professionals as required.

There were little planned activities going on in the service however those that used it, and their relatives, told us the stimulation they received and family orientated environment met their needs.

The provider and registered manager had a good oversight of the service as they delivered the majority of the care and support. Formal feedback was not sought and no audits took place on the service. However, due to the continuity of care and regular interventions, they were both in a position to identify issues and rectify them. Those we spoke with talked of a responsive approach to issues or concerns.

All those we spoke with told us they would recommend the service due to its small size, dedicated care and support and family feel.

We inspected Brooklodge on the 10 December 2014. This was an unannounced inspection. At our previous inspection in November 2013, the service was meeting the legal requirements of the areas we assessed.

Brooklodge is a privately owned and operated care home without nursing providing accommodation and care for up to three older people. There were two people living at the home at the time of our visit.

At the time of the inspection the home had a registered manager in place. 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.

People who lived at the home told us they felt safe living there. Relatives also told us that they felt confident their family member was safe and well looked after. The manager and staff understood their responsibility to keep people safe and to manage risks. There were appropriate policies and procedures in place to support and assist staff to keep people safe and to minimise risk. People’s medicines were stored, checked and administered safely.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). No one was subject to a DoLS authorisation at the time of our inspection. For people who were assessed as not having capacity, records showed that their families and other health professionals were involved in discussions about who should make decisions in their best interests.

People’s care needs had been assessed prior to moving to the home and these were reviewed regularly with family members where appropriate. This included making adjustments to care provided if required. The manager made prompt and appropriate referrals to other health or social care professionals when required.

Staff received appropriate training, supervision and support. They understood their roles and responsibilities.

People were treated with respect, in a kind compassionate way and had their dignity upheld. The manager and staff involved people in decisions about their care and how the home operated.

People’s food and drink needs were managed appropriately. They were involved in daily discussions about food and drink choices and were free to eat in their own rooms or with the provider, manager and their family if they wished to.

The manager had a quality assurance system. They carried out audits, sought the views of people living in the home, their family members, staff and other health and social care providers. People knew how to make complaints and staff knew how to respond to complaints appropriately.

We conducted this inspection to follow up concerns identified at our previous inspection which was carried out on 02 July 2013. These concerns related to the information available to show how people needed to be supported, the incorrect use of malnutrition screening tools and various omissions in relation to the management of medicines.

Following the July 2013 inspection we required that the provider produce an improvement action plan, which we received. This inspection showed us that improvements had been made.

We found information was available to show how people needed to be supported. Daily records were now being kept to record people’s nutritional intake where they were at risk of malnutrition.

Various improvements had been made in relation to the management of medicines. However a stock accounting record needed to be devised, which we discussed with the manager.

Records kept in respect of people’s health were now accurate. People’s weights were now being recorded which enabled the correct application of MUST (Malnutrition Universal Screening Tool) and the Waterlow Pressure Ulcer Risk Assessment Tool. Handwritten Medication Administration Records (MAR) were fully completed.

One person living at Brooklodge told us, “It’s good care here. I enjoy sitting here in the lounge because people I know wave at me from the street and I can wave back.” Another person told us, “As soon as I press the bell they’re here for me.” Relatives we spoke with told us their family members were well looked after and enjoyed the family environment at the home.

On reviewing care records we found that plans of care were not devised from needs or risk assessments. We had particular concerns that risk tools to identify malnutrition were not being utilised properly. Staff had identified that some people's appetites had diminished and some action had been taken but no plans were in place to address these concerns.

We found omissions in relation to the management of medicines. Medication Administration Records (MAR) did not contain sufficient information and one person's recent prescription had not been added to their record. Controlled drugs had not been stored or recorded in accordance with legal requirements. We also had concerns about disposal of unused medicines and the effectiveness of the annual audit process.

Because of the size of the home there was considerable scope for people to choose what they wanted to eat and when. People we spoke with said the food was good. People were encouraged to eat as necessary.

The home had a complaints and concerns procedure which was available to people living at the home and any visitors.

Two people we spoke with told us that they were very happy living in Brooklodge. One person said: "I'm very happy here, they look after me very well." Another person told us: "It couldn't be better."

One person told us that they enjoyed all the 'soaps' on the television and that they were hoping to get some talking books from the library, as their eyesight was very poor now.

Another person told us they, "Like the two little dogs".

People told us that they were receiving the care they needed and that they were happy with the service.

We were told by one person that the manager had gone with them to the hospital, as they had asked, for support when they had needed to attend for a day procedure.

One person we spoke with told us how they liked watching the chickens in the garden and the birds in the aviary from their bedroom window.

Another person said they liked their bedroom very much and told us that they were getting a new bed, which was adjustable and said, "It will make things so much easier for me".

We spoke to all three people living at Brook Lodge about their experience of living within a family home.

One person told us "I knew the home before I came here and was given the information before moving in, the owner came to visit me first".

We were told "I feel part of the family here, the owner looks after us very well".

A second person told us 'I've lived here for over a year, my relative visits most days, and the owner keeps us both informed about any changes'. 'I know I have records written about me, I see them occasionally but I prefer to talk to the owner if I want anything changing, or need to see the doctor'.

Another person told us they "Enjoyed living with the owners family and sharing the communal rooms with them, with one person telling us how they "enjoy living in a normal family environment filled with young people and animals".

Another said "I have my own room, and when I want to be on my own there is no problem, although its so nice having young people about".