This inspection took place on 4 and 8 October 2018 and was unannounced. We last inspected the service on 30 January 2018 and we rated the service as requires improvement and we found the service to be in breach of regulation 17 in good governance. The previous provider had submitted an action plan telling us what improvements would be made. Since our last inspection a new provider has registered with us. At this inspection we found the new provider had made sufficient improvements to meet the legal requirements of the breach, however further improvements were still required. This is the fourth consecutive time the service has been rated as Requires Improvement.

Brookside residential 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. Brookside accommodates up to 25 older people that may live with Dementia in one adapted building. At the time of this inspection 23 people were using the service.

A manager was at the service and they had submitted their application to register with us. 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.

Although some improvements had been made since our last inspection, further improvements were required to ensure staff administered people’s medicines safely. Staff were aware of the risks to people and how to manage those risks such as ensuring people had enough to drink. Staff knew how to escalate any concerns they had about people in order to safeguard them from harm. People told us there was enough staff to meet their needs. People were protected from the spread of infection and where incidents and accidents took place, lessons were learnt and action was taken

Since our last inspection 18 staff had left the service. A training programme was in place to ensure all of the new staff recruited had the skills and knowledge for their role. People’s needs were assessed before they moved into the home and provided staff with the required information to meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Further training was required to ensure staff fully understood the Mental Capacity Act.

People and their relatives described the staff as caring and kind. People’s choices about how they spent their day were routinely respected and people were encouraged where possible, to retain a level of independence. People were treated with dignity and respect.

Improvements had been made to ensure care records reflected people’s preferences to enable staff to be aware of what was important to them and their wishes. The provider was in the process of recruiting designated staff to improve the activities provided to people. Systems were in place to ensure any complaints received were responded to.

The new manager and provider had an action plan in place which was being followed to embed the changes they had made, and to continue to drive improvement in the home.

This inspection took place on 30 and 31 January 2018 and was unannounced.

Brookside Residential 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.

Brookside Residential Home accommodates up to 25 people in one adapted building. At the time of this inspection there were 23 people using the service.

At the last inspection the service was rated as requires improvement. At this inspection the service was rated requires improvement again. This is the third consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in post at the time of the inspection. 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 risks were not always suitably managed in order to keep them safe.

People told us they received their medicines as prescribed however we found some issues which showed that medicines were not always managed safely.

People’s care plans were not always up to date with current information, important personal information and professional advice.

Systems and processes in place to monitor the quality and safety of the service needed some improvement, as the issues we identified during the inspection had not been identified through these processes.

People received support to be pain free and comfortable at the end of their lives however their wishes in relation to end of life care were not always recorded.

Staff knew how to protect people from avoidable harm and abuse. Staffing levels were sufficient to meet people's needs and staff had their suitability to work in a care setting checked before they began working with people. Premises were kept clean and tidy and people were protected from the risk of infection.

People’s needs and choices were assessed prior to them moving into the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported by trained staff however some staff needed more support to check they had understood the training they received. Staff received regular supervision and felt supported in their roles.

The environment was suitably adapted to meet people’s needs. There was a good choice of food, which people enjoyed and they received support to meet their nutrition and hydration needs. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.

Staff were kind, caring and compassionate with people. People were supported to express their views and encouraged and supported to make their own choices. People were treated with dignity and respect and their independence was respected and promoted.

People knew how to complain and concerns were acted upon.

The registered manager was also the provider and was freely available to people, relatives and staff. People, their relatives and staff were involved in the development of the service and they were given opportunities to provide feedback that was acted upon.

This inspection took place on 21 October 2016 and was unannounced. At our last inspection in March 2015 we found that the service was not always as responsive, caring, effective or as well led as it should be. At this inspection we found there had been some improvement but more was needed to ensure the provider consistently followed the principles of the Mental Capacity Act 2008 and people were not being deprived of their liberty unlawfully.

Brookside Residential Home provides support and care for up to 25 people, some of whom may be living with dementia. At the time of this inspection 25 people used the service.

The service had a registered manager. 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 Mental Capacity Act 2005 (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The Deprivation of Liberty Safeguards (DoLS) are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The provider did not consistently follow the principles of the MCA by ensuring that people consented to their care and support.

People were safeguarded from abuse and the risk of abuse as staff knew what constituted abuse and who to report it to. The registered manager had previously made referrals for further investigation when they had suspected abuse had taken place.

Risks to people's health and wellbeing were identified, assessed and reviewed. People were provided with personalised care to meet their needs and preferences. Care plans included life history information and staff knew people's preferences.

There were enough suitably qualified staff, who had been recruited using safe recruitment procedures, available to maintain people’s safety and meet their individual needs. People’s medicines were stored and administered by medication trained staff.

Staff were supported to fulfil their role effectively. There was a regular programme of training that was relevant to the needs of people at the home. Care was personalised and met people’s individual needs and preferences.

People’s nutritional needs were met and they were supported to access a range of health care services. When people became unwell staff responded and sought the appropriate support.

People's privacy and dignity was respected. Staff were observed to be kind and caring and they told us they were well supported by the registered manager.

The provider had a complaints procedure and people knew how to use it.

Systems were in place to monitor the quality and safety of the service. When improvements were required these were made in a timely manner.

The inspection took place on 20 March 2015 and was unannounced.

Brookside House provides personal care and accommodation for up to 25 older people, some of whom are living with dementia.

A registered manager is 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.

People’s risks were assessed in a way that kept them safe from the risk of harm. Where possible people’s rights to be as independent as possible were respected.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

We found that there were enough suitably qualified staff available to meet people’s care needs. Call bells were responded to in a timely manner.

Staff were trained to carry out their role and the provider had plans in place for updates and refresher training. The provider had safe recruitment procedures that ensured people were supported by suitable staff.

Staff had some knowledge of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), but not all had received the training. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Staff knew how to support people in a way that was in their best interests but advice hadn’t been sought from other agencies to ensure formal authorisations were in place where people may be restricted.

Improvements to the choice and presentation of food would mean people received a diet that met their preferences.

People told us that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld.

People had opportunities to be involved in hobbies and interests that were important to them but were not always involved in reviews of their care and treatment plans to ensure they were up to date.

The provider had a complaints procedure available for people who used the service and complaints were appropriately managed.

Staff told us that the registered manager was approachable and led the team well. Staff received supervision of their practice and had opportunities to meet regularly as a team.

There was a positive atmosphere within the home. The registered manager had systems in place to monitor the service and we saw that improvements had been made when identified as necessary. Further improvements to how the service is monitored were necessary to ensure good quality standards were met.

We carried out this inspection as part of our scheduled inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with six people that used the service, two relatives, four members of staff and the provider. We spoke with a visiting district nurse and the regular visiting district nurse on the telephone. People told us that they liked living in the home and were very settled. One of the relatives we spoke with told us that they were pleased with the care and attention provided. One person living in the home told us, "I am settled and quite content with my lot. The staff treat me very well”.

We saw that people were supported to make decisions and were involved in the planning of their care. We saw that people were treated with care and respect. We saw that people were supported to remain as independent as possible and that appropriate risk assessments were in place.

The staff we spoke with had a good knowledge and the skills to provide the care that people required. We were told and saw evidence that people using the service were protected from harm, abuse and neglect. There were arrangements for the management of people's finances in place.

The home had a complaints procedure which people living in the home were aware of.

We visited Brookside Care Home to inspect the home as part of our routine scheduled inspections. The visit was unannounced which means the provider and the staff did not know we were coming.

We spoke with six people that lived in the home, three visiting relatives, several staff and a local GP.

People who lived in the home told us that they were very happy with the care and attention to detail that they received in the home. One lady told us "I can't fault it. The staff are marvellous, very friendly and compassionate to us all."

One relative told us "They have done marvels with my Mother, although she would rather be living at home, she has settled here well. I am reassured every time I visit that she is being well looked after."

The GP told us that she was very satisfied with the care delivered at the home, and that the staff were vigilant to the health needs of the people who lived in the home.

People that used the service told us they were involved in the care planning stages and their needs and choices were identified and discussed.

People that use the service told us they had lovely meals and plenty of choice. They loved chatting to the cook and had chance to ask for their favourites when they had their little meetings. One lady told us we are offered drinks all day and the food is very nicely served and dinners were always hot.

People told us that the home is always well maintained and tidy and staff are careful to leave areas free from clutter to avoid anyone falling.

We saw that the home has some outdoor space which is accessible to all people that use the service, including those in wheelchairs which the individuals told us they enjoyed in the summer.

People that live in the home told us they have access to a call system with an accessible alarm facility in every room. Each room in the home is centrally heated with individual temperature controls and each room is protected by the smoke alarm system

One lady told us that the staff always offer support and assistance to make sure she is safe, they encourage us to be independent when they can but also know when to help us so we feel we can do something’s to help ourselves.

A visiting district nurse told us that the staff are very efficient at asking for advice and opinions about individuals care and they are confident that the care needs of individuals are being met.

The people that use the service told us that the staff are very professional and appear knowledgeable, but they also check things if they are not sure which is good. One lady said she feels so much better for being at the home as the staff have looked after her so well.