Brookview Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 52 people living at Brookview Care Home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found that the service remained good.

There had been a change in management since the last inspection. The new manager was not present during the inspection. However, we met with the regional director, regional support manager and regional quality manager who were supporting the service. People, visitors and staff spoke positively about the new manager and that improvements had been made since their arrival.

People felt safe, their needs were regularly assessed and they were protected from harm and abuse. Accidents and incidents were recorded and monitored to identify emerging trends and individual risks were assessed.

People’s care and support needs were regularly assessed and linked to a dependency tool to determine staffing requirements. A review was being undertaken at the time of the inspection.

A medicines policy was in place to guide staff practice. Staff received training and their competency to do so was regularly checked. We raised an issue about a person refusing their medicines and the regional management team took immediate action.

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. Staff sought consent before carrying out care support and people told us they were happy with the care they received.

Staff were supported to develop their skills, knowledge and competencies by completing a wide range of developmental training.

There was an extensive refurbishment programme underway which was nearing final stages. The environment was clean, bright and airy and of a high standard. Specialist equipment was readily available.

Food served was nutritious and meal time experience calm and pleasant. Staff supported people who needed assistance in a kind and unobtrusive manner.

The inspection team observed interactions that were extremely kind, caring and patient. Staff clearly knew people’s needs and preferences and warm and trusting relationships had been developed.

Care delivery was extremely person-centred and people were treated as individuals. Some records reviewed did not fully reflect the person-centred care being delivered. We were informed that this would be improved in a programme of transfer to new documentation.

Staff contacted health care professionals promptly when people were unwell and people were supported to access a wide range of services to maintain their health and well-being.

There was a programme of activities and a new activities co-ordinator was being recruited.

There were robust audits used to assess and monitor the quality of the service. We saw that these had identified where the service was not compliant with the provider’s policies and procedures which resulted in action plans being implemented to improve the service.

This inspection was unannounced and took place on the 25 February 2016.

The service was previously inspected in January 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Brookview Nursing and Residential Centre provides personal care and accommodation for up to 67 people with nursing, residential and respite needs, and also offers dementia, convalescence and palliative care. Fifty eight people were being accommodated at the time of the inspection.

Brookview Nursing and Residential Centre is a purpose built three-storey building, with a pleasant and spacious interior. The ground floor (Alderley suite) has facilities for residents living with dementia. The first floor (Mottram suite) and second floor (Chelford suite) are for older people who require nursing care. The bedroom accommodation consists of a majority of single bedrooms and some double bedrooms all having en-suite facilities. There are three lounges, three dining areas, laundry and a hairdressing salon. There is a garden at the rear of the building and several smaller sitting out areas around the building. People had access to a secure garden.

At the time of the inspection there was a registered manager at Brookview Nursing and Residential Centre. 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 manager was present during our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Brookview Nursing and Residential Centre to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service spoken with was generally complimentary about the standard of care provided. People living at Brookview Nursing and Residential Centre told us the registered manager was approachable and supportive.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. Staff told us they were well supported in their roles and responsibilities.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

There was a quality monitoring system in place which involved seeking feedback from stakeholders and people who used the service and their relatives about the service provided periodically. This consisted of surveys and a range of audits that were undertaken throughout the year.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

We observed the lunchtime meals and saw staff supported people appropriately and in an unhurried way. Staff were very attentive, friendly and quick to respond whenever a person needed assistance. People had a choice of meals and drinks at lunchtime, breakfast and supper. The chef ensured special dietary needs were met, such as soft and pureed meals for people with swallowing difficulties.

We spoke to five people who lived in the home and six relatives or friends. They all said that they were very happy with the support that they or their relatives/friends received. One person said; "The staff are lovely. They are very caring and supportive."

We looked at the care plans and risk assessments for five people and saw that they were person centred and regularly reviewed and updated.

We looked at the procedures in place for keeping people safe from harm and we saw that they were clear and the staff understood how to recognise the signs of abuse and use the systems in place.

We spoke to the registered manager and four members of staff who all said that they enjoyed working at the service and that they thought that the service offered quality support to the people who lived there.

We looked at the systems in place for recruiting new staff and saw that all the appropriate checks were carried out prior to staff commencing work at the service. We looked at the support arrangements in place for staff and saw that they were good.

We saw that there was a complaints procedure available for people to access.

Prior to our visit to the home we had received some information of concern regarding staffing levels and some health and safety issues in the home. We looked in these issues but were unable to find evidence to support them.

We spoke to three people who used the service. The three people told us they liked living at the service and one person said; “It’s lovely here” and “There is a beautiful view from my room - that's why I chose it.” Another person said; "The food is very good and the staff are wonderful."

We also spoke to three relatives who told us; "I am delighted and thrilled with the care my relative is receiving, this home was recommended to us," and "The home offers excellent care. We have had experience of care homes and this is a good one." They also told us; "The manager is very professional, her door is always open for a chat."

We spoke to ten members of staff who were on duty during our visit. Most of them liked working at the home but gave differing views about the levels of staffing and the procedures in place within the home.

When we visited Brookview we spoke with people who live there and they told us that they liked living in the home and staff provided flexible services. For example, one person told us they could have meals of their choice whenever they wished and that their relatives and friends were welcomed anytime. People said they enjoyed activities of their choice and the home was a happy place where the care and support was wonderful. People said they had been provided with details about the home, staffing levels and the services provided before admission. They said resident meetings were held on a regular basis and people said they could air their views. Direct comments included; “You can speak to anyone and get things sorted”. “I feel safe, I like living here”. “I am always asked my opinion about everything that goes on in the home”.

Other comments included;” This place is a home from home” , “ Staff are really good”, “Nothing is too much trouble for the staff ”,” They look after you how you want”, “The staff are a really good team” ,“ I can pretty much do as I want but staff make sure I am always safe and well cared for”. “The management and staff are so good that this place really does feel like home”.

Relatives of people living in the home told us. ”This place is homely. The staff are lovely and very supportive. The staff are welcoming and my mum always looks well cared for when we see her”.

Discussions with local authority and advocacy services revealed that the manager of the home fully understood her duty to protect vulnerable adults.