We inspected Brookview Nursing Home on 13 March 2017.This was an unannounced inspection. The service provided accommodation, nursing and personal care for up to 60 older people and younger adults, with a range of conditions including dementia and physical disabilities. On the day of our inspection there were 53 people living at the service, who required varying levels of care and support.

Our last inspection took place on 5 July 2016 and at that time concerns were identified relating to staffing levels and inconsistent quality monitoring and record keeping. We found the provider was in breach of two regulations, relating to governance and staffing. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made but other improvements were still required.

We found significant improvements had been made regarding the quality monitoring systems, staffing levels and the opportunity for people to pursue meaningful person-centred activities. This meant the service was no longer in breach. However we did identify some concerns regarding the ineffective and inconsistent management of pressure areas.

A registered manager was in post and present on the day 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 received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected from the risk of harm or abuse by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored, administered safely by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to help ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The service acted in people’s best interests and maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

We inspected Brookview Nursing Home on 5 July 2016.This was an unannounced inspection. The service provided accommodation, nursing and personal care for up to 60 older people and younger adults, with a range of conditions including dementia and physical disabilities. On the day of our inspection there were 53 people living at the service, who required varying levels of support.

Our last inspection took place on 25 January 2015 and at that time concerns were identified relating to staffing levels and inconsistent quality monitoring and record keeping. We found the provider was in breach of two regulations, relating to governance and staffing. Following this the provider sent us their action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been met. We found some improvements had been made regarding record keeping, however other improvements relating to staffing levels and quality monitoring were still required.

During this inspection we found quality monitoring systems were inconsistent and ineffective and had failed to identify shortfalls within the service. Insufficient staff on duty at times meant people’s care and support needs were not consistently met and the opportunity to pursue meaningful person-centred activities was limited.

A registered manager was in post and present on the day 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 received care from staff who were appropriately trained and confident to meet their individual needs. They were supported to access health, social and medical care, as required.

People’s needs were assessed and their care plans provided staff with guidance about how they wanted their individual needs to be met. Care plans we looked at were centred on the individual and contained the necessary risk assessments. These were regularly reviewed and amended to ensure they reflected people’s changing support needs.

Policies and procedures were in place to help ensure people’s safety. Staff told us they had completed training in safe working practices. We saw staff supported people with patience, consideration and kindness and their privacy and dignity was respected.

People were protected by thorough recruitment procedures. Appropriate pre-employment checks had been made to help protect people and ensure the suitability of staff who was employed.

People received their medicines in a timely way. Medicines were stored and administered safely and handled by staff who had received the necessary training.

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals.

Staff received training to make sure they knew how to protect people’s rights. The registered manager told us that to ensure the service acted in people’s best interests, they maintained regular contact with social workers, health professionals, relatives and advocates.

There was a complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

We identified one breach and one continuing breach under the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.

This inspection took place on 15 January 2015 and was unannounced.

Brookview Nursing Home provides accommodation, nursing and personal care for up to 57 older people and younger adults, including people living with dementia and physical disabilities. At the time of this inspection there were 52 people using the service.

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.

Prior to the inspection we received two complaints stating that the home was short-staffed during the evenings and at night. One complainant said that if a member of staff ‘called in sick’ they were not replaced.

During the inspection we received numerous concerns from people who used the service and their relatives about staffing levels. People told us staff were not always available at the times they needed them. People said this had resulted in them not being able to get up or go to bed when they wanted to, being late for meals, and missing an activity.

People who used the service told us there were not enough staff available to support them in the mornings, after lunch, at nights and at weekends. Relatives said there were not enough staff in the mornings and at weekends.

We observed lunch being served. We saw there were not enough staff available to provide sufficient support for everyone who needed it. Some people’s meals went cold as they waited for staff to assist them. And some people had to wait up to 50 minutes for their meal to be served.

During the inspection we also found that improvements were needed to record keeping. Daily records, in particular, had a number of gaps so it was not clear if people’s plans of care had been followed. Gaps in care records put people at risk of not receiving the care they need as staff cannot provide continuity if they do not have an accurate record of what care has already been provided.

There were arrangements in place to regularly assess and monitor the quality of the service. However audits had not picked up gaps and other issues in care records. Nor had they identified that people’s care was being delayed due to insufficient staffing levels. This meant that the audit system was not fit for purpose.

People told us they felt safe living in the home and felt that their possessions were safe. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the well-being of any of the people who used the service.

Meals were well-presented and appetising and people had a choice of dishes. People had mixed views on the food but said there was usually something they liked on the menu.

People told us their health care needs were promptly met and relatives informed if they were unwell. People had access to a range of health care professionals and a local GP ran a ‘surgery’ at the home once a fortnight. This meant people didn’t have to travel to an outside surgery for appointments if they didn’t want to.

People said the staff were hardworking, kind, patient, and caring. They also told us both they and their visitors were always treated with respect. There was a friendly and inclusive atmosphere within the home with visitors coming and going and joining in with activities.

People were involved in making decisions about their care. People were dressed in clothes they had chosen, and were clean and well-presented.

People had personalised plans of care and told us staff responded to their changing care needs.

The people who used the service, relatives, and health and social care professionals were involved when care was reviewed.

People told us there were a variety of regular activities on offer and they knew the activities co-ordinator who consulted with them about what activities they wanted. Everyone we spoke with told us they had enjoyed the recent trip to a stately home.

People knew who the registered manager was and said they would speak to her if they had a concern. Records showed that some changes and improvements had been made to the service in response to people’s suggestions.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our visit we spoke with five residents, two relatives and ten staff, including the registered manager. People made positive comments about how staff treated them with respect, ensured their dignity and encouraged their independence and choice. These included, “There are plenty of activities and trips out,” and “Staff always treat me with kindness and respect my wishes. All felt that meals were satisfactory, often enjoyable and said menu choices were always available, but that meals lacked variety.

People were particularly pleased with their environment, which they said was always fresh and clean. One person told us, “I like my own room, which I chose because of the quiet and its garden aspect.” People also told us that staff usually listened and acted on what they said and assisted them when needed.

However, we found that medicines were not always safely managed and that some of the arrangements for ensuring staff competency to practise and provide care and support for people did not always ensure people’s best interests.

At our visit we spoke with three people accommodated and two peoples’ advocates about the care and services they received and their experiences in the home.

One person told us about some of the ways the service engaged and involved them. Examples they gave included for their involvement in meetings to determine their care, social activities and daily living arrangements. Along with provision of key service information and satisfaction surveys conducted with them.

All confirmed that staff usually treated them with respect and mostly ensured their rights to privacy, dignity, choice, independence and fulfilment. Including when assisting them with their personal care and support.

However, whilst we saw many instances during our visit that told us people’s rights to dignity and choice were recognised and that staff sought peoples’ views. We also saw this practice was not always followed and that inconsistencies occurred.

People were mostly satisfied with the food provided and said that alternatives were available at each meal. Two people said they would prefer a choice of when to have their main meal, which they said was always served at lunchtime. One person wanted to be offered more variety.

Three people and two peoples’ advocates expressed overall satisfaction with their care and support and described suitable arrangements for their health care needs. This included for the purposes of their routine health screening, for their medicines and to provide them with the equipment they needed, such as for their mobility and pressure area care and relief.

One person’s advocate confirmed, ‘Staff know my wife as a person in her own right and understand her needs.’

All felt the home was usually well maintained and clean and were satisfied with their own rooms, which they were able to personalise. Three people commented on the lack of suitable ventilation in the main dining room, which we also found at our visit.

On person told us that a family member advocated on their behalf for their care and finances, which were accounted for.

All those we spoke with confirmed they were confident to raise any concerns or complaints they may have and felt these would be properly dealt with.

Three people and two peoples’ advocates confirmed that staff, was usually available when they needed them and that they usually listened and acted on what they said. One person said, ‘Staff, work as a team.’