This inspection took place on 21 March 2017 and was unannounced. The service is a care home without nursing care and is registered to provide accommodation for up to 28 people. There were 26 people living at the service on the day of our unannounced visit and two of those people were in hospital.

The manager had been in post for nine weeks at the time of our inspection and had commenced the registration process. 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 who used the service and their relatives felt the service was safe.. There were systems and processes in place to minimise the risk of abuse and staff were very clear about their role in safeguarding people from harm. There was a culture of transparency and people were encouraged to whistle blow on poor practice.

The manager analysed falls so that action could be taken to avoid future falls where possible. The directors of the service had put in place systems for maintaining the building and ensuring there were regular fire safety checks. There were processes in place for the safe recruitment of staff and there were enough staff to provide the care to meet people’s needs. There were effective, organised systems in place for the safe handling of medicines.

There was induction and on-going training in place for the staff, as well as planned supervision and appraisals. People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly and the team were committed to ensuring that people were supported in the least restrictive way possible.

People were supported to eat and drink sufficient amounts and were encouraged with regard to their capacity to make choices about food and drink and provide feedback. People received effective healthcare support from a range of external healthcare professionals

People were supported by caring staff that knew them well. The service had a person centred culture focussed upon supporting people to meet their assessed needs. Many people living at the service had a diagnosis of dementia and staff had been given additional training in dementia awareness. People's rights to privacy and dignity were valued and respected.

Each person had a care plan written from an assessment of their needs. Relatives were encouraged to provide feedback on the service and felt they could raise concerns. Complaints were taken seriously, investigated and responded to with understanding.

Robust and frequent quality assurance processes by the directors were in place regarding the safety and quality of the service. The manager and deputy once established in post would take on more of these responsibilities. Regular evaluations took place to ensure that the service had a positive impact on the lives of the people living at the service.

The inspection took place on 3 May and was unannounced. The Service provides accommodation and personal care for up to 28 older people, some have a diagnosis of dementia. On the day of our inspection there were 26 people using the service.

The manager of the service was seeking registration with the Care Quality Commission (CQC) and was being supported by the current registered manager who has become the operational manager for this and other services for the provider.

A registered manager is a person who has registered with the 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 were protected from the risk of abuse as staff had attended training so that they had a knowledge and understanding of how to safeguard people, if they suspected abuse was happening. The manager had shared information with the local authority when needed.

The people using the service were supported by a sufficient number of staff. The provider had ensured appropriate recruitment checks were carried out on staff before they started work. Staff had been recruited safely and had the skills to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice were in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these were assessed and decided by appropriately trained professionals. People at the service were subject to the DoLS. Staff had been trained and had a good understanding of the requirements of the MCA and DoLS.

We saw that positive and caring relationships had been developed between people and staff. All staff in the afternoon took a drink with the people using the service. This was an opportunity to talk and discuss any issues and was referred to as butterfly time. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times. People were given choices in their daily routines and their privacy and dignity was respected.

Staff knew people well and were trained, skilled and competent in meeting people’s needs. Staff were supported with supervision, annual appraisals, staff meetings and training. People, where able, were involved in the planning and reviewing of their care and support.

People’s health needs were managed appropriately with input from relevant health care professionals. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health. The service provided meals over two sittings so that staff could support and focus upon people’s nutritional needs. Staff ensured that people’s health needs were effectively monitored.

People were supported to maintain relationships with friends and family so that they were not socially isolated. The service used the services of an advocate. There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views.

Before any person used the service, an assessment of their needs was completed to determine that the service would be able to support them.

People were supported to report any concerns or complaints and they felt t

We spoke with seven people who used the service, looked at 13 care records and spoke with two relatives, the provider, manager and four members of staff. We viewed the staff rotas, infection control procedures and quality monitoring systems. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were greeted, our identifications were noted and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs.

We reviewed staffing records regarding The Mental Capacity Act (MCA) 2005 in relation to Deprivation of Liberty Safeguards (DoLS) and saw this training was up to date. The CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that the service had made the appropriate applications and correct policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit. This meant that people were not unlawfully deprived of their liberty.

Is the service effective?

There were systems in place regarding infection control and monitoring care plans which ensured effective organisation in the delivery of care.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were reviewed monthly and updated appropriately which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. One person told us, “The meals are lovely and staff always ask if you have had enough to eat.” The activities team had devised activities in regard to individual needs and also group activities. During our inspection we saw people who used the service engaged in a range of activities.

Is the service responsive?

The service had an effective complaints procedure in place. The service had implemented an action plan as a result of our last inspection regarding improvements to the laundry, sluice and infection control requirements. This ensured people received safe and appropriate care.

Is the service well-led?

The service had worked with people who used the service and their families to record personal information about the people’s life histories. We saw memory boxes outside people’s rooms and also military uniforms, jockey outfits and wedding dresses to remind people of their past professions. This also helped people to locate their room. We saw that some flooring had been replaced as well as all of the windows and many rooms had been redecorated and had new furniture. The service had worked well with other organisations including the DoLS team.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines. We found the provider had improved arrangements for the administration and recording of medicines. We found medicines were stored safely for the protection of people who used the service. We found that medication records were in good order, provided an account of medicines used and demonstrated that people received their medicines as prescribed. We found that that suitable arrangements were in place to identify and resolve any medication errors promptly.

On this inspection we did not speak with anyone who used the service about the way their medicines were managed.

This was a follow up inspection because during our inspections on 29 April 2013, 07 May 2013 and 09 December 2013 we found the service was not meeting certain standards of care. This was in relation to infection control, safety and suitability of premises and care and welfare of people who used the service.

During this inspection on 13 March 2014 we looked at seven people's care records, spoke with staff and the manager of the service, spoke with two relatives and completed a Short Observation Framework for Inspection (SOFI).

We found evidence that people were respected and involved in their care. We saw good interactions between staff and people who used the service. We observed people smiling and found that they were provided with a range of activities and opportunities, which promoted their independence and community involvement. We noted that the service had made improvements in relation to mealtimes. The service offered two meal sittings at lunchtime opposed to one previously. We saw that this increased staff availability and meant that people's needs could be met in a timely way during mealtimes.

We found that the service had made improvements in relation to ensuring people's care and welfare. We were assured that people's needs were assessed and that their care plans reflected their individual needs. We observed care being delivered in line with people's needs.

We were assured that the provider had taken appropriate steps in relation to the safety and suitability of the premises. The environment was found to be suitably designed and adequately maintained. We observed that bathrooms and toilets were in a good state of repair, the lift was functioning and areas that posed risk to people living with dementia were locked and not accessible to them.

During our inspection we found that people’s rooms and communal areas were clean. However we also found that appropriate standards of cleanliness and hygiene were not being maintained specifically in the sluice on the second floor and the laundry room. There were not effective systems in place to reduce the risk and spread of infection. We have asked the provider to take action.

On this inspection we were not able to talk with anyone who used the service about the way their medicines were managed. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the administration and recording of medicines.

As part of this inspection we spoke with three people who used the service, five care staff, the head of care and the manager. One person told us that they liked living at Brookwood Manor because they “Didn’t have to do their shopping and cooking anymore.” Another person told us that they liked “Spending time in their bedroom because it was quieter.”

We found that there were not suitable arrangements in place to ensure that people's dignity was maintained, especially at mealtimes. We noted that there needed to be improvements made in order to promote people's rights to independence and personal choice.

We saw evidence that care provided to people did not meet their individual needs; we found evidence that people's care had not been managed in a way that protected them from the risk of harm or further decline in their health or wellbeing.

We saw that the provider had improved the systems that monitored people’s dietary and fluid intake.

There were several areas within the environment that still required improvement in order to ensure that the place in which people live is safe, homely and well maintained.

We found that the provider had improved staffing levels since the last inspection was carried out which meant people were supported by adequate levels of staffing during the day and the night times.

We saw that there had been an improvement in recording information which ensured people were protected from the risk of malnutrition and dehydration. The recording of people's weights had improved and audits provided evidence that confirmed each person who used the service was weighed regularly.

People told us that the staff were kind and caring and one person told us that "I like fish and chips and like having a good sing song with the staff." Another person told us that "They felt safe because the staff were kind and cared for them."

The provider had ensured that staff employed were well led by the appointment of a new manager. We saw training records that confirmed staff had been provided with the appropriate training to carry out their role effectively.

We found that people's weights and fluid intake records were now accurately maintained and all records seen had been reviewed daily. We saw that health and safety records were up to date which included all fire records.

We found that staff were aware of procedures related to safeguarding of vulnerable adults. We saw there were displays of information and documents for staff to refer to if they suspected abuse. We found that staff knew how to report any concerns to more senior staff or to the local safeguarding authority. Information was also displayed to inform visitors about actions they might take if they suspected abuse of vulnerable adults.

The majority of people were unable to communicate their views verbally. We were able to observe people's non verbal communication cues to inform us that people appeared relaxed and at ease with the staff who were supporting them.

One person stated that "Its nice here and the staff care for me well."

One person told us that they were "Quite happy and that the food was good. Another person told us that they would "Like to go out more and help in the garden."

We spoke to people about the environment. Several people we spoke with told us that the environment had been decorated recently. One person told us that they liked their room and had been able to bring some personal items in to make it feel familiar to them.

Although the majority of people were unable to communicate their views verbally, we were able to observe people's non verbal communication cue's to inform us that people were relaxed and at ease with the staff who were supporting them. However one person we spoke to was able to tell us that they thought that the service was clean and tidy. Another person we spoke to stated the service was a "100 percent better than it was last year."

During our visit to the service we saw that care workers interacted with people in a caring, respectful and professional manner and people who used the service were given appropriate information and support regarding their care or treatment.

Two people were able to tell us that they found the staff "Wonderful and that nothing was too much trouble". Another person confirmed that the staff were kind and caring and they "Knew what they were doing".

We spoke with four people who use the service including relatives who were visiting, and they told us they were happy with the care, treatment and support they receive and are involved in making decisions about their care.

We spoke with one person and asked them if they had been involved in the development of their care plan. They told us they had sat with a staff member and told them about their life history, experiences and listed personal choices and preferences including “what I like and what I don’t like to do”.

People we spoke with were aware of the refurbishment work at the home and were looking forward to the “homes revamp”.

We asked people about the food in the home and the choices available, one person told us the “porridge is very good; they give me things I like and know what I don’t like to eat”. Another person told us they like the food and was looking forward to today’s lunch of fish and chips as “the fish and chips are good here”.

We asked people if they were not happy about their care or treatment what they would do and people told us they would speak to the staff or the manager.

One person told us the “staff and manager are very approachable”. Another person told us they had no reason to complain about the service but “knew what to do if they had to and were not afraid to do so”.

We spoke with four people who used the service, the provider, the manager, one relative and five staff members as part of this inspection. Two people who used the service told us that they were happy with the support they received and that they felt safe. One person told us that response times to call bells had improved. Another person told us that they would like to go out in the garden more often.

We found that the systems for assessing and reviewing the quality of the service had improved and that regular audits were now completed.

There were several areas within the environment that require improvement in order to ensure that the place in which people live is safe, homely and well maintained.

We found that the service was not maintaining accurate records that related to the care and welfare of the people who used the service. There was a lack of information provided within some records that could place people at risk of harm and compromise their health and safety.