This inspection was unannounced and took place on the 1 June 20172017. Broomhouse Nursing Home provides accommodation and personal care for up to 40 adults with learning disabilities or autistic spectrum disorder. Some were also living with a range of medical or chronic health conditions. At the time of our visit, there were 37 people living at the service, within an age range of 51 to 90 years old.

There was a registered manager at this service. 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.

At our last inspection in December 2015 we rated the service as ‘Good’ overall. At this inspection we found the service remained ‘Good’ overall.

People, relatives and staff were confident people received safe care. The environment was mostly clean, safe and well maintained. Related improvements in progress and emergency planning measures helped to further ensure this.

People were protected from the risk of harm or abuse. Risks to people’s safety associated with their health and environment were assessed before they received care and regularly reviewed. Staff supported people in a safe, skilled and timely manner. People’s medicines were safely managed. Staffing arrangements helped to ensure people’s safety.

People and relatives were happy with the care provided. People were supported to maintain and improve their health and nutrition by staff who were supported, trained and knowledgeable to ensure this. Staff consulted with and supported people to access external health professionals when they needed to. Staff understood and followed related instructions for people’s care when required.

Staff understood and followed the Mental Capacity Act (2005) to obtain people’s consent or appropriate authorisation for their care when required; to ensure their rights and best interests.

Staff were caring, treated people with respect and promote their dignity people’s dignity, independence and rights in care.

People and their families were informed and supported to understand the care they could expect to receive from staff at the service. Staff knew people well and had good relationships with them and their families. Staff understood and they followed what was important to people for their care and relationships with others.

People received personalised, timely care that met with their known wishes, lifestyle preferences and promoted their social inclusion. Exploration of ways to help further tailor people’s individual arrangements for their occupation and leisure was agreed.

Staff often supported people to engage and participate in home life and the extended community; to do things they enjoyed there that were meaningful to them. Environmental equipment, specialist aids and adjustments for vehicle access helped to promote people’s independence.

Staff shared relevant information about people’s care with external care providers when required; to ensure people’s personalised and consistent care if this needed to be provided outside the service.

People and relatives knew how to make a complaint about the service if they needed to. The provider regularly sought the views of people, relatives and staff; to inform and make service improvements when required.

The service was well managed and led. Staff were informed, supported and understood their role and responsibilities for people’s care. The provider’s governance arrangements helped to ensure the quality and safety of people’s care, ongoing accountability and continuous service improvement.

We completed an unannounced inspection of Broomhouse Nursing Home on 18 December 2014. Broomhouse Nursing Home is registered to provide care for up to 40 people who require nursing or personal care and supports people with learning disabilities.

The manager had been registered with the Care Quality Commission since 2010. 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.

At our previous inspection in October 2013 we identified a breach in regulations relating to the management of medicines. Following this the provider sent an action plan telling us about the improvements they intended to make. During this inspection we found those improvements had been made.

At this inspection the people who used the service told us they felt safe and well looked after. Families we spoke with felt reassured that the care their relatives received was safe and they spoke positively about the staff who worked at the home. However, we found improvements were required to identify and refer potential incidents to the local safeguarding authority and ensure people had plans in place to protect them when required.

People’s health and care needs were well managed by staff who were supported in their role by effective supervision and training. Staff demonstrated a good understanding of individual people’s needs including needs relating to nutrition and hydration. Appropriate arrangements were in place under the Mental Capacity Act 2005 for people who were not able to give consent to aspects of their care and treatment.

People told us, and we observed throughout our inspection, that people using the service and staff enjoyed each other’s company and had fun together. Staff noticed and checked if people appeared unwell. People we spoke to felt understood by staff and we saw that people were encouraged to be independent and were treated with respect.

Throughout the day we saw people engaged in a variety of activities that were of interest to them. People were also supported to maintain contact with their families and friends and the local community. People had opportunities to share their ideas and suggestions about the service, and raise concerns if they needed to.

The manager was committed to an open and transparent leadership style and as a result people we spoke with found him approachable. The manager was supported by senior staff who were encouraged to value their own staff teams. Procedures for auditing and monitoring the quality of services were in place, however we found some aspects of monitoring were not up to date and had been temporarily affected by other developments taking place in the service.

Some of the people who used the service were unable to communicate with us due to the nature of their disability without assistance from staff. We did speak with three people who told us that they were happy at Broomhouse. One said "I like the staff here, they help me and I like the food". Positive comments from relatives included "My relative is safe and looked after, we are pleased with the support they give to us".

We saw that people were supported to make simple decisions and when people were unable to make more complex decisions for themselves the provider acted in accordance with legal requirements.

We saw that people's care records contained detailed information about their needs and they had access to a range of health and social care professionals. Care and treatment was planned in a way that ensured each person's individual safety and wellbeing.

We found that although systems were in place to manage the risks associated with medicines, we saw that they were ineffective during our inspection. This meant that the provider was unable to identify if some people's medicines had been given as prescribed.

We observed positive interactions between people using the service and staff who responded appropriately when they became distressed or unsettled. Staff were well supported in their responsibility to deliver care and treatment appropriately.

We saw that there was a complaints system in place to handle complaints effectively.

Some service users had communication needs which limited the amount of information they could give us about the service. Where possible we did speak with people at the home, spoke with relatives who were visiting and observed the interactions staff had with people.

Most people told us they liked living at the home. We observed people readily approaching staff and chatting openly to them. Where people had been out they were eager to tell staff who had not accompanied them what they had been doing.

We looked at a sample of peoples bedrooms and talked to people about some of their interests. The rooms were individual to each person containing family photographs and the possessions which were important to them.

Relatives told us the home did keep them informed of significant events and that they had confidence in the management of the home. Relatives confirmed to us that they were asked for their opinions about the home.