This inspection took place on 28 February 2017 and was unannounced. We last inspected the home on 15 May 2015 when we found the provider to be compliant.

Brownlow House Residential Care Home is a care home registered to provide accommodation, personal care and support for up to 24 people with dementia, mental health illness and older people. At the time of our inspection, 20 people were living in the home.

Brownlow House Residential Care Home has a dining and lounge room on the ground floor with a conservatory used as additional dining and lounge space. The conservatory opens up to an accessible garden with a patio area. The home has 22 bedrooms with one double bedroom, spread across three floors with bathroom and shower facilities. All bedrooms are with washbasin and toilet facilities. The first two floors are accessible via lift. The home has kitchen and laundry facilities.

The service had a manager who was going through registration process with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 using the service told us they felt safe at the service and enjoyed living there.

People were protected against abuse and poor care by staff that were trained in safeguarding adults. The service had good systems to identify and manage risks. Risks to people were assessed and regularly reviewed. Care plans and risk assessments supported the safe management of people’s medicines. The service kept accurate records of medicines administered by staff that were well trained. The service was clean and had effective measures to prevent cross contamination.

People’s nutrition and hydration needs were met and staff kept detailed daily care records on how people were supported and what they had for meals. People and their relatives were very happy with the quality of food and the choices they were offered.

The service had sufficient numbers of staffing to meet people’s individual health and social care needs. People and their relatives told us staff were always available and easy to get hold of. The service worked closely with various health and care professionals to support people with their needs and wishes. People received weekly GP visits.

The service followed appropriate recruitment practices. Staff received induction and regular training, and records confirmed this. Staff received regular one-to-one supervisions and yearly appraisal.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

People told us they had good relationship with the staff and found them kind and caring. Staff knew people well, treated them like individuals and provided person-centred care. Staff recognised people’s need to remain independent, and enabled and supported them wherever possible to remain independent.

The care plans were personalised and people’s individual needs and likes and dislikes were recorded. People and their relatives were involved in planning their care and were asked about their views. The service offered people with a range of activities. People and their relatives told us they were asked for their feedback and their complaints were acted upon promptly.

People, their relatives, staff and health and care professionals told us the service was very well run and the manager was knowledgeable. The manager worked with health and social care professionals to ensure the service supported people to maintain healthy lifestyle.

The service had records of audits and monitoring checks of various aspe

This inspection took place on 14 May 2015 and was unannounced which meant that nobody at the home knew about the visit in advance.

Brownlow House Residential Care Home is registered to provide accommodation and personal care for up to 24 older people. The home is spread over three floors with 17 bedrooms including seven double rooms. The home has a registered manager in place. 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.

There was insufficiently clear communication about whether people living in the home had their own bedrooms, or were sharing with another person which placed them at risk of sharing a bedroom with a stranger, without their consent or a best interest decision being made.

Risks to people’s safety were identified and managed effectively, and there were systems in place to protect them from abuse. People’s privacy and dignity was protected. People were involved in decisions about their care and how their needs would be met. Sufficient staff were available to meet people's health and social care needs. People’s medicines were managed safely, and staff knew what to do if people could not make decisions about their care needs. Support was obtained swiftly from relevant health care professionals when people’s needs changed.

People received appropriate support with their meals, and were encouraged to engage in activities both within and outside of the home. Staff were very aware of people’s likes and dislikes regarding their care and support needs.

The home was kept clean and any maintenance issues were addressed promptly. Appropriate systems were in place to ensure the safety of the premises.

People using the service, relatives and staff found the management approachable and supportive. Staff received effective training and supervision in their role. Systems were in place to monitor the quality of the service, and address areas for improvement. People felt able to express any concerns, so these could be addressed.

This was a follow up visit as the service had been non-compliant in some areas at last inspection. On this occasion we found that the new manager had addressed most of our concerns.

We observed staff being kind and caring during our early morning visit to this home. There were 19 people residing at the home, although one was in hospital. The provider had reduced the number of people staying there as double rooms were being converted to single rooms as people moved on. Staff were very familiar with the needs of people who used the service and when we pointed out that there was an insufficient number of staff to support people who were early risers, the provider said an additional member of staff would be available from 6.30am from 1st April 2014.

There was a high standard of record keeping and the 'Resident of the Day' system meant care plans and risk assessments were regularly reviewed with input from the person themselves whenever possible. We asked the manager to ensure that the lift remained accessible to people at all times and they undertook to ensure this was the case.

Most staff members were up-to-date with most of their mandatory training. This included sessions on dementia and mental health awareness.

When we visited the home, four out of the five people we spoke to who used the service were positive about the care they received. One person said the staff 'are very good'. We observed staff being kind and gentle and there was a calm atmosphere despite the staff team being very busy.

The home assessed people's capacity to make decisions on admission to the home and kept this, their care plan and their risk assessments under review. There was a choice of food available and people's dietary needs and choices were taken into account. Staff received appropriate training for their role and there was an emergency on call sytem to assist them in the event of an emergency.

We noted that there was a rolling refurbishment underway to update the building, but we were concerned that certain aspects of lift maintenance had not been attended to and that information about the fire action plan was not available. The home had not notified the Care Quality Commission of all the events it is required to in order to comply with the regulations.

At the time of the inspection there were twenty-two people living at the home, one of whom was in hospital. We spoke with fifteen of them and one relative visiting the home.

People were very positive about the home. They told us “There’s enough to do,” “I can go out when I want to,” “It’s very relaxing here,” “Staff are brilliant,” “I love my room,” and “My room’s alright.”

We observed staff supporting people in a positive manner that respected their dignity. People indicated that they received sufficient support from staff, and had choices about their living arrangements, had opportunities to develop independence skills, and that they were able to go out as much as they wished. A number of improvements had been made to the home environment including refurbishing some people’s bedrooms.

We visited the home unannounced on a Sunday morning, and on a weekday night. At the time of the inspection there were twenty-one people living at the home. We spoke to fourteen of them and two relatives visiting the home. We also spoke to four staff members, and looked at six people's care records.

People were generally very positive about the home. People told us “I’m quite content,” “The food is quite good here,” and “The staff are phenomenal – they deserve a medal.” Others noted “They’re very good, but I’d like to go out,” and “The food is variable, sometimes very good.” One visitor told us “my [relative] is happy and content being here.”

We observed many examples of staff supporting people in a friendly manner that respected their dignity.

People indicated that they received sufficient support from staff, and they felt safe at the home. However some people told us that they did not like having to share a bedroom with another person, that they wished for more opportunities to be independent, and that they were unable to go out as much as they wished.There was also room for improvement to the home environment including refurbishing some people’s rooms.

At the time of the visit 22 people were living at the home, with two people in hospital. We observed how people were being cared for within the home, talked to ten people living at the home, one visitor, and three staff members. A new manager had recently been appointed to the home.

Overall the feedback was that people are provided with the care that they need, and are well settled in the home. They are given choices and have formed good and supportive relationships with staff.

People spoke highly of the support provided by staff at the home, their kindness and patience. Overall there had been an improvement in the number of activities provided in the home. However some people indicated that they would like to have more varied activities, particularly opportunities to go on trips outside of the home.

People were happy with the home environment and the cleanliness, as one person said ‘its nice and clean.’ However improvements were needed with regard to staff supervision, training in a small number of areas, quality assurance procedures and records of care provided, to further protect people living at the home.