We carried out this unannounced inspection on 03 October 2018. At the last inspection carried out in December 2016, we rated the service as ‘requires improvement’. At this inspection we found that the provider had made improvements and the service is now ‘good.’

Brunswick House is a ‘care home’ which provides support for people who are living with learning disability, autism or mental health conditions. 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.

The home accommodates a maximum of five people in one adapted building. There were three people living in the home at the time of inspection.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

People were cared for by staff who were trained in recognising and how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People were encouraged and supported to take positive risks and incidents and accidents were monitored carefully to ensure action could be taken to reduce the risk of re-occurrence.

People received their medication at the right time and there was sufficient staff on duty to keep people safe and to meet their needs in a personalised way.

Staff had access to specialist training which helped them support people in a confident and relaxed manner. People’s needs had been thoroughly assessed and were understood well by the staff team.

Staff were warm and caring in their work and people enjoyed their relationships with staff. People had opportunities to develop their independence and confidence through daily tasks and activities.

Staff organised themselves in a way that put people’s needs first and people and their relatives were supported to be involved in reviews of care and support.

Staff worked hard to help people maintain and improve relationships with their families.

The registered manager has developed a person centred culture where people’s needs are a priority and staff are supported to improve their practice. The provider has maintained a good oversight of the home and processes are effective in identifying areas for improvement and ensuring action is taken.

The inspection took place on 28 October 2016 and was unannounced. Our last inspection of the service took place on 1 December 2015 and the provider was rated as Requires Improvement.

Brunswick House is registered to provide accommodation and personal care to a maximum of five people who may have learning disabilities or mental health needs. At the time of the inspection there were three people living at the home.

There was no 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. A new manager had been recruited and was in the process of applying to register as a manager. This manager was present throughout the inspection.

People were supported by sufficient numbers of staff who had undergone recruitment checks to ensure they were safe to work. Staff understood how to report concerns on abuse and manage risks to keep people safe. Medications were given in a safe way.

Staff did not always have access to training and supervision to support them in their role. Staff understood the importance of seeking consent in line with Mental Capacity Act 2005 but did not always understand how to support people who had Deprivation of Liberty Safeguards in place. People were supported to have enough to eat and drink and had been supported to access healthcare support when required.

People were supported by staff who were kind and treated people with dignity. People were supported to be involved in their care and maintain relationships with people important to them. People had support from advocacy services where required.

People were involved in the planning and review of the care. People felt supported by staff who knew them well and were given opportunity to take part in activities that were meaningful to them. People knew how to make a complaint if needed.

Staff felt supported by their manager but felt that more frequent supervisions were required to discuss their work. Incidents that should be reported to us and the local authority safeguarding team had not always been reported. Audits were completed but these were not done consistently. People were given opportunity to feedback on their experience of the service and felt able to approach the manager with any issues.

Our inspection was unannounced and took place on 1 December 2015.

The provider is registered to accommodate and deliver personal care to five people who lived with a learning disability or associated need. Four people lived at the home at the time of our inspection.

The manager was registered with us as is required by law. 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.

Medicines were given to people as they had been prescribed. However, medicine records did not always confirm how many tablets should be available or where prescribed cream should be applied.

Staff knew the procedures they should follow to ensure the risk of harm and/or abuse was reduced. However, the systems in place to manage people’s money did not always ensure that their money was being properly safeguarded.

Staff had received or were to receive the training they required to fully equip them with the skills they needed to support the people in their care.

Staff were available to meet people’s individual needs. Staff received induction and the day to day support they needed to ensure they met people’s needs and kept them safe.

Recruitment processes ensured that unsuitable staff were not employed. People felt that they were supported by an adequate number of staff who were kind and caring.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

People felt that they were offered and enabled to engage in educational and recreational activities that met their preferred needs.

Systems were in place for people and their relatives to raise their concerns or complaints.

People, relatives and staff felt that the quality of service was good. The management of the service was stable. However, the registered manager and provider had not undertaken regular audits to determine shortfalls or see if changes or improvements were needed.

Three Deprivation of Liberty Safeguards (DoLS) approvals had been made but the provider had not notified us of this. This meant that the provider was not meeting legal requirements. Providers have a legal responsibility to inform us of all DoLS approvals.

The inspection was completed by a single adult social care inspector. On the day of the inspection the service was provided to two people. As part of this inspection we spoke with two people who used the service. We spoke with a person who was considering moving to the home. We spoke with their relatives. We spoke with the new manager who told us they were completing the necessary paperwork to apply to CQC to become the registered manager. We spoke with two members of staff and looked at three care records. We also reviewed records relating to the management of the home. We observed staff interact with people.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Care plans had been developed and were in the process of being rewritten. This was to improve the way to ensure they were person centred and reflected people’s needs. The care plans were reviewed regularly. Care plans were not always reflective of people’s needs. However, staff demonstrated a good understanding of people’s needs and risks. People were given choices and supported to make decisions themselves.

Care plans identified where risk assessments were required, however, we were not able to see some of the risk assessments as they had not been completed. After the inspection the manager told us that immediate action had been taken to ensure all risk assessments and new care style plans were in place. They assured us that these were now reflected people’s needs. This meant that staff had access to information to meet people’s needs and keep them safe. People we spoke with told us they felt safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Documented procedures were in place for The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made. The manager agreed to speak with the relevant supervisory bodies to ensure the home was meeting updated guidance related to the Deprivation of Liberty Safeguards. The manager also told us that DoLS was considered prior to people moving to the home. This meant that systems were in place to safeguard people as required.

Staff had received training in The Mental Capacity Act 2005 and demonstrated a good understanding of this. We saw some mental capacity assessments and any subsequent best interest decisions that had been made. The manager told us that a consultant who worked for the provider would be reviewing and completing new capacity assessments where required. Records identified people’s ability to make their own decisions. This meant that systems were in place to safeguard people as required.

Staff had been trained in safeguarding vulnerable adults. They were aware of the types of abuse and what action to take if they suspected abuse was taking place. Staff were also aware of whistleblowing procedures. This meant that systems were in place to safeguard people.

People were protected from the risks of inadequate nutrition and dehydration. We saw that weekly menus were in place. These gave people choices of healthy balanced diets. People could access drinks if they choose. Assessments identified any special dietary needs such as diabetic diets. We saw that people’s weight was regularly monitored. This allowed staff to take any necessary action in relation to people’s health and diet.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care and support that met their needs. People told us how they were supported. The manager told us they worked with external and internal professionals such as psychologists and psychiatrists. This was to ensure people’s health and social care needs were met. People we spoke with confirmed they were involved in decisions about their care. This meant that people received care in the way they wanted.

A new audit had been developed for checking clinical records. We saw that audits that had lapsed had now been restarted. For example we saw evidence of audits in relation to infection control, environmental checks and medication audits. The manager had not conducted a clinical file audit as they were already aware of the issues related to care plans and risk assessments. We saw evidence that they were taking action to ensure that improvements were made. This meant the service was aware of actions they needed to take to continually improve.

Is the service caring?

People were supported by kind and attentive staff. Staff we spoke with told us how they supported people. People confirmed staff were caring. We saw that staff were polite, respectful and considerate towards people. They demonstrated patience and reassured and encouraged people. One person said, “It’s alright here, the staff are alright.” We observed staff communicate with a person who was viewing the home with their relatives. Staff were welcoming and involved them in discussions.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. Staff told us that if people wished to attend a place of worship they would support them with this. This meant people’s diversity and individuality were promoted and respected.

Is the service responsive?

We saw records that showed the service responded quickly to meet people’s needs and ensured people’s safety and dignity was maintained. For example, referrals had been made to professionals where specialist input was required. People confirmed that they were given choices and encouraged to express their views.

The complaints process was available on a communal notice board. One person said, “If I have a complaint I tell them and they write it in the book.” The manager told us that no complaints had been received since the last inspection.

Is the service well-led?

The manager told us they would be completing the necessary paperwork to become the registered manager. We saw that the new manager had been responsible for a number of recent improvements to the service. The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff told us they now felt supported in their roles and felt their views were listened to. Staff told us they were happy to be involved in the new changes.

The service had a quality assurance system. A number of audits had recently been re-commenced following a period where they had not been completed. The manager showed us information that they had to report to the provider each week. This was then analysed and any action agreed. This meant the quality of the service was continually improving.

There were five people living in the home on the day of our inspection. We spoke with four people who lived at the home, the manager, director and four members of staff about the service provided.

People who lived at the home had complex support needs, with some behaviour that challenged. We saw that staff knocked on doors to respect people's privacy and spoke with people in a respectful way. One person told us,” Staff always knock when they come to my room. They speak to me kindly.”

Staff involved people in decisions about their care. However, the signage, activity and menu planners in communal areas did not meet the needs of all of the people who lived there and did not respect people’s individuality.

All people spoken with told us they took part in various activities of their choice. One person told us,” I go to college. I cook for myself.” Another person told us, “I do things I like. I go bowling and shopping.”

Reviews of care plans and risk assessments to meet people's individual needs and reduce risks were not always carried out.

Staff were trained and supported in their role. They had the information needed if they had any concerns or there was an allegation of abuse. Safeguarding information was not available to all of the people who lived here.

Systems to audit the safety and quality of the care and ensure that people received care that met their needs were not robust. One person told us, “I knew how to complain at the other home but not here.”