This inspection took place on 10 and 11 April 2018 and the first day was unannounced.

At our last inspection in March 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a lack of clear guidance for the use of ‘as required’ medicines and staff did not always sign to state they had applied topical creams. Staff had not received refresher training and supervision meetings. The service did not have a robust quality assurance system in place to ensure they were meeting the requirements of the fundamental standards.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection we found improvements had been made in all three areas. However new breaches were identified with regard to risk assessments and care plans not being reviewed and updated during the transfer of the care plans to a new computerised system called PCS, which meant there was a continued breach in good governance. You can see what action we told the provider to take at the back of the full version of the report.

De Brook Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

De Brook can accommodate 52 people over three floors. At the time of our inspection 45 people were living at the home.

There was not a registered manager in post at the time of our inspection. A new manager had started working at De Brook the week before our inspection and had initiated the process to become the registered manager. 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.

De Brook was introducing a new computerised care planning system called PCS. However, at the time of our inspection, the vast majority of care plans and risk assessments continued to be paper files. The paper care plans and risk assessments had not been reviewed since January or February 2018. Some care plans had been updated where people’s needs were known to have changed; however others had not. This meant the care plans and risk assessments may not be reflective of people’s current needs.

Significant improvements had been made in the quality assurance systems used at the home. Audits and monitoring were now in place for falls, nutrition, medicines, pressure area care, infection control and staff training and supervisions. Actions taken after each incident, accident or audit were recorded and monitored to ensure they were completed. However it had been noted in managers meetings in December 2017 that the care plans and risk assessments needed to be reviewed and kept up to date during their transition to the PCS system and this had not been done.

People received their medicines as prescribed from trained staff, whose competencies in medicines management were observed annually. The temperatures of the clinic rooms and medicines fridge were not consistently recorded. We have made a recommendation that the medicines audit is reviewed so they cover all areas of the national guidance for the management of medicines in care homes.

Health and safety checks were made and equipment was serviced in line with national guidance and the manufacturer’s instructions. Water was sampled for Legionella’s disease; but a written Legionella’s risk assessment was not in place and boiler water temperatures were not checked. We have made a recommendation that the service consults the national Health and Safety Executive and D

This inspection took place on the 28 February and 1 March 2017 and was unannounced. The service was last inspected in August 2016 when it was rated as Requires Improvement.

De Brook Lodge is owned by Ideal Care Homes (Number One) Limited. The service is a purpose built care home that provides residential care for up to 52 people. All the bedrooms are single rooms with en-suite facilities. The home has three floors accessible by lift. Each floor has a lounge / dining area. At the time of our inspection there were 48 people living at the home.

The service had a new manager who had worked at De Brook for six weeks prior to our inspection. They were in the process of being registered with the Care Quality Commission. 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 new managers’ appointment the home had had a series of temporary managers after the previous registered manager left in November 2016.

We found the new manager was now completing a full system of audits to monitor and improve the home. Care plans were being re-written and new recording tools had been introduced.

The staff we spoke with were all positive about the new manager and the changes they had made.

We found a new medicines ordering policy had been agreed with the pharmacy and implemented. This should ensure the home does not run out of people’s prescribed medicines as had happened previously.

We found Medicine Administering Records (MARs) were fully completed for prescribed medicines. However there were gaps in the recording of topical creams and guidelines for when ‘as required’ medicines, for example pain relief, were to be administered.

All the people we spoke with said they felt safe living at De Brook and that the staff were kind, caring and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

There were sufficient staff on duty to meet people’s needs. Staff told us the new manager had addressed the high levels of sickness that the home previously had.

A safe system for recruiting new staff suitable for working with vulnerable people was used. A thorough induction process was in place, with training and staff shadowing experienced staff to get to know people and their needs. However refresher training was not up to date. The new manager was aware of this and was arranging for the refresher training to be completed. Staff had not received regular supervision meetings. The new manager had a plan in place for completing supervisions every two months with every staff member.

A handover was completed between each shift to inform incoming staff about any changes in people’s needs; for example due to illness. One diary had been introduced for the whole home to ensure items were not missed by having separate diaries on each floor.

Care plans and risk assessments were in place for each person. Two thirds had been re-written since the new manager had been appointed and they were written in a person centred way. The care plans included details of people’s needs and guidelines for staff in how to meet these needs. However we found two care plans that did not fully reflect people’s needs. Risk assessments identified risks to people’s health and well-being and how these were to be mitigated. Care plans were now being evaluated on a monthly basis.

The provider had introduced new capacity assessment forms, which were in the process of being completed with each person and their family where appropriate. These detailed whether the person had the capacity to consent to their care at the home. If they did not have capacity a Deprivation of Liberty Safeguards (DoLS) application was made. Staff did not

This inspection took place on the 3 and 4 August and was unannounced. The service was last inspected in February 2015 and was rated as ‘good’ in all areas.

De Brook Lodge is owned by Ideal Care Homes (Number One) Limited. The service is a purpose built care home that provides residential care for up to 52 people. All the bedrooms are single rooms with en-suite facilities. The home has three floors accessible by lift. Each floor has a lounge / dining area.

The service had 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.

All the people living at De Brook Lodge and their relatives told us they felt safe. They said the staff were kind and caring and knew their needs well. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the deputy managers and registered manager would act on any concerns raised.

There were enough staff rota’d to work to meet people’s needs. The registered manager acknowledged there had been some staff shortages due to long term staff sickness. Disciplinary action had been taken where staff had a poor attendance record. We saw the rota’s had the correct number of staff rota’d to work. The number of staff for each shift had recently been increased to meet people’s needs and staff recruitment was underway to fill any vacancies.

A system was in place to hand ensure staff had the information they needed to meet people’s needs. Staff were able to read a person’s care plan when they moved to the home and received a verbal handover of their needs. A staff handover was completed at the start if every shift. A seniors communication book was used and each person had daily notes completed. However during our inspection we found that staff returning from annual leave had not been given information about one person whose needs had changed whilst they had been off. The staff had not had time to read all the notes from when they had been off before starting to support people. In this instance this meant the person did not receive their drinks thickened as required. We have made a recommendation that the service use current good practice guidance for ensuring staff are provided with information about any changes in people’s needs following an extended period off work.

People told us they received the care they needed. Care records we reviewed showed that risks to people’s health and well-being had been identified and guidance was in place to help reduce or eliminate the risk. Care plans were written in a person centred way. The care records had been updated when people’s needs changed; however they had not been formally reviewed each month as per the homes policy due to senior care staff being on long term sick leave. People were supported to make advanced care plans for the end of their lives. The registered manager had implemented a plan to ensure all care plans were reviewed.

A robust system was in pace to recruit suitable staff. Staff completed mandatory training and received an induction when they started to work at the home. Some staff had not completed all their refresher training. Staff said they felt supported by the deputy managers and registered manager and could approach them at any time if they had a concern. Formal supervisions were held every three to six months. These had not been as frequent as planned due to the long term sickness of two senior carers. The registered manager was implementing a plan to ensure all supervisions were completed.

People received their oral medicines as prescribed. However topical cream charts did not contain the prescribing instructions. We found signatures were

This inspection was carried out on the 21 of February 2015 and was unannounced. This means we did not give the provider prior knowledge of our inspection.

We last inspected De Brook Lodge on the 5 July 2013 and identified no breaches in the regulation we looked at.

De Brook Lodge is a care home providing personal care and accommodation for up to 52 older people with dementia. The home is set within its own gardens and car parking is available at the home. It is located in Flixton and public transport routes into Manchester and surrounding areas are close by. De Brook Lodge is situated over three floors with lounges and dining areas on each floor. The first and second floor are accessed by a lift.

The home has a manager who is registered with the Care Quality Commission. 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.

During the inspection we saw people were supported to be as independent as possible. We observed staff responding to people with compassion and empathy and people were seen to be engaging with staff openly. Staff were knowledgeable of peoples’ assessed needs and delivered care in accordance with these.

We found the home was clean and there were quality assurance systems in place to ensure shortfalls in the service provided were identified and actioned to seek improvement.

People told us they liked the food provided at De Brook Lodge and we saw people were supported to eat and drink sufficient to meet their needs.

There were arrangements in place to ensure people received their medicines safely and staff were knowledgeable of these. We saw medicines were provided in a safe way.

We observed people engaging in activities and staff were respectful of people’s wishes.