We inspected Little Brocklesby House on 15 and 16 November 2016. This was an unannounced inspection. The service provides care and support for up to 36 people. When we undertook our inspection there were 23 people living at the home.

People living at the home were mainly older people. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some living with dementia.

There was not 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. A new manager had just been appointed.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect them. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service, but that this would need constant reviewing as people's needs changed. The provider was taking into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed and care planned and delivered in a consistent way. People and relatives were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear but staff did not at times keep some records up to date. Risks associated with people’s care needs were assessed and the plans were followed by staff.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information. Activities were on offer for people to take part in, which some people declined, but others enjoyed.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements. However, some checks were not robust enough, such as those for fire safety and senior staff did not highlight mistakes to staff to ensure people were safe.

We carried out an unannounced comprehensive inspection on 9 June 2015. Two breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

At the last inspection on 9 June 2015 we found that the provider was not meeting the standards of care we expect in relation to record keeping for administration and receipt of medicines. Also there was no system in place to test the quality of the service being provided.

We undertook this focused inspection on 7 January 2015 to check that they had followed their plan and to confirm they now met the legal requirements. During this inspection on the 7 January 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relations to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Little Brockelsby House on our website at www.cqc.org.uk.

Little Brockelsby House provides care for older people who require personal care. It provides accommodation for up to 36 people. At the time of the inspection there were 25 people living at the home.

At the time of the inspection there was not 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.

On the day of our inspection we found record keeping for the administration and receipt of medicines had improved. A new medicines auditing system was in place to ensure staff were administering medicines safely. Systems were now in place to test the quality of services being offered. Results were fed back to people who used the service, visitors and staff. Any actions to be taken forward were recorded and signed when completed.

We inspected Little Brockelsby House on 09 June 2015. This was an unannounced inspection. Our last inspection took place on 02 June 2014. The service provides care and support for up to 36 people. When we undertook our inspection there were 26 people living at the home.

People living at the home were mainly older people. Some people required more assistance either because of physical illnesses or because they were suffering from memory loss.

There was no registered manager in post. The service had been without a registered manager for two and a half months. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. There was no one subject to such a restriction.

Medicines were stored in an unclean environment with poor stock control. Record keeping for the receipt of medicines and administration was poor.

Current records were stored in a secure environment, but archived records were stored in a damp environment. They were in insecure boxes, many of which were not labelled. People who did not need to know what was in those records had access to this area.

People had been consulted about the development of the home, but no quality checks had been completed to see whether the quality of the service was acceptable. Lessons learnt from any events had not been passed on to staff to improve their practice.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to poor medicines administration and storage of medicines, poor storage of records and testing the quality of the services provided. You can see what action we told the provider to take at the back of the full report

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care but had not signed their care plans. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. Staff did not always record the dietary intake of people who required to have their weight monitored.

During our inspection visit we spoke with six people who received a service and with two relatives by telephone. We spoke with the manager, deputy manager and three care staff. We also looked at three care records, three staff files and a variety of documents related to the running of the service.

People we spoke with told us they liked living at the service and received good quality care. One person said, “The staff are kind and helpful.” Another said, “My rooms kept lovely.”

One relative told us, “I can’t praise them enough.” Another said, “My (relative) tells me they are happy with the care” and, “Calls the staff angels.”

People told us they felt safe and knew how to complain. One person said, “If I have any problems I go to staff and they will correct them for me.” One relative told us, “I feel I could discuss any problems with team leaders or the manager.” Another said, “I know I can trust the staff (which) gives me peace of mind.”

We saw from records and observations staff encouraged and supported people to make choices about the care they needed and how it was delivered. We noted people’s agreement to care and treatment was sought and important decisions relating to care and treatment were made with this in mind.

We found peoples care was effectively planned and safely delivered. The management and administration of medicines met required standards and care was provided by staff with the right skills and training to do the job.

We saw there were systems in place to monitor and review the safety and effectiveness of the service and care home environment. We noted however that in some key areas identified actions to ensure and improve service quality were insufficient or were not followed through.

At our last visit in September 2012 we identified a concern about record keeping which we asked the provider to address. In particular we saw a system for reviewing people's needs had been put in place during May and June 2012 but had not been continued.

At this visit we saw systems had been introduced to review and evaluate care plans and risk assesments on a monthly basis. We saw monthly recording of people's weights, fluid intake and skin integrity now took place.

People told us the home was clean, warm and safe. We spoke with eight people who lived in the home. One person said, "This home is lovely, the staff are nice, the food is good and it's secure." Another person said, "I think it's safe and warm here."

Members of staff had time to interact with the residents and activities were provided throughout the day by an activities coordinator. One resident said, "There's always something to do here and we go out on trips to the village quite often in the summer."

A visitor we spoke with said, "The staff always seem to be cheerful and joking with the residents. They're also very caring when they talk to them. The food is lovely and XXX is always talking about it. The rooms are very large and comfortable. The home is really clean."

When we visited the home we saw that there was a calm and homely atmosphere. We were able to speak with five people, two relatives, two members of care staff and the manager and her deputy.

People told us they were encouraged to remain as independent as possible and were able to make choices about things in their lives. Care staff treated people in a respectful way but we saw there were no locks on a lot of the toilet and bathroom doors and some people did not like this.

People said they enjoyed living in the home and were able to have a doctor or nurse visit them when they needed it. A relative told us they thought the home was good and that staff treated the people living there very well.

People living in the home told us they felt safe and they would tell the manager if they did not. Staff told us what safeguarding vulnerable adults meant to them and a relative told us they always saw staff treating people in a kind way.

Staff understood the care needs of people living in the home very well and had received the appropriate training. They felt supported by the manager but supervision sessions were not always documented.

People in the home and their relatives told us they were asked about their opinions of the home but the regular monitoring of the quality of care was not robust and records kept in the home were not always as comprehensive as they should have been.

Our inspection team on this occasion was made up of one inspector. We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the visit, speaking with people who use the service, their relatives, the staff supporting them and from looking at records. We also spoke with health and social care professionals during and after the visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk of injury.

The registered manager ensured staff were supervised and were trained to do their job.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People told us they could express their views at group meetings, meetings on a one to one basis and by completing surveys.

Relatives told us they were included in some aspects of running the home and felt their opinions were valued.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "Staff are brilliant here" and "Staff take time to understand my needs."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.