Brook House provides accommodation, nursing and personal care to up to 32 older people, many of whom are living with dementia and healthcare needs which require nursing care. At the time of our inspection 28 people were using the service.

At our last inspection in March 2016 we rated the service “Good”. At this inspection we found the evidence continued to support the rating of “Good” and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm. There were assessments in place, which identified support needs and how care was to be delivered. People were protected by staff who knew how to recognise if a person was experiencing or at risk of abuse. Staff recruitment procedures ensured that people received care from staff who were safe to work with people. There were sufficient numbers of staff to meet people’s care needs, including supporting people to take their medicines as prescribed.

People's needs had been assessed and there were care plans in place to ensure they received safe and effective care. Staff received induction and on-going training which meant they were able to meet people's specific care needs, including support to receive specialist health care services. People were supported to eat and drink enough to meet their needs. There were policies and procedures to ensure people had maximum choice and control of their lives and that they were not restricted unnecessarily.

People were supported to maintain relationships that were important to them. This enabled people to develop meaningful relationships with the other people and staff at the service. People were involved in making decisions about matters important to them. They were encouraged to express their views as much as they could. We observed people being treated with privacy, dignity and respect.

The service was responsive to people's needs and staff listened to what people had to say. Staff responded to people promptly and respected people's individual wishes and choices. The service supported people to communicate their needs and understood information that was given to them by providing this in a way they could understand.

People and their relatives were confident that any concerns or complaints they raised would be dealt with. The service was well-run and had received compliments from people and their relatives. The registered manger and the rest of senior management were aware of their regulatory responsibilities. The service monitored the quality of care people received and acted to improve how people were supported.

We undertook an unannounced inspection on 22 March 2016. At our previous inspection on 22 July 2014 the service was meeting the regulations inspected.

Brook House provides accommodation, nursing and personal care to up to 32 older people, some of whom are living with dementia. At the time of our inspection 32 people were using the service.

The service had 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. The registered manager was also the registered manager for another of the provider’s services. Whilst the registered manager was at their other service the head of care and other senior members of staff undertook the day to day management of the service.

People received the support they required from staff to have their health and social care needs met. Staff were knowledgeable about the people they supported. This included their preferences, routines and their support needs. Staff provided people with the support they required in line with their care plans. Staff regularly discussed people’s needs to identify if the level of support they required changed, and care plans were updated accordingly.

Staff were knowledgeable about signs and symptoms that a person’s health may be deteriorating and liaised with healthcare professionals as required to meet those needs. Staff were aware of the support people required with their nutritional needs and in regards to risks to their safety. Risk management plans were developed and we observed people being supported in line with these plans to maintain their health and safety. People received their medicines as prescribed and safe medicines management processes were followed.

Staff ensured people were engaged and a range of activities were provided at the service. This included implementation of programmes to keep older people active and providing people with dementia with sensory stimulation.

Staff had built caring and friendly relationships with people. People were aware of who the staff were and we observed people and staff engaging in friendly conversations. There were sufficient staff to meet people’s needs, and staffing levels were flexible to provide people with the support they required. People told us there were always staff around and if they needed any assistance a staff member came to support them promptly. We observed staff spending time with people in communal areas as well as engaging with people in their rooms.

People were involved in decisions about their care and staff offered people choices about daily activities. Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. People were supported to make decisions about end of life care and how they would like to be supported during that time.

Staff received the training their required to ensure they had the knowledge and skills to undertake their role. Systems were in place to ensure staff remained up to date with the training considered mandatory for their role. Staff were supported by their line manager and received regular supervision and annual appraisals.

The registered manager and the management team monitored the quality of service delivery. A range of weekly and monthly audits were undertaken, and information was gathered about key aspects of service delivery. Where it was identified that improvements were required these were undertaken promptly.

There were open and honest conversations amongst the staff about service delivery. Staff were invited to express their views and opinions, and these were used when l

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

When we visited Brook House there were 31 people using the service. We spoke with four of the people using the service, five relatives, the registered manager and five other members of the staff team. We reviewed four people's care plans and five staff files.

Was the service safe?

People told us that they felt safe living at Brook House. One person said, “Oh yes, it’s really safe here, the team approach makes it like a home from home”. People said if they had any concerns then they would speak to staff or the manager. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. There were mechanisms in place to help to safeguard people from the risks of abuse. People were treated with respect and dignity by the staff.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This has helped to ensure that people’s needs were met.

The manager set the staff rotas. They took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This had helped to ensure that people’s needs were met.

Staff recruitment procedures were robust to ensure that only suitable people were employed.

Is the service caring?

People were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting people. The people we talked to said the staff treated them well and respected their wishes, dignity and privacy. Relatives of people living in the home were very positive about the care given to people. We observed that staff knocked on doors before entering people’s rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Is the service responsive?

The way in which care should be provided was set out clearly in care plans and we saw that care was delivered in line with this. Relatives of people who use the services told us that if a person’s needs changed, their care and support was tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service effective?

People were protected from the risks of inadequate nutrition and hydration. Also, people told us that they liked the food they were provided with and we saw that it met their cultural needs. People's needs were regularly assessed. Care plans were "person-centred" focusing on people's individual needs. We found that care was delivered in line with these care plans.

People’s health and care needs were assessed together with them, and they were involved in their care and support planning. All the risk assessments and care plans that we saw had been signed by people indicating their agreement with what was written down. People told us that they had been involved in their care and support plans and that the plans reflected their needs. One person said, “Staff explained to me what was in my care plan after an earlier discussion with me and my daughter about what I needed”. We inspected four people’s care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments.

Is the service well-led?

Systems were in place to effectively assess and manage risks in relation to people's health, safety and welfare. 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 were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We received anonymous information alleging that staff were being employed without the required checks. We spoke with two members of staff and the manager and checked staff recruitment files during this unannounced inspection.

The home was registered in February 2013 and many staff were newly recruited or transferred from other homes operated by the provider. Staff said they had the checks required. We saw the recruitment process included the required checks being completed before new staff started work.

We spoke with four people who use the service, six visitors, three members of staff and the registered manager during this unannounced inspection.

People told us that staff gave them the help and support they needed and described staff as "kind", "caring", "responsive" and "wonderful". They said that the home was kept clean and that they had all they needed in their room. Comments about the food included "the food is good", "we get enough to eat" and "always plenty".

Relatives said they had visited and decided that the home was the right place and said that the care and support provided met their expectations. They said there were enough staff who were responsive to people's needs and that communication was good because they were kept informed and updated about any changes. People made positive comments about the environment and said it was kept clean. Visitors said that they were made to feel welcome and offered drinks.

Staff said that they had the required checks before they started work and completed an induction that gave them the information they needed to do their job. Staff told us that one of the things they did well was provided good care and support to people who use the service.

We saw some good interactions between staff and people who use the service with staff clearly knowing people and how to meet their needs. Although the home was newly built we found some communal areas were very warm during our visit.