Our comprehensive inspection of Northbrook Care Home took place on 23 November 2017 and was unannounced. At our last comprehensive inspection on 8 September 2015 we rated the home as requiring improvement in the areas of Safe and Responsive. We returned to the home on 30 January 2017 to review actions taken in relation to this. At this focused inspection we found that the provider had addressed the failures and was subsequently rated good in all areas.

Northbrook Care Home is a care home providing accommodation and personal care for up to four people with learning disabilities and mental health support needs. At the time of our inspection three people were living at the home.

The home has a 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.

Staff members had received training in safeguarding of adults, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the service were well managed. People’s medicines were managed and given to them appropriately and records of medicines were well maintained.

We saw that staff at the service supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the needs of the people using the service.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Information about capacity was included in people’s care plans. Staff members had received training in MCA. Deprivation of Liberty Safeguard authorisations had been applied for and received where people had been identified as being unable to make decisions.

Staff who worked at the service received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager and those whom we spoke with told us that they felt well supported.

We saw that the meals provided to people were healthy and varied. Alternatives were offered where people chose to eat other foods, and drinks and snacks were available to people throughout the day.

Care plans and risk assessments were person centred and provided detailed guidance for staff around meeting people’s needs. Picture assisted easy read versions had been developed for people.

The service provided a range of activities for people to participate in throughout the week. People were supported to take holidays away from the home. Staff members supported people to participate in activities of their choice. People’s cultural, religious and social needs were supported by the service and detailed information about these was contained in people’s care plans.

The service had a complaints procedure that was provided in an easy read format. People told us that they would tell the manager or staff member if they were unhappy about anything.

Regular quality assurance checks took place. Where actions were identified as a result of these they were quickly addressed.

People’s health needs were regularly reviewed. The service liaised with health professionals to ensure that people received the support that they needed.

At the last inspection on 8 September 2015 we found a breach of regulation and some areas which required improvement. Following the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to safe management of medicines and what actions they would take regarding the ineffectiveness of the central heating system, lack of activities for people and the inaccessibility of the premises to people with mobility needs.

We undertook this focused inspection to check that they had met legal requirements and to confirm that they now followed their action plan and made improvement to the service. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Northbrook Care Home on our website at www.cqc.org.uk.

Northbrook Care Home is a small home providing accommodation and personal care for up to four people with learning disabilities and mental health support needs. At the time of our inspection, four people were using the service. Each person using the service had their own room with a hand wash basin, toilet and a shower and shared a lounge. The service did not have a registered manager in place at the time of this inspection because the previous registered manager had left the service and was deregistered. The provider had employed a new manager who was yet to apply to register with the Care Quality Commission.

A registered manager is a person who has registered with the 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 told us staff administered their medicines. We found that medicines were administered and recorded by staff as prescribed by healthcare professionals. Staff signed Medicine Administration Record Sheets (MARS) to confirm that the medicines were administered. We noted there were protocols for managing medicines and it was evident that medicines were audited. This ensured that errors in medicine administration were identified and appropriate action taken.

A mobile ramp was provided to enable people with mobility needs to access the back garden. The provider confirmed that risk assessments would be completed by an occupational therapist to ensure people could use the mobile ramp safely. We saw that activities were planned and provided to people. Care files showed people's needs were reviewed with their involvement and staff provided personalised care that reflected the needs and preferences of people.

This unannounced inspection took place on 8 September 2015. At our last inspection on 12 June 2014 we found the provider did not meet required standards for care and welfare of people who use services, and requirements relating to workers. During this inspection we found that improvements had been made in each of these areas and the service now met the required standards.

Northbrook Care Home is a small home providing accommodation and personal care for up to four people with learning disabilities and mental health support needs. At the time of our inspection four people were using the service at the home. Each person who lived at Northbrook Care Home had their own room but shared a bathroom and a lounge. The premises were not fully accessible to people with mobility needs and we have made a recommendation about this.

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.

We found that people’s medicines were not managed appropriately. Some of the medicines kept at the home did not match the records and the protocols for medicines when required were not up-to-date. The central heating system was not always working as it should and this put people’s safety at risk. These issues are a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and you can see what action we have told the provider to take at the back of this report.

Relatives told us that there were enough staff at the home. We found that the home had a good staff recruitment system in place which meant that people were supported by staff who were checked appropriately. We noted that staff had attended various training programmes related to their roles and that they had regular supervision sessions with their managers. However, we observed that some staff were not using language appropriate to people’s age which could mean they were not always treating people with respect and dignity.

Staff sought consent from people, in line with the requirements of the Mental Capacity Act 2005 (MCA), before providing care and support. The MCA is a law designed to protect and empower people who may lack the mental capacity to make their own decisions about their care. We noted that MCA had been completed and Deprivation of Liberty Safeguards (DoLS) authorisation had been obtained for three people. The DoLS are legal safeguards that ensure people’s liberty is only deprived when absolutely necessary for their own safety.

People and relatives were satisfied with the food provided by the service. They told us they could choose what to eat and when to eat. They told us the service provided fresh food and one person told us they were involved in food shopping.

Each person had a care plan which was based on their assessment of needs. We noted people’s relatives and representatives were involved in the review of care plans and that the care plans were reviewed regularly.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

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.

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

This is a summary of what we found:

Is the service safe?

People were put at risk because some care workers were not appropriately checked if they were suitable to work with people who used the service. Safeguarding procedures were in place and staff had been provided with safeguarding training. We observed the way staff communicated with the people using the service and saw they treated people with respect and dignity.

Is the service effective?

The care plan review system was not effective because there was no evidence that people who used the service or their representatives were involved. Also risk assessments were not effective as potential risks to people were not always identified and included in the risk assessments. Staff knew people’s likes and dislikes and were able to meet their needs.

Is the service caring?

Staff were caring and attentive to people’s needs. People received individualised care and support. The service had a key working arrangement which meant each person who used the service had a named care worker who was responsible for and ensuring of meeting their needs.

Is the service responsive?

Arrangements were made for people to attend medical appointments and social activities. The provider worked with healthcare professionals, for example, General Practitioners, to ensure people’s medical needs were met.

Is the service well-led?

The home had a registered manager and a deputy manager. Regular staff supervision and staff meetings took place to ensure that staff had up-to-date information about the policies and procedures of the home. There was a medication auditing system and other regular health and safety checks which would assist the manager to identify and address risks.

People who used the service understood the care and treatment choices available to them. They were able to make their preferences, likes and dislikes known through key worker sessions. Staff were able to communicate with people who had particular communication needs. People’s care and treatment was planned and delivered in a way that protected them from unlawful discrimination as the provider held best interest meetings and consulted specialist professionals to support people. The provider made regular checks on the service.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had been trained to support people in protecting themselves and knew what action to take to protect people. Staff held professional qualifications and were encouraged to take up training. They felt supported in their work.

We found that where possible people were involved in planning their care. People were involved in the community and they were supported to go out to groups and local shops and parks. We found that the provider had taken steps to ensure that the environment was safe.

There were sufficient staff to meet the needs of people who use the service. The management team monitored the quality of the service provided and had implemented changes to the delivery of care when required.

You can see our judgements on the front page of this report.

We carried out a full review of the service in March 2011. This included a visit on 11th March. During that visit we spoke to people who use the service about their care. The purpose of this second visit was to check that improvements had been made in relation to the areas listed above. The information that we needed to check mainly related to records kept by the provider. Therefore we did not discuss these with people who use the service. However we did speak to a person who had recently started to live at Northbrook. She said that she liked it there and was happy. During the visit we saw that people who use the service were treated with patience and respect.

We spoke to two of the three people using the service. One person was able to give us some feedback but the other was unable to do so due to the level of her learning disability. The third person chose not to leave her room and not to talk to us.

The person we spoke to said that she said that she liked her room, liked everything there and liked the staff.

A care manager told us that she never had any issues with the care provided by the service and that the service worked very well with people. There had been big improvements in the two people that had been living at Northbrook for a while and the newest person to use the service had settled well and her challenging behaviour had lessened. The care manager was about to place another person with the service.