Brookside is a care home based in Melksham in Wiltshire. The provider is an Orders of St. John Care Trust home and is registered to provide care for up to 50 people.

At the time of our inspection there were 48 people living at the home. Accommodation was arranged over two floors. Brookside care home has 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. The service was last inspected in March 2014 and was found to be compliant. This was the first rated inspection.

The service excelled in encouraging and enabling people to voice their opinion about how the home was run. People were at the forefront in making decisions such as, the building of a sun lounge, the choice of having a juice dispensing system, how the home would be decorated and the selection of furniture for the lounge and the new sun lounge. People made friends and staff understood the importance of enabling and supporting friendships and relationships that people may form.

The culture in the home was one of care and compassion for each person and small examples such people decorating stones for the rockery demonstrated how the service valued each person. Staff were proactive in putting forward ideas on how they could better support people, such as putting a toaster on the tea trolley to encourage people to eat more. Staff worked together with people to improve their emotional wellbeing through the use of life story books and there were many positive outcomes for people particularly those living with dementia.

People told us they felt safe living at Brookside. Medicines were managed safely and people received their medicines on time and in a place of their choosing.

Staff had received appropriate mandatory and specific training in order to meet the changing needs of people. Staff told us they felt well supported by the management team. They received support and on-going development through reviews and an annual appraisal with their line manager.

There was a policy and procedure in place in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The MCA is a law about making decisions on what to do when people cannot make some decisions for themselves. The Deprivation of Liberty Safeguards (DoLS) are part of the Act. They aim to make sure that people in care homes, are looked after in a way that does not inappropriately restrict or deprive them of their freedom. The policy and procedure in place were being implemented effectively and consistently within the service.

People had sufficient to eat and drink and the food choices on offer were varied and nutritious. People told us the food was “really good” and ”excellent” and they felt they had a good diet. People took an active role in making decisions about the menu choice on offer.

A range of activities over five days a week were available which people were free to take part in if they wished. The service was soon to implement an activity programme over seven days a week because of the uptake of the activities so far on offer. People told us they enjoyed taking part in different events and social events which the home provided.

Before people moved into Brookside an assessment of their needs was undertaken. Care plans had been completed which explained how people wished to be supported and care needs were monitored and reviewed to ensure the support given continued to meet people’s needs.

The registered manager and the staff team strove constantly to improve the quality of the service people received by ensuring people were at the forefront of making decisions which affected them. The local mayor praised the home for the way it interacted with th

At our last visit we saw some equipment was damaged which may have increased infection control risks. We saw the provider did not have adequate systems in place for the use of specialist cleaning equipment and products to maintain cleanliness and hygiene or prevent the spread of infection.

At this visit we saw equipment was well maintained. The systems in place for the use of specialist cleaning equipment had been reviewed and the home had sufficient systems in place to stop the spread of infection.

During our visit we spoke with people who used the service about the standard of cleanliness in the home. One person said “the home is always clean and tidy.” Some people had complex needs which made it difficult for some to tell us about their experiences but we saw they were cared for in a hygienic environment.

During our visit we were able to meet and talk with people living at the home. Some people had complex needs which made it difficult for some to tell us about their experiences. One person said “staff are respectful of me and my wishes.” We spoke with one relative and staff. We made observations of how care was provided to people and looked at records. The staff we spoke with showed they had detailed knowledge of the people they were caring for. We saw people were spoken to by staff in an appropriate, friendly and kind manner.

We saw some equipment was damaged which may have increased infection control risks. We saw the provider did not have adequate systems in place for the use of specialist cleaning equipment and products to maintain cleanliness and hygiene or prevent the spread of infection.

We looked at records which showed the provider followed a recruitment and selection processes for the employment of new staff. The people we met spoke positively about staff. One person told us “staff treat me very well and do things the way I like.” Another person said “staff are excellent and very kind.”

We looked at how care needs were being monitored and evaluated for people. The provider had an audit system to monitor the homes quality and care standards. We observed a lack of information some areas. This meant it was not possible to show how some information had been analysed and evaluated or how service improvement plans had been developed.

During our inspection, we met with fourteen people who used the service, one external healthcare professional and fourteen members of staff, including the chef and managers, as well as care workers.

People said they liked living in the home. One person told us “I do just what I want to do here”. Another person told us, “they look after us so well”. People said they liked the meals. One person told us there was “lots of choice about meals”. People said staff supported them when they needed. One person told us “I ring my bell and they come”. A person described the home as “wonderful”.

We observed the provider had taken action to make improvements in a wide range of areas. This included ensuring improvements were made in assessments and care plans for people. The home now had clear systems to make sure their own infection control policies were followed. Systems for staff training had improved; a care worker told us there was “lots of training here”. The provider had taken action to ensure people had the equipment they needed. The quality of care was monitored regularly and included listening to a range of different people about the services provided.

People told us they liked living in the home. One person said “you couldn’t find any fault if you tried” and another “I wouldn’t want to move, I’ve lived here for a long, long time”. Visitors said how supportive staff were. One relative told us “any problem, they get on the phone immediately”. We observed care workers were uniformly polite and helpful to the people they were caring for. Visitors told us they thought that the staff were dedicated, hardworking and caring.

Although some people were very positive, other people told us the home did not meet their needs in a range of areas. They said the reason largely related to a need for more staff. One person told us “it has deteriorated here, there is a lack of staff”. We observed some people’s privacy and dignity was not up-held as staff were not always available to care for them when needed. Care was not consistently assessed, planned and delivered in the way people needed. While people who went to the dining room received their meals promptly and were fully supported, this was not the case for people who remained in their own rooms. Staff were not fully trained to meet people's needs and in some instances sufficient suitable equipment to meet peoples care needs was not provided. Procedures were not being followed to make sure the risk of the spread of infection was prevented.

We spoke to a number of people who lived at the home but they had limited capacity to provide meaningful feedback about the service. However we spent some time observing them and the staff providing care and support to them. They were clean and well presented and appeared to be content and relaxed in the company of staff that they were familiar with. Staff were gentle, warm and attentive, friendly and informal, but at all times polite.

We spoke to two relatives. They told us that they had some concerns about their relatives’ care. They told us “There are lots of very good staff but care is not consistent. We constantly have to remind them to do the most basic tasks. When we visit we have to brush her hair and clean her nails. Sometimes when we visit she has been given a drink but it is out of her reach or in a china cup which she cannot manage".

Another relative, who visited the home frequently said they regularly undertook tasks to support their relative because the staff had not had time. They said they were concerned that their relative was not receiving adequate food and drink and had been losing weight. They acknowledged that there was nutritional care plan in place to ensure that their relative was supported and encouraged to eat and drink but they were not confident that this was always followed. They told us they did not trust the records as they believed they had been falsified in the past. They told us that they had reported their concerns to the home’s manager on numerous occasions. They felt that the manager listened to their concerns and put measures in place to address them but “things keep slipping back because some staff do not follow instructions and they are not adequately supervised”. One relative said that the manager was never seen “on the floor” of the home and “spends all of her time in the office”.