This comprehensive inspection took place on 14 August 2018 and was unannounced. Brant Howe 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.

Brant Howe provides personal care and accommodation for up to 29 people. Accommodation is provided over three floors with a stair lift to access the second floor. There is a separate building in the grounds with two living spaces for people who prefer to have more independence. The home is situated in the market town of Kirkby Lonsdale.

There was 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. At Brant Howe the registered manager is also the registered provider.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and we found some characteristics of 'outstanding' evident. This was echoed by the consistent and very positive comments in the feedback we received from people who used the service, their relatives and the staff. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We found several examples that demonstrated the staff and management were passionate about providing an excellent service. A relative told us, “This is an excellent care home. The staff are brilliant and treat residents like they are one of their own family.”

There were sufficient numbers of suitably trained staff to meet people’s needs. Staff training was ongoing and staff had received a variety of training that enabled them to safely support and care for people. We observed a strong, family orientated service where staff were not afraid to display their affection. We were told by a relative, “There’s always plenty of staff around and it’s so touching observing them with residents. They [staff] pick up if a resident is feeling down or upset and comfort them accordingly.”

Staff were also supported and rewarded by the registered manager and deputy manager through regular staff meetings, supervision, appraisals and regular team outings.

We saw that the service worked with a variety of external agencies and health professionals to provide appropriate care and support to meet people’s physical and emotional health needs.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the service to protect people.

When employing fit and proper persons the recruitment process had included all of the required checks of suitability.

People’s rights were protected. The registered and deputy managers were knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

Hazards to people’s safety had been identified and managed. People were supported to access a wide variety of activities that were made available to them and pastimes of their choice.

People were treated with respect and their dignity and privacy were actively promoted by the staff supporting them.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the provision.

The registered provider had made some improvements to the environment for the people who lived there and this was ongoing. The building was being well maintained and was a clean and

This comprehensive inspection took place on 2 October 2015 and was unannounced. We last inspected Brant Howe in October 2013. At that inspection we found the service met all five of the essential standards we looked at.

Brant Howe is a residential care home that provides personal care and accommodation for up to 27 people. Accommodation is provided over two floors with a stair lift to access the upper floor. There is a separate building in the grounds with two living spaces for people who prefer to have more independence. The home is situated in the market town of Kirkby Lonsdale. Brant Howe is a large detached property set in its own grounds with seating areas for people to enjoy the gardens with some car parking space.

There was a registered manager in post who is also the registered provider. 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 living at the home were safe. Staff understood their responsibilities in safeguarding people. The service had a positive approach to risk. There were sufficient numbers of suitable staff to meet people’s needs and promote people’s safety. The recruitment procedures demonstrated that the provider operated a safe recruitment procedure to ensure that fit and proper persons had been employed.

Where safeguarding concerns or incidents had occurred these had been reported by the registered or deputy manager to the appropriate authorities and we saw records of the actions taken by the home to protect people.

People received their medications as they had been prescribed. Appropriate arrangements were in place in relation to the storage, care planning and records for the administration of medicines.

Staff had completed training that enabled them to deliver care and support people effectively. The staff team understood their obligations under the Mental Capacity Act 2005 (MCA). When decisions had been made about a person’s care where they lacked capacity, these had been made in the person’s best interests.

People’s individual preferences for food and drink were catered for this also included people’s specific health and dietary requirements. Staff gave excellent support to those who required extra help in eating and drinking.

Staff were responsive to people’s individual needs and people’s preferences and wishes. We saw caring relationships had been built between staff and people, and excellent support was provided for their family members. Staff were friendly and kind to people and treated them with respect. We observed a lot of laughter and friendly banter between the management, staff, visitors and people who lived at Brant Howe.

People were supported to maintain good health and appropriate referrals to healthcare professionals had been made. People had been supported during their end of life care to fulfil their wishes in the way in which they had identified. Health professionals and relatives told us they felt the home provided excellent care to the people who lived there.

There were meaningful and personalised activities made available to all people in the home and in the local community. People were encouraged and supported to pursue their individual hobbies and interests. People made excellent use of local community facilities as well as the resources in the home which engaged people with variety of activities such as flower arranging, poem reading, music for health and sensory activities.

There was a clear management structure in place and staff were very happy with the level of support they received. The management culture of the home was open, dedicated to providing excellent care to people, and equipping staff to provide excellent care. People and relatives were encouraged to inform the registered and deputy manager if they were not happy with any aspect of their care or service received.

The home was extremely well led and the managers acted as excellent roles models to the staff. Their person centred approach ensured people living at Brant Howe experienced a much individualised and high quality service that optimised expectations and outcomes during their life in the home.

During our inspection we observed that staff asked people for their consent before they carried out care, assistance or support. We also saw staff were patient and allowed people time to consider their options and respected their wishes.

People we spoke with told us they were "very happy" with the care provided in the home. They told us, "The staff are wonderful, they are very kind and nothing is too much trouble”.

We reviewed the recruitment records of the staff and found that they had been recruited using an effective procedure. This included all of the appropriate checks to ensure that the person being employed was of good character.

Records we looked at showed people were regularly asked on a one to one basis about any concerns or comments they may have.One person we spoke with told us about the suggestions made by a number of people living at Brant Howe had been acted upon.

People were given information in the service user's guide about what to do if they needed to make a complaint. People using the service that we spoke with told us they had no complaints and would be happy to raise their concerns directly with any member of staff.

We observed that people's privacy and dignity was upheld and staff sought their views to influence the care, treatment and support offered. People we spoke with told us they were happy with their care, treatment and the surroundings. One person said, “You cannot fault it here, I feel at home and the staff treat us very well.”

The home had created a friendly, open and welcoming atmosphere. We found that people were engaged in their surroundings and alert, frequently having conversation with each other and with staff. They told us they had been involved in making decisions about their care and said they were well supported. Relatives we spoke with were also positive about the service the home offered, saying comments such as, “My relative feels safe and well cared for and treated with respect." And another said, "Staff go the extra mile, we have been impressed with the care the whole staff team provide."

We found the home had staffing levels that allowed time for both the care and the social needs of people to be well met. There was a varied programme of group and individual activities. The staff team were experienced and well trained with a range of training that supported them to do their job.

In the last year the home had been updated with replacement double glazing windows and a new kitchen more suited to large scale catering.