Brimington Care Centre is a registered care home. People in care homes receive accommodation and personal care as a package of care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Brimington Care Centre accommodates up to 45 people.

The home provides accommodation over two floors and people have shared access to communal rooms and bathrooms. At the time of the inspection the home was fully occupied. Many of the people were living with dementia.

At our last inspection in June 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 on-going 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.

The inspection took place on 13 November 2018 and was unannounced.

People continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to and follow. All staff were clear about action they would take. Recruitment of staff was carried out to ensure that adequate numbers of suitable staff were available to support people. People received medicines as they were prescribed.

People continued to receive effective support from staff who had a sufficient level of skills and knowledge to meet their specific needs. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible, whilst involving them as much as possible to make decisions. The policies and systems in the home supported this practice.

People continued to be cared for by staff who displayed kindness and compassion in ways that upheld their privacy and dignity. Staff ensured that people were supported to make choices and maintain a good level of independence in line with their abilities and wishes. People’s diverse needs were recognised and support and access to activities was supported and enabled by staff.

The provider had effective systems in place that were used to regularly review people’s care and support that had been provided. Care plans and detailed assessments were individualised and contained a wealth of information about people, their needs and wishes.

People using the service were well known by staff and the staff team continued to work consistently to ensure that support provided respected their needs. People’s own communications methods were well known and understood by staff who were keen to advocate on behalf of people whenever they were unhappy, wanted to make preferences known, or wanted to raise an issue.

The care home continued to be well-led, with checks and monitoring arrangements used to maintain the quality of the service provided. Staff were positive about the leadership and skills of the registered manager and people using the service had a good relationship with the registered manager too. Further information is in the detailed findings below.

We inspected Brimington Care Centre on 9 February 2016. This was an unannounced inspection. The service was registered to provide accommodation and nursing care for up to 44 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 43 people living in the care home.

At our last inspection on 23 September 2014 the service was found to be non-compliant regarding consent to care and treatment and complaints and action was required. The provider subsequently submitted an action plan detailing how they proposed to address the identified shortfalls. On this inspection we found improvements had been made in these areas and no other concerns were raised.

A registered manager was in post and present on the day of the inspection. 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.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

People were kept safe because staff understood their responsibilities should they suspect abuse was taking place and knew how to report any concerns they had. Potential risks to people’s safety had been assessed and measures had been put in place to mitigate these risks. There were enough staff on duty to keep people safe and meet their needs. Accidents and incidents were monitored and analysed to reduce the likelihood of recurrence. There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

People’s medicines were managed safely, in accordance with current regulations and through guidance for staff, who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People received consistent care and support from an established staff team who knew and understood their needs. They were happy, comfortable and relaxed with staff and said they felt safe. They received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional staff training specific to the needs of the service. Staff received one-to-one supervision meetings with their manager.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were protected from risks associated with eating and drinking as their nutritional needs were assessed and any specific dietary requirements were managed effectively. Staff enabled people to make informed choices about what they ate and supported them to maintain a balanced diet. People were supported to maintain good health and to obtain treatment when they needed it. The service had effective relationships with healthcare professionals, which ensured people received the care and treatment they needed in a timely manner.

People were supported with patience, consideration and kindness and their pr

We spoke with ten people using the service, five relatives, four staff, an internal trainer and an external health and social care professional. We received information in July 2014 and September 2014 that suggested complaints were not dealt with effectively and that people were not cared for adequately. We looked at these areas as part of our inspection visit.

Below is a summary of what we found.

Is the service safe?

Medicines were prescribed and given to people appropriately and they were stored securely. We saw medicines being administered and saw that staff were patient and allowed people time to take them.

We received information in September 2014 that told us there had been two issues related to care that had been investigated through safeguarding procedures. We found that the provider had taken steps to ensure people’s care was delivered as required but that records did not always verify the action taken. This meant there was the potential for unsafe care.

Is the service effective?

We found that people’s decision making capacities were not being assessed in a consistent manner and that where people lacked capacity the provider was not always acting in their best interests.

A relative told us they thought their family member had improved since using the service and was eating better and an external professional told us that their advice was sought as required.

We looked at three people’s care records and saw that these were mostly up to date and contained useful information for the provision of care. We saw people’s weight was monitored on a regular basis and any loss or gain was identified and acted on.

We saw that staff were involved in specialist training for dementia during our visit. The trainer described staff as having a “genuine interest” in learning. Staff we spoke with told us they had completed medication training and training records we saw verified this. This meant staff received appropriate training to safely administer medication and meet the needs of people with dementia.

Is the service caring?

People we spoke with were mostly satisfied with their care; one person and their relative both told us “Staff are very friendly”, another person said “It’s lovely here” and another person told us “I like it here”.

Our observation of people’s care found that staff were caring and helpful and had friendly relationships with people. During the lunchtime period we saw that most people received assistance as they required it and in a sensitive manner. Most people were complimentary about their meals and told us they enjoyed their food. One person said “It’s very nice”.

Is the service responsive?

We received information of concern in July 2014 that suggested people’s complaints were not listened to or properly addressed. We looked at the service’s complaints records and saw that only summaries of the complaints were available. The manager told us that some of the correspondence in response to a specific complaint could not be located. This meant there was the potential for complaints not to be dealt with satisfactorily.

Is the service well led?

We found that records for the running of the service were mostly up to date but there were aspects of complaint management records that could not be located and complainants were not always satisfied with the outcome of their complaint.

We found that some care records were not always up to date, which had the potential for unsafe care. Staff training records were up to date and showed staff received sufficient guidance for their role.

We looked at various aspects of the care at Brimington Care Centre, including observing the staff, talking to people who live at the care home and reviewing the documentation.

A partial tour of the building, including some of the bedrooms, showed that the building was comfortable, well maintained and did not smell. We saw that there was documentation to show that the building was safe, and that the necessary checks to ensure that safety were taking place.

We identified a minor problem with regard to documentation around people giving consent to their care and treatment, and discussed with the registered manager and deputy how this could be improved.

We spoke with three people who live at Brimington Care Centre to gain their views of living at the care home. We also observed the staff at various times throughout the day, to see how they interacted with people, and this was a positive experience. We asked if people were happy living at the care home and we were told: “The staff are marvellous, they really are really caring, and I’m very happy.” A second person said: It’s a lovely home, I’ve got a beautiful bedroom and the staff are very good.” A third person said: “I’m very happy here. I’ve got everything I need, there’s a lovely garden and the chickens are back for the summer.”

On the day of our visit to Brimington Care Centre there were 40 people living at the care home.

We spoke with two people who live at the care home, and observed the staff at various times throughout the day. We asked if people were happy living at the care home and we were told: “I’m very happy thank you” and “I think I’m very well suited, the staff look after me very well.”

Our observations of staff interacting with people at Brimington Care Centre showed that there was a level of respect and understanding, with staff taking the time to reassure people while talking to them in a friendly manner.

Our observations during our inspection visit did not raise any questions or issues regarding peoples’ safety at the care home. We asked several people if they felt safe living at the care home, and they said that they did.