The inspection took place on 28 February and 1 March 2018 and was unannounced.

Brockenhurst 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. The home provides accommodation, for up to 38 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 37 people living at the home. The home is a large property situated in Littlehampton, West Sussex. There are five dual occupancy rooms, where two people share a room and the remaining bedrooms are single occupancy. It has three communal lounges, two dining rooms and a garden. There is a passenger lift so people can access the first and second floors.

The home was the only home owned by the provider, who was also the registered manager. The management team consisted of a registered manager and team leaders as well as an administrative person with a management role. A registered manager is a '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 home is run.

At the last inspection of 17 October 2016 we rated the service as Requires Improvement and served six requirement notices. We asked the provider to complete an improvement plan to show how these requirements would be addressed. The provider submitted an action plan detailing how the requirement notices would be met. We have summarised the requirement notices served following the previous inspection along with of our findings at this inspection:

• The provider had not ensured the risks to service users were adequately assessed and action taken to mitigate the risks. At this inspection we found action had been taken to address this and care records showed risks to people were assessed and details recorded of action staff needed to take to mitigate the risks. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured medicines were safely managed. At this inspection we found the provider had taken action to meet this and medicines were safely managed although we noted there was a lack of clear guidance recorded for one person who had pain relief on an ‘as required’ basis. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured staff were trained and supervised in their work including a lack of proper induction. At this inspection we found improvements had been made in this area and staff had access to a range of training and an induction for newly appointed staff as well as supervision. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured people were supported to have a positive dining experience and that action was not always taken to monitor those at risk of losing weight. At this inspection we found improvements had been made in this area. People’s weight was monitored and nutritional assessments carried out. People were supported to eat and drink and said they liked the food. We did identify one person who had been assessed as having difficulty chewing and had their meals pureed to assist but this had not been referred for specialist assessment regarding this. At this inspection we found improvements had been made in this area and this regulation was now met.

• The provider had not ensured the requirements of the Mental Capacity Act 2005 (MCA) were being followed. This included a lack of a ‘best interests’ meeting where one person had medicines covertly administered and a lack of documentation where people had a Power of Attorney appointed to make decisions on their behalf. At this inspection we found improve

The inspection took place on 17 October 2016 and was unannounced.

Brockenhurst is a residential care home providing accommodation, for up to 38 older people, who are living with dementia and who require support with their personal care needs. On the day of our inspection there were 38 people living at the home. The home is a large property situated in Littlehampton, West Sussex, there are five dual occupancy rooms, where two people share a room, other rooms are single occupancy. It has three communal lounges, two dining rooms and a garden.

The home was the only home owned by the provider, who was also the registered manager. The management team consisted of a registered manager and team leaders. A registered manager is a ‘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 home is run.

Risk assessments related to some people’s needs were in place to ensure that people were provided with safe care. However, not all risks, specific to people’s needs had been considered. For example, people were unable to use call bells due to their cognitive abilities, this had not been identified or assessed as a risk and consideration had not been taken to ensure that people could call for assistance if needed.

People had access to medicines and records showed that these were administered on time. However, there were concerns regarding the administering of medicines. For example, medicines were not dispensed using a non-touch method and this increased the potential risk of cross contamination. The administration and recording of medicines and the management of risk to people’s safety were areas of concern.

People were supported by staff that had the relevant experience to meet their needs. However, there were concerns regarding the lack of formal training and support that staff received. Observations of staff’s practice and of records raised further concerns about the amount of training and support staff had been provided with. The lack of formal training and support provided to staff were areas of concern.

People were asked their consent before being assisted and there were measures in place to ensure that people’s relatives' had been involved in decisions about people’s care needs. However, practice and the lack of records confirmed that here was a lack of understanding in relation to the practical application of mental capacity assessments (MCA) and the deprivation of liberty safeguards (DoLS) and some decisions were made by people who were legally unable to make decisions on people’s behalves. The lack of understanding and practical implementation of the MCA and DoLS were areas of concern.

People appeared to enjoy the food that was provided. One relative told us, “X seems happy with the food here. They enjoy it.” However, there were concerns regarding some people’s dining experience and some people’s access, particularly those that spent time in their rooms, to food and drink. Appropriate measures for a person that had lost weight had not always been taken. The experience of people when having their meals and the lack of action taken in relation to a person whose weight had decreased were areas of concern.

Care records provided details about the person’s care needs, however these did not always contain sufficient information to provide staff with appropriate guidance to suitably meet people’s individual needs. Some people, who spent time in their rooms, were at risk of social isolation and there was not sufficient stimulation or meaningful activities to engage people and occupy their time. The lack of information in people’s care reviews and the lack of meaningful activities were areas of concern.

People, relatives’, staff and visiting healthcare professionals’ were complimentary about the leadership, management and culture of the home, they found the manager professional, caring and approachable. Comme

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions:

Is the service Safe? Effective? Caring? Responsive? and Well-led?

Below is a summary of what we found. The summary describes what relatives of people using the service and members of staff told us, what we observed and what we learnt from the records we looked at. We talked with three of the staff, a deputy manager, the registered manager (provider) and a consultant who works with the service. Records we looked at included three care records, staff training records, management audits and the service’s quality assurance documentation.

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

Is the service safe?

All staff were up to date with training about safeguarding vulnerable people. They were given a handbook specifically about their safeguarding responsibilities. Staff we spoke with had a clear understanding of what constituted abuse and how to refer any concerns as safeguarding or whistle blowing issues.

Care plans included strategies for identifying and minimising behaviours that could cause people distress or difficulty to themselves or others.

Is the service effective?

Care plans included a standard range of assessments giving baseline scores. They were reviewed periodically, which enabled planning to meet people’s care needs and reduce identified risks. Staff we spoke with said the care plans guided the care and support people received. Staff knew how to access information. They received a handover of updating information each time they started work, with additional information if they had been away from the home for a significant period, such as a holiday.

Records showed staff were observant of changes in health and wellbeing. Health professionals were contacted in a timely way, as necessary. The home used body maps to show clearly where any mark or injury was observed but these were not being used to track progress of treatment.

A person with a relative who lived in the home told us they were informed about care plan reviews, invited to take part and informed of outcomes. They were informed about, and asked their opinions on, any health changes. Review records showed changed needs were identified and responded to. For example, a person’s declining mobility had been addressed by provision of additional equipment and staff training.

Is the service caring?

We observed attentive, meaningful and friendly interactions between staff and people in the home. Staff explained care intentions to people and allowed time for responses. Staff told us there were always enough staff to meet people’s needs. A person who lived in the home told us “They like to know we are happy.” Another said “The staff are very kind, they spend time with us.” A visitor told us they always saw staff smiling, talking and using non-verbal communication with people.

People we spoke with, who lived in the home, said they got up when they pleased in the mornings and went to bed at times that suited them. One said “There’s nothing you have to do, you do what you like.” We saw people were invited and encouraged to join in activities, but there was no pressure to do so if they declined. We saw a person being supported to eat their lunch. The staff member continually checked the amount of direct assistance the person wanted, whilst allowing independence of action.

Is the service responsive?

Staff were supported in delivering care by an organised training programme, which included dementia awareness. All but one of the staff had achieved or were working towards diploma qualifications.

The provider spent considerable time in the home. They had close working relationships with staff and engaged routinely with visiting relatives. This meant they were available to observe or be alerted to any shortfalls and to address them. An annual survey of people’s relatives, staff and visiting professionals provided extra feedback to the provider on people’s views of the quality of the service. A staff member told us “The manager is very open and welcomes observations.” Complaints were recorded and addressed.

Management and staff told us of changes they had made to staffing at lunch times, following our observation at our previous inspection that some people were insufficiently supported.

Is the service well-led?

The provider is also the manager of the home. They used a consultant to assist with monitoring the quality of service and maintaining up to date knowledge of developments in the care industry. We met the consultant and found they had a detailed knowledge of the service. The two deputy managers were also involved in developmental work. The provider had arrangements in place for business continuity in the event of a contingency situation arising.

Staff meetings covered care and operational issues. Staff we spoke with said they felt management listened to their views and kept them well informed of developments and plans. They expressed a strong identity as a team working together to meet the needs of people who lived in the home.

At the time of our visit there were 38 people living at Brockenhurst. The home specialises in caring for people with dementia.

We gathered information from a variety of sources. These included talking with five people who lived at the home and four relatives. We also spoke with the manager and four members of staff. We left comment cards for people to complete if they wished to inform us of their views on the home, 15 were returned. These were from relatives, friends and visiting healthcare professionals.

Everyone told us that they were happy with the care and support they received. One person said, “I think it is wonderful here, they look after me so well and the food is very good”. Another told us, “The girls are kind to me”. Relatives were very positive about the home. One said, “I can sum it up in one word; fantastic!” Some of the feedback on comment cards that we received included, ‘The care given to my wife is first class’ and, ‘I cannot fault the care, I felt there was a real compassionate attitude here’.

Staff were enthusiastic about working in the home. One told us, “I love it here”. Another said, “If it was my Mum or Dad I could sleep in peace if they were here”. One relative told us, “Mrs Matthews and her staff are the best you can get”.

People told us that they were happy with the support they received from the home to access healthcare professionals.

The provider had a system to assess and monitor the quality of dementia care that people received. This included seeking the views of people who used the service or their representatives and acting upon their wishes.

Due to their disabilities many of the people accommodated were not able to tell us about their experiences. To help us to understand the experiences people have we used our Short Observational Framework for Inspection (SOFI) tool. This tool allows us to spend time watching what was going on in a service and helps us to record how people spent their time, the type of support they get and whether they have positive experiences.

We spent 30 minutes watching care and support provided to five people just before lunch. We found that people had positive experiences. The care staff readily engaged with people talking about their families and visitors. They also explained to people what they were going to do after lunch. The care staff on duty knew what support each person needed and they respected their wishes if people wanted to be left on their own.

We spoke with three members of staff who were on duty. We were informed that people had been treated with respect and dignity. We were also informed that people had been encouraged to make choices as far as they were able.

We also spoke with two relatives who were visiting. They confirmed they were very satisfied with the care and support provided. One relative told us, “This is first class, as far as care homes go.” The other one said, “There is a massive sense of humanity about the provider and her staff; they really care. There is a clear sense of personal engagement with people.”