The inspection took place on 14, 19 and 20 June 2018. The first day of our inspection visit was unannounced.

Brockhampton Court Care Home with Nursing is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Brockhampton Court accommodates up to 58 people within a large adapted building, and specialises in care for older people and younger adults with physical disabilities. At the time of our inspection, 48 people were living at the nursing home.

The provider is also registered to operate a domiciliary care agency at this location. It provides personal care to people living in their own houses in the community and operates from a main office located within a separate building in the home’s grounds. It provides a service to older people who may have physical disabilities . At the time of our inspection visit, 28 people were receiving care and support in their own homes from the agency.

Not everyone using the domiciliary care agency receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

A registered manager was in post and present during our 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.

The provider’s systems and procedures designed to ensure people received their medicines safely and as prescribed were not always as robust or effective as they needed to be, and did not always reflect current good practice. The provider had not adequately assessed the broader risks to people’s health and safety and done all that was reasonably practice to mitigate these. The provider did not have formal systems in place for the clinical supervision of nurses or managerial supervision of care staff. People’s care plans did not always fully demonstrate an individualised assessment of their care and support needs or fully support a person-centred approach to people’s care. The provider had failed to notify us of eight serious injuries involving people who used the service, in line with their registration with CQC. The provider's quality assurance systems and processes were not as effective as they needed to be.

Staff received training in, and understood, their individual responsibility to protect people from abuse and discrimination. The staffing levels maintained ensured people’s needs could be met safely at the nursing home, and that people received reliable and consistent care and support in their own homes. The provider completed checks on prospective staff to ensure they were safe to work with people. The provider had taken steps to protect people, staff and visitors from the risk of infection.

Staff completed the provider’s induction and participated in a programme of ongoing training to help them work safely and effectively. Staff helped people to prepare their meals in their own homes, and offered physical assistance to enable people to eat and drink where they needed this. Any risks associated with people’s eating and drinking were assessed and managed. Staff helped people to access healthcare services and played a positive role in ensuring their day-to-day health needs were met. The overall design and adaptation of the nursing home enabled staff to meet people’s individual needs safely and effectively. Staff and management understood and promoted people’s rights under the Mental Capacity Act 2005.

Staff approached their work with a kind and caring attitude and

This inspection took place on 30 March and was unannounced.

Brockhampton Court provides personal and nursing care for up to 58 people, some of whom are living with dementia. At this inspection 43 people were living there.

A registered manager was in post and present during our 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 were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Staff had access to detailed care plans and risk assessments and were aware of how to protect people from harm.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. The provider completed appropriate checks on staff before they started work to ensure they were safe to work with people.

People received their medicine from staff who were trained to safely administer these and who made sure they had their medicine when they needed it. Staff followed safe practice when assisting people with their medicines.

People received care from staff who had the skills and knowledge to meet their needs. Staff attended training that was relevant to the people they supported and adapted to meet specific needs. Staff were supported by the provider and the registered manager who promoted an open and transparent culture.

People were involved in decisions about their day to day care. When people could not make decisions for themselves staff understood the steps they needed to follow to ensure their rights were upheld. People’s likes and dislikes were known by staff who supported them in a way which was personal to them. Staff provided care and support which was personalised and respected people’s likes and dislikes. People took part in activities they liked and found stimulating. People felt involved in the day to day running of the home and were kept up to date with changes and developments.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and information was given to them in a way they could understand. People’s independence was encouraged and staff respected their privacy and dignity.

People had a choice of food to eat and could choose alternatives if they wished. People had access to healthcare when needed and staff responded to any changes in need promptly and consistently.

People and staff felt able to express their views and felt their opinions mattered. The provider and registered manager undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

We talked with a number of the people who lived in this home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

Most people told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were usually available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “It’s all very good” and another said, “Really nice bunch of staff”.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

We spent time in one of the lounges, so that we could see how people spent their time. We spoke with six people who were living at the home, and we also spoke with two relatives, three staff members and the manager. We checked some of the records which the home is required to keep, including care records for four people.

We found that people were treated with respect and kindness. People told us, "it's a lovely place and they look after us all really well" and, "the care here is absolutely wonderful". One relative said, "we're very pleased with the way they've looked after her".

People told us that they received a high standard of care and support. There was clear and detailed information for staff about people's needs and how they should be met. Records showed that staff were providing care which met people's needs.

Staff had been provided with training about how to recognise and report concerns about possible abuse or neglect. People told us that they felt safe at the home. They said that they would know who to talk to if they had any concerns. They were confident that they would be listened to and that their concerns would be taken seriously.

People were very positive about the staff, and described them as, "excellent in all respects" and, "always willing to help". One person told us, "the matron sets a very high standard and the staff follow her lead".

During our visit we spoke with five people who lived at Brockhampton Court. We saw how one person who was being looked after in bed was being cared for. We spoke with two people who had come to visit relatives, with three nurses and the manager.

We observed that the nurses and carers worked together well as a team. Throughout the day we saw that staff were checking with each other to make sure that people had been attended to. We observed staff helping people gently and without rushing them and noted that they spoke to them in a warm, friendly and respectful way. The people we spoke with were complimentary about life at the home and said that the staff are very good.

A person whose mobility had improved since they moved to the home told us they put their improvement down to “the good care I have been given”. Other people told us that staff treated them well and said “oh yes, they are very good here” and, “You don’t need to inspect here you know, it is very good. All the girls are so kind and the matron is so competent.”

We saw evidence that people’s various health care needs had been identified and that the nurses and care staff had worked hard to make sure that they provided the right care. We saw examples of good outcomes for people such as a person whose pressure sores were very serious when they arrived but had almost healed and another who was falling less often due to liaison between the home and health professionals.

Quality assurance arrangements included monthly internal reviews and an annual check by an external company. The results of the October 2010 check which included information from surveys sent to residents and relatives showed that people were very satisfied with the care provided at the home. A display in the staff break area showed photographs of well known older people and challenged staff to consider their views towards ageing and ageism.