We carried out an unannounced comprehensive inspection on 1 and 2 and 3 October 2018.

Brook Lane Rest Home is a care home without nursing for up to 25 people. On the day of our inspection there were 25 people living at the service. It specialises in care for older people who may be living with dementia.

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.

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 the last inspection on 19 and 24 February 2016, the service was rated Outstanding.

We met and spoke with most of the people living in the service during our visit. However, some people were not able to fully verbalise their views. Due to people’s needs we spent time observing people with the staff supporting them. Others could tell us about the care and support they received. Staff told us and we observed staff using other methods of communication with people who could not verbally express their views, for example by the use of pictures.

People lived in a service whereby the provider’s caring values were embedded into the leadership, culture and staff practice. For example, one of the provider’s values included choice. Recorded into each resident/family meeting held a documented about how people were given choice in nearly every aspect of the service. This included choice over menus/meals, and activities. The service was extremely well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. People, relatives and staff said the providers were approachable.

The provider, registered manager and management team were open and transparent and were very committed to the service and the staff but mostly to the people who lived there. They told us how recruitment was an essential part of maintaining the culture of the service and told us about how some people were involved in the recruitment of new staff. This ensured people had a say over staff who worked in the service.

The provider, registered manager, deputy manager provided excellent leadership to staff; and had considerably improved the life experiences of people who lived at Brook Lane Care Home. The providers and registered manager were passionate and committed to developing a service where people received genuinely person-centred care. People were supported to develop close relationships with each other and with all the staff. The management created a warm and relaxed environment and we observed a strong caring relationship between people and the management team including the provider. People knew about the management team and staff’s family’s and interests which helped maintain these relationships.

People remained safe at Brook Lane. People who could, said they felt safe living there. One person said; “I do feel safe with the staff” and relatives, staff and professionals agreed people were safe.

People received their medicines safely by staff that had received regular updated training. People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient number of staff to help keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

This inspection was carried out by two inspectors. It took place on 19 February 2016 and was unannounced. A further visit took place on 24 February 2016 to complete the inspection. Staff were aware of the date we were returning for our second visit.

Brook Lane is registered to provide accommodation care and support for up to 25 people, any of whom could be living with dementia. The home does not provide nursing care. At the time of our visits 24 people were living there.

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’. The nominated individual who was also registered with CQC regularly worked at the home. 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. All people we spoke with said that the registered manager and nominated individual were dedicated, supportive and approachable. They said whatever people needed was provided to ensure people had the best quality of life they could achieve.

We found this service had consistently provided a good quality of care and support and this was reinforced by reviewing our previous inspection reports. The nominated individual, registered manager and all the staff we spoke with were passionate about providing an excellent service and about putting people at the heart of everything they did.

People we spoke with were very settled and contented. Relatives and friends visiting the home had only positive experiences and praise for this service. Staff treated people as individuals at all times and with dignity and respect. Staff were extremely knowledgeable about people’s likes, dislikes, preferences and care needs. Staff we spoke with told us how they encouraged and supported people to make decisions for themselves, which ensured people were able to live the life they chose. Staff had a calm, friendly manner which people responded to positively. Staff paid attention to little things which enhanced people's quality of life and they researched thoroughly to provide equipment which would enhance people's dignity and maintain their independence.

Health and social care professionals highly praised the service describing how quickly they responded to any deterioration in people's health and how well they managed end of life care. The home had worked very effectively in collaboration with health care professionals to continuously improve the care and support provided to people. They had taken part in projects, for example to reduce the occurrence of falls and to reduce the number of hospital admissions. The success of these projects enabled the provider to share this learning with others. A social care professional who had worked with the home for a number of years said "It is the little extras that make it so special...If any home ever deserved outstanding status for their hard work and dedication to getting it right it is Brook Lane”.

Staff told us that they loved working at Brook Lane. They were mentored and supported to achieve their very best and they were offered good quality training. This ensured they were skilled in caring for people with a wide range of physical, health and emotional needs. Staff had received training about how to ensure people’s rights were respected and how to safeguard people from abuse. They had a good understanding of the Mental Capacity Act 2005 and asked for people's consent before completing any care task. Where people lacked capacity decisions made to act in their best interest were clearly documented. This ensured people's rights were respected. There were safe staff recruitment procedures in place and staff were deployed in sufficient numbers to support people effectively with their physical needs and still to have time to sit and talk with them.

People's needs were thoroughly

During our visit we spoke with eight people, 4 relatives, five staff and the manager. To help us to understand people's experiences of the service we observed the care people were receiving at different times of the day. A visitor said “I am very pleased with the home” and said the staff looked after them "very well”. People said they received help and support in a respectful manner. Another person said "the staff are marvellous.” Relatives said they were happy with the care and people were always well dressed and clean. Two relatives told us they came at different times of the day and there were “always staff around”. We saw the staff were courteous and respectful when providing care and support to people.

People said they were offered choices and "they (the staff) always ask you if you want to get up”. A person told us “I can get up when I want” and “there is help when you need it”. We looked at six care plans and saw they were individualised and included the necessary information to inform staff about the specific care people needed. We saw these were reviewed on a regular basis. We observed care in the communal areas and saw staff supporting people with their meals in a respectful way which preserved people’s dignity. A relative commented “the staff keep me informed if there are any changes in mum’s condition”. Another relative said “they get the doctor in very quickly”. This meant people or their relatives were involved in their care and treatment and received help and support when they needed it.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were adequate staff with the skills and knowledge to support people with their care. Records were maintained securely and available when we requested them.

During the visit we observed how people spent their time, the support they received from staff and whether they had positive outcomes. We also spoke with nine people who were living at the service. We spoke with healthcare professionals, two relatives and the staff. People told us the staff treated them well and they were supported to make choices about their care. They told us the “staff were lovely” and helped them as needed. People said their privacy and dignity was respected and this was not “a problem”. A relative commented that the care was “first class”. Another person commented they “could not have anywhere nicer “to live. We were told the staff had good knowledge of people’s needs and cared for “the whole person” and not just their personal care.

We found that people were supported and staff spent time assisting people and were aware of their needs. Staff were friendly, respectful and courteous when speaking with people. People were supported to eat and drink and they were offered choices. Equipment was in place to support people to maintain their mobility and independence. Appropriate arrangements were in place for the management of people’s medicines.

People told us they felt safe and said they would talk to staff if they had any “worries”. People and their relatives were confident that any concerns they raised would be taken seriously .There was a robust recruitment and selection process in place and checks were completed prior to employment.

We spoke to a number of the residents, their relatives and the staff. People told us that they were treated with respect and that the staff were very kind, courteous and respectful. People were offered choices and there was no restriction to time when they got up or went to bed. People commented that the staff were very good and attentive. They said that they could approach the provider and the manager with any concerns and were confident these would be addressed. People told us that if they had any problems they could talk to the staff. They said that the staff ‘give you the time you need and they don’t rush you.’

A person told us that their preferred bedtime was around eight to nine o’clock and the staff assisted them as needed. People told us that the food was ‘very good and you have lots of choices.’ They told us that the staff assisted them in choosing from the daily menu. People told us that the home was ‘always very nice and clean.’ Relatives told us that they visited several times a week and found the care ’very good.’

A visiting professional said that the staff they attended the home regularly and the staff sought help and advice for the residents as appropriate.