Brookdale House is a care home accommodating up to 22 people. The accommodation is arranged over two floors with a stair lift available to access the upper floor. There is no passenger lift. There is a mature garden to the rear and a patio with seating areas. People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Brookdale House is owned by Tuella Limited who, throughout this report, are referred to as the provider. At the time of our inspection there were 18 people using the service.

The service does not have a registered manager. 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 and associated Regulations about how the service is run. The registered manager who had been in post at our last inspection left in March 2018. In August 2018, the deputy manager was appointed as manager and is applying to register as manager with the Care Quality Commission.

We last inspected Brookdale house in October 2017. That inspection identified four breaches of the Regulations. People had not always received safe care and treatment, safeguarding concerns had not always been escalated appropriately to relevant agencies. The Care Quality Commission (CQC) had not been notified of events which had occurred within the service as required by the Regulations and the governance and quality assurance arrangements were not sufficiently robust.

We also made four recommendations. These were:

- That the medicines arrangements within the service reflected best practice guidance.

- That the use of covert medicines and the assessment and documentation of mental capacity assessments. was underpinned by the principles of the Mental Capacity Act 2005.

- That staff received an appraisal to support their ongoing development.

- That the activities provision be reviewed to ensure this met the needs of people using the service.

This inspection found that some improvements had been made but that many of these needed to be embedded further. There had been a period of five months when the service had been without a registered manager and this had delayed progress with addressing some of the areas where improvements were required. There was evidence that the manager was now acting to address these.

The provider had not completed all the relevant checks before employing staff.

Improvements were needed to ensure that the premises were decorated and adapted to a consistent standard throughout and in order to meet people’s needs.

We continued to find that some risks to people’s health and wellbeing were not being adequately assessed.

The use of covert medicines was being reviewed but best interest’s consultations still needed to be more clearly documented.

People told us the food was tasty and that there was sufficient choice. However, records did not reflect that people were always being offered regular fluids. Aspects of the meal time experience could be improved.

The cleaning arrangements needed to be more robust.

Overall medicines were managed safely, but there were some areas where further improvements could be made.

Records did not demonstrate that new staff were completing the provider’s induction in a timely manner.

More could be done to ensure that each person’s faith and spiritual needs were documented and catered for. Improvements were needed to ensure that people were supported to develop a personalised end of life care plan.

Improvements were still needed to ensure that people had regular opportunities for meaningful interaction and to take part in a range of social activities tailored to their individual needs.

A provider

Brookdale House is owned by Tuella Limited who, throughout this report, are referred to as the provider. Tuella Limited purchased the service in September 2016. The home is located in a residential area close to local amenities in Chandlers Ford. It can accommodate up to 22 people. On the ground floor there is a kitchen, a dining area and three separate lounge areas of varying sizes. The laundry and office are situated on the first floor. The accommodation is arranged over both of these floors with a stair lift available to access the upper floor. Three of the rooms were currently arranged as shared rooms. To the rear of the service there is currently a self-contained bungalow that was used as living accommodation by the previous provider. The new provider has plans to redevelop this building into an extension containing an additional 11 rooms, a lounge, quiet room, ground floor bathroom and platform lift. There is a mature garden to the rear with seating areas. The home does not provide nursing care. There were 18 people living in the home when we inspected, some of whom were living with dementia.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Improvements were needed to the governance arrangements within the service. There was a no robust programme of audit to assess and monitor the quality and safety of the service. The registered manager did not have an accurate oversight of events affecting the safety and wellbeing of people within the service.

Risks to people’s safety had not always been identified and addressed. Incidents and accidents had not always been reviewed to identify trends and minimise the risk of reoccurrence.

Some aspects of medicines management required improvement.

The registered manager had failed to notify the local authority and CQC of a number of safeguarding incidents which had occurred within the service.

Consent had not always been sought in line with the requirements of the Mental Capacity. Relevant applications for a deprivation of liberty safeguard (DoLS) authorisation had been submitted by the home and had either been authorised or were waiting to be assessed by the local authority.

People told us the food was tasty and that there was sufficient choice. Where people required a modified diet, this was provided and presented in an attractive manner. However, records did not reflect that people were being offered regular fluids. Tools used to monitor people’s nutritional needs were not yet being used effectively.

Aspects of the home’s décor and furnishings needed to be updated or replaced and cleaning arrangements were not always effective. The premises had not been designed or adapted for the needs of people living with dementia. The provider had plans to refurbish the premises and it was anticipated that this would start in November 2017.

There were sufficient numbers of experienced staff to meet people’s needs. Staff were provided with an induction, regular supervision and training opportunities but had not received an appraisal.

Where necessary a range of healthcare professionals had been involved in planning and monitoring people’s health and wellbeing support to ensure this was delivered effectively.

People were cared for by staff who were kind, caring and attentive. The atmosphere in the communal areas was good natured and people looked relaxed and happy in the company of the staff.

Overall, staff were observed to provide care in a manner that was mindful of people’s privacy and dignity.

People had care plans which provided guidance for staff although these were not always updated to reflect changes in people’s needs. People received care and support which sui