An unannounced comprehensive inspection visit took place on 18 December 2018 and we returned on 19 December 2018 to speak with staff and to review their quality assurance systems.

Brookdale Nursing Home is registered to provide personal care to older people including people living with dementia. Brookdale Nursing Home is a nursing home, which provides care for up to 40 people across two floors. At the time of our inspection there were 31 people living at Brookdale Nursing Home. People had their own bedroom and not all the bedrooms had en-suite facilities and four bedrooms were for shared occupancy. People had the use of shared communal lounges, dining rooms and bathrooms on each floor. To aid people’s movement around the home, a passenger lift and stairs helped people move between floors.

People in care homes receive accommodation and nursing and/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.

At our last inspection we rated the service Good overall. Prior to and immediately following this inspection visit, we received information raising concerns about continence care, infection control and limited opportunities for people to pursue their interests. We looked at these concerns at this inspection and we found standards in how people were cared for had not been consistently maintained. In Well Led, people and staff told us changes to the feel and culture of the home had changed and although some improvements were noted, these needed to be embedded further to determine if they improved people’s care and welfare. Overall, the rating has now changed to Requires Improvement.

The service did not have a registered manager, although a manager was appointed at the home in September 2018 and was in the process of applying for registration with us. 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.

Not all staff were positive about the changes in management, however staff agreed the changes being implemented by the manager were to improve people’s experiences and care outcomes.

Staffing levels helped ensure people received the consistent care they needed, although staff said the use of agency staff meant the shift did not always operate effectively. The regional manager was confident staff levels were right and said staff needed to be deployed and managed more closely to improve the delivery of care. Staff did not always have time to sit and spend time getting to know people more. Our observations during this visit, were of positive and friendly interactions between staff and people but they were limited.

Staff did not always treat people with dignity and respect. Relatives and staff told us people wore other people’s clothes and the laundry system was not effectively managed to ensure people’s own laundry items were returned. People’s clothing was transferred to other areas of the home in black bin bags which showed no respect for people’s personal property. Some people said staff entered their rooms without knocking which they did not appreciate.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

People’s care plans provided information about the person’s preferences and included some knowledge staff had gained about the person’s interests and life history. Care records were reviewed and evaluated to ensure they remained up to date and changes made as required. However, some care plans we reviewed required more

Brookdale Nursing Home provides accommodation, care and treatment for a maximum of 40 older people. On the day of our inspection there were 35 people living at the home.

The inspection took place on the 2 August 2016 and was unannounced.

We completed an unannounced comprehensive inspection of this service on 7 and 10 July 2015. We found there was a breach in the legal requirements and regulation associated with the Health and Social Care Act 2014. The provider did not have suitable arrangements in place to prevent people being unnecessarily deprived of their liberty. We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulation and when their actions would be completed by. We completed a focussed inspection on16 December 2015 and we found the actions required had been completed and these regulations were now met.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said there was sufficient staff available to support people living at the home safely. They told us staff were caring and promoted people’s independence as much as possible. People said they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed.

Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns. They told us an assessment of their family member’s needs before and when they arrived at the service supported staff to provide the care they needed. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. We saw the registered manager acknowledged when things had not gone well and put actions in place for improvements.

Staff we spoke with knew how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect. They knew people well, and took people’s preferences into account and respected them.

The management team had assessed people’s ability to make specific decisions about their daily life when they needed to. They had put in place support for people to ensure decisions were made in a person’s best interest within the legal framework. Staff we spoke with understood how to work with people to ensure they made their own decisions where possible.

People who lived at the home and staff were encouraged to share their views and concerns about the quality of the service. People and their relatives thought the service was well managed. The provider and registered manager had systems in place to monitor how the service was provided, to continuously improve the quality of care.

We completed an unannounced comprehensive inspection of this service on 7 and 10 July 2015. We found there was a breach in the legal requirements and regulation associated with the Health and Social Care Act 2014. The provider did not have suitable arrangements in place to prevent people being unnecessarily deprived of their liberty. We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulation and when their actions would be completed by.

We undertook this focused inspection to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Brookdale Nursing Home on our website at www.cqc.org.uk.

The provider is registered to provide accommodation and personal and nursing care for up to 40 people at Brookdale Nursing Home. The home environment is divided into two floors.

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.

People were supported by staff that ensured people could make their own choices and decisions. We saw staff waited for people to consent to their care and make their own choices, for example, what they wanted to eat and what they wanted to do. People told us they received care and support in the least restrictive way which promoted their own choices and routines.

We saw for people who were unable to make a specific decision about an aspect of their care and treatment this had been made in their best interests by people who had the authority to do this. Where people had potential restrictions in place and did not have the mental capacity to agree to these the registered manager had now made Deprivation of Liberty applications to the supervisory body for authorisation. By doing this, the registered manager had followed the correct process to take on the legal responsibility to make sure people were not unlawfully restricted of their freedom or liberty unnecessarily.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made continue to be implemented and embedded into practice.

The inspection was carried out by one inspector. At the time of our inspection there were 34 people who were using the service. Below is a summary of what we found. The summary is based on our observations during the inspection. Due to people's health conditions we were only able to speak with one person who used the service. We also spoke with the operations director for the service, five staff who were supporting people and from looking at records. After the inspection we spoke with four relatives by telephone.This evidence helped us answer the five questions detailed below.

Is the service safe?

People were treated with dignity and respect by staff. People told us they felt safe. We observed a relaxed atmosphere and positive relationships between the people who used the service and staff. There were risk management plans in place for people and health and safety. There were appropriate and safe arrangements in place to ensure people received their medicines as they were prescribed by a doctor. Recruitment practices were thorough and all necessary safety checks had been carried out. Newly recruited staff did not work by themselves until they felt confident and when they had been assessed to do so.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. We found that one application had been submitted to a registered assessor through the appropriate channel. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was evidence of people and or their relatives or an advocate being involved with the development of care plans. We found that other assessments had been carried out in relation areas such as nutrition, mobility and skin condition. All assessments had been regularly reviewed. Appropriate systems were in place to ensure specialist diets were given to people who had long term conditions. A process for monitoring people who failed to eat or drink enough was in place.

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff encouraged and supported people in leading interesting and enriched lifestyles. The person we spoke with said they received the standard of care that matched their needs. A relative told us, "They (staff) have been lovely to me and so supportive."

Is the service caring?

The person we spoke with was positive about the way they were cared for and supported. They told us, "I am very satisfied, it’s (care) excellent." People were cared for by kind and attentive staff. We observed people asking staff to do things for them. Staff responded to the requests promptly and efficiently. There were signs on each bedroom door to advise when a person was receiving personal care to protect their privacy and that staff should not attempt to enter.

People were offered a range of activities and staff spent one to one time with people. Staff assisted people in maintaining communications with relatives even when they lived in another country. Staff were supported by a team of health and social care professionals who worked closely with them in providing people's care needs.

Is the service responsive?

Staff respected people’s confidentiality and asked for permission before sharing personal information with other organisations. Staff had obtained written consent from people or their relatives for a range of procedures such as personal care. When people who lived in the home made suggestions for changes action had been taken as far as practically possible. We found evidence that people were able to make choices about their care and activities. One person said, “I am asked if I want to join in the activities.” Records’ confirmed people’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

We found evidence that staff sought professional advice when they had identified concerns about people’s health and safety. Staff followed the guidance provided by healthcare professionals to ensure that people received appropriate care and support.

Is the service well led?

The service had a quality assurance system in place. Records showed us that improvements had been made when they were identified through monitoring processes. There were clear processes in place for dealing with complaints. Regular audits had been carried out that enabled staff to make changes that could be of benefit for the people who used the service. A relative told us, "Everything is well managed."

Staff told us they were clear about their roles and responsibilities, the ethos of the service and the quality assurance processes. There were clear lines of responsibility and staff knew who they could seek guidance from if they were unsure about something. Staff told us they received good support from senior staff to help them when they had a problem and to carry out their role effectively.

34 people were living at the home when we visited. We talked with five of them as well as two people who were visiting a relative. We also spoke with the registered manager, the provider’s property and safety manager and three members of staff including nursing, care and catering staff.

The people we spoke with were complimentary about the home and the staff. One person told us: “It’s alright here. I get on very well with everyone and the staff are very nice.” One of the visitors told us: “It’s very good. The staff are all very helpful.”

We watched staff as they cared for people. They provided care and support that met people’s needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found that the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were supported to be trained to an appropriate standard.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

37 people were living at the home when we visited. We talked with three of them as well as three relatives who were visiting. We also spoke with the registered manager and three members of staff. This included nursing and care staff.

The people we spoke with told us that they were happy with the home and the staff. One person told us, “I can’t complain about anything.” One visitor told us,”It’s got a homely feel. They make you feel at home as a visitor.” Another visitor said, “Nothing’s too much trouble. No matter what time you go in they’re all brilliant.”

Staff knew about the needs of the people they were caring for. We looked at care plans for four people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had been trained how to recognise signs of abuse and knew how to report concerns.

People were protected from the risk of infection and their medicines were managed appropriately.

We saw that sufficient numbers of appropriately skilled and qualified staff were employed to meet people’s needs. We looked at records which showed that the provider was regularly monitoring the quality of its service.

We spent the day observing people, their routines and interactions with staff. We spoke with five people living at the location. People indicated that they were happy with the care they received from the location.

Below are a few examples of what they said to us;

“I think it’s a very good place for us old ones. I used to do inspections and I know what to look for. It’s a good place and the staff are nice”.

“Oh yes they look after us very well. I have got a good family as well who come and see me”.

“Yes it’s quite good here”

“I like it here and the staff are nice”.

The manager and staff team were committed to provide a good service to the people who live at this location. Staff told us;

“It is a happy place to work and the residents are happy. They tell us that they are happy”.

“The care here is very good”.

We found many positive aspects of care being provided. Everyone we spoke with was complimentary about staff of all levels.

The atmosphere of the location was friendly and welcoming.

It was clear that staff really do want to provide a good service to the people in their care.

We found a number of areas which did not meet government standards such as medication management and cleanliness. Evidence gained throughout our inspection suggests that the lack of regular management observations, audits, checks and staffing levels are contributory factors to the shortfalls we identified.

Brookdale Nursing Home provides accommodation, care and treatment for a maximum of 40 older people. On the day of our inspection there were 34 people living at the home.

The inspection took place on the 7 and 10 July 2015 and was unannounced. At our last inspection in September 2014 we found the provider was meeting the all the regulations focussed on.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and caring, and thoughtful towards people and treated them with dignity and respect when meeting their needs. Staff we spoke with demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. Staff had up to date knowledge and training to support people who lived at the home.

We saw staff treated people with dignity and respect whilst supporting their needs. Staff knew people well, and took people’s preferences into account and respected them.

People were able to make choices about their day to day care and staff supported them to make decisions in their best interest. The registered manager had identified that some people would need assessments by the local authority to ensure people did not have their liberty deprived in an unlawful way. Applications had not been submitted to the supervisory body so the decision to restrict somebody’s liberty was only made by people who had suitable authority to do so.

We saw people had food and drink they enjoyed. People were supported to eat and drink well.

People told us they had access to access to health professionals were needed. Relatives had an inconsistent experience when receiving updates about their family member and being involved with their care provision.

People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home. People and relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

People were involved in some pastimes they enjoyed. Staff really knew people and their needs well. Relatives told us they were not consistently involved with their family member’s care but felt able to approach the registered manager to discuss their concerns. They knew who to speak to if they needed to make a complaint and felt confident any issues raised would be resolved.

People and relatives said the registered manager was very approachable. Staff felt supported by the registered manager. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service.

The provider had identified areas of improvement in the quality of service provision. Systems in place to monitor and improve the quality of the service were partially effective because they had identified some but not all the areas of concern. Improvements were not consistent because some of the audits had not been fully implemented. The provider needed to action the on going concerns and effectively monitor the future quality of service provision.

You can see what action we told the provider to take at the back of the full version of the report.