This was an unannounced inspection which we carried out on 23 November 2016 and 5 December 2016.

We last inspected Brooke House in June 2015. At that inspection we found the service was meeting all of the legal requirements in force at the time.

Brooke House is a purpose built care home that provides personal and nursing care to a maximum of 50 older people, including people who live with dementia.

The service did not have a registered manager. A manager was in place who was in the process of registering with the Care Quality Commission. 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 protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. Other people could tell us they felt safe. People appeared contented and relaxed with the staff who supported them. People and relatives said staff were kind and caring

Appropriate training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices where they were able about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Records were in place that reflected the care that staff provided.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

Staff and people who used the service said the manager was supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

People had the opportunity to give their views about the service. The manager acted on feedback in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided.

We carried out an unannounced comprehensive inspection of this service on 27 January 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of regulation relating to record keeping.

We undertook this focused inspection to check that they had followed their plan and to confirm that 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 Brooke House on our website at www.cqc.org.uk.

We found the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

Records were up to date and reflected the care and support provided by staff. Risk assessments were in place to reduce risks to people’s safety. They were regularly reviewed and evaluated to ensure people received safe care and treatment that met their current needs. Care plans were put in place where risks had been identified. They were regularly reviewed to record people’s current individual care and support needs. Care plans detailed how people wished to be supported. Detailed individual information was in place to help staff provide care to people in the way they wanted. Staff knew the people they were supporting and provided a personalised service.

This was an unannounced inspection which we carried out on 27 January 2015.

We last inspected Brooke House in May 2014. At that inspection we found the service was meeting all legal requirements.

Brooke House is a purpose built care home that provides personal and nursing care to a maximum of 50 older people, most of whom live with dementia.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Due to their health conditions and complex needs not all of the people who used the service were able to share their views about the support they received.

We have made a recommendation about the management of some medicines with regard to the use of “as required medicines” and to ensure the correct procedure is adhered to for the administration of covert medicines when people lack mental capacity.

Care records did not always reflect the care and support provided by staff.

People said they felt safe and they could speak to staff as they were approachable. Comments from relatives and people included, “I would say he is safe here.” And, “I definitely feel (Name) is safe from physical harm.” Another said, “I think my relative is safe, the staff are just so busy.” And, “I think the staff are caring, and (name) is safe, the staff are just so busy.” And, “(Name) is safe here.” We found at the time of inspection there were not enough staff always on duty to provide individual care and support to people. This was immediately addressed after the inspection as more staff were employed to be on duty.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

The necessary checks were carried out to ensure the building was safe and fit for purpose.

Staff were appropriately trained and told us they had completed training in safe working practices and were trained to meet people’s specific needs.

Brooke House was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received training and had some understanding of the Mental Capacity Act 2005 (MCA) and Best Interest Decision Making.

Menus were varied and a choice was offered at each mealtime. The catering staff provided special diets which some people required. People commented, “The food isn’t bad, there’s plenty to eat.” And, “The food is lovely, the chef is great.” A relative commented, “The food looks excellent, it’s spot on, there is a very good choice on the menu.” Staff were sensitive when assisting people with their meals but we observed meal times were not well organised for people who lived with dementia.

Staff were knowledgeable about people’s needs and we observed that care was provided with patience and kindness and people’s privacy and dignity were respected. People said staff were kind and caring. Comments included, “The staff are canny, I couldn’t say anything bad about them.” And, “The staff are kind.” Another person said, “I love it here.” And, “Lovely girls here, all of them are good.”

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Activities and entertainment were available for people. An activities committee was being formed to develop ideas for more activities and entertainment. People commented, “I go for a pub lunch every month.” And, “I sometimes sit and have a drink of lager in the evening.” Another person said, “I have been taken out in a taxi to visit my friends.” And, “We do lots of activities, dominos, cards, painting and sing-a-long.”

People were being supported to maintain some control in their lives. They were given some information in a format that helped them to understand if they did not read to encourage their involvement in every day decision making.

People had the opportunity to give their views about the service. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

The registered manager was introducing changes to improve the quality of care and to ensure the service was well-led for the benefit of people who used the service.

We found one breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010 in relation to record keeping, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

The reason for this visit was to check if improvements had been made in areas of care and welfare, cooperation with other providers and quality assurance following a previous inspection. We spoke with some people who received care but, due to their needs, some were unable to communicate with us.

Some relatives we spoke with were appreciative of the care provided by the home. One person said; "I'm delighted at how my relative has settled here." Another person said; "The staff are excellent, we are kept informed about any changes to my mother's condition."

Records showed care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We saw the provider had an effective system to regularly assess and monitor the quality of service that people received.

We found people's health, safety and welfare were protected when more than one provider was involved in their care and treatment. This was because the provider worked in co-operation with others.

At the time of our visit there were 22 people who lived at the service, this included one person who was in hospital. We were informed one floor of the home was specifically to provide care for people with dementia. During our inspection we spoke with twelve people who used the service, seven relatives and six members of staff.

We left comment cards following our visit to gain feedback on the service and received one response which said; "Excellent care is provided to my mother. Staff are attentive and listen to myself re the care."

The manager started work at the home the week before the inspection. We found she had identified some areas for improvement before our visit. However we found strategies were not in place to meet the needs of people who lived with dementia.

We saw staff were supportive and kind to people. They tried to respect people's privacy and dignity as far as possible although we observed staffing constraints made this difficult at times.

We found although some care records were in place they did not document all the care and support needs of people.

The emotional and psychological needs of people with dementia were not met as staff were too busy as they attended to people's personal care needs.

Staff were not knowledgeable about how to care for people with dementia if they displayed behaviour that challenged.

The building was purpose-built and was designed to meet the needs of people with dementia. More work was required with regard to signage and decor to maintain the independence and orientation of people with dementia.

We found there was not enough cooperation with outside agencies to help make sure all the needs of people with dementia were met.

We found although there was a quality assurance system in place it did not effectively monitor the quality of care to people with dementia.