We inspected this service on 8 March 2017. The inspection was unannounced.

Brookfield Nursing Home is registered to accommodate persons who require nursing or personal care. The home offers care for up to 66 people. At the time of our inspection there were 59 people living at the Home. Brookfield supports older people who have nursing needs and people who are living with dementia.

At a previous inspection on 20 January 2016 we found the provider had not taken reasonable steps to ensure the administration of medicines were managed properly. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found that the provider had not acted in accordance with the principles of the MCA and associated code of practice. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the home had made significant improvements to address the areas of concern and bring the service up to the required standards.

The service did 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 2008 and associated Regulations about how the service is run. However, we saw evidence that the service was in the final stages of recruiting to this position.

People received their medicines as prescribed. Staff administering medicines checked each person's identity and explained what was happening before giving people their medicine. Medicines were stored securely and in line with manufacturer's guidance.

People were supported by staff who had been trained in the MCA and applied it's principles in their work. Staff told us, and records confirmed they had effective support. Staff received regular supervision (one to one meetings with their manager). Staff spoke positively about the support they received from their seniors and the provider.

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortified meals, these were provided by kitchen staff who clearly understood the dietary needs of the people they were catering for.

Staff understood people's needs and preferences. Staff were knowledgeable about the support people needed. Staff were kind and respectful and treated people with dignity and respect.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements. Following our last inspection the service had submitted an action plan outlining what actions they would take to address the improvements needed following a previous inspection. This had been submitted to the Care Quality Commission as required. During our inspection we saw that the actions in the plan had been completed.

We inspected this service on 23 May 2016. This was an unannounced focused inspection.

We had previously carried out an unannounced comprehensive inspection of this service on 20 January 2016 and found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. One of the breaches was in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not always protected from the risks associated with their care and treatment in relation to pressure ulcers. We also found people were not always protected against the risk of falls because they did not have a call bell within reach. As a result of this breach and the impact this had on people who lived at Brookfield, we rated the key question of ‘Safe’ as inadequate. We issued a warning notice telling the provider they must make improvements to meet the legal requirements in these areas by 5 April 2016. We undertook this inspection to check the service had made these improvements.

This inspection and report only covers our findings in relation to the prevention and treatment of pressure ulcers and the risk of falls if people did not have access to a call bell. We did not look at the whole key question relating to 'Safe’. We will review this during our next planned comprehensive inspection of the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brookfield on our website at www.cqc.org.uk

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.

The provider and registered manager had improved the system for the prevention and treatment of pressure ulcers. All staff had received training in this area. People's care plans had been reviewed and contained detailed risk assessments. Where risks were identified there were management plans in place to mitigate the risk. Staff followed the plans and completed monitoring charts to record how people's position was being changed to reduce the risk of pressure ulcers. These were up to date and there was a record of the staff input and care being carried out.

People had call bells in reach. Call bells were answered promptly and people were offered assistance in a timely way. Some people were unable to use a call bell. Staff had identified the risks to people who were unable to use the call bell. Care plans included details of how those risks would be managed and staff followed the care plans to ensure people were safe.

Staff had a better understanding of people’s needs. Communication between nursing and care staff had improved and they were working more effectively as a team.

We inspected this service on 20 January 2016. This was an unannounced inspection.

Brookfield is a care home providing nursing care for up to 66 people. At the time of our visit there were 63 people living at the service.

At a comprehensive inspection of this service in November 2014 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds with three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were in relation to the care and welfare of people, supporting staff, maintaining accurate care records and monitoring the quality of the service people received. The provider sent us an action plan to tell us how they would ensure the service met the legal requirements of the regulations. At this inspection in January 2016 we found improvements had been made. However, we also identified some other areas of concern.

People were asked for their consent before care tasks were carried out. However, staff did not fulfil their responsibilities under the Mental Capacity Act 2005 (MCA) because they had not always taken appropriate action where people might not have the capacity to consent to other decisions about their care.

People had a range of risk assessments in place. However, the service had not ensured people were always protected from the risks associated with their care in relation to falls, pressure area care and the administration of medicines.

People felt safe when being supported by staff. Staff were clear about the action they would take to keep people safe from abuse. People and staff were confident they could raise any concerns and these would be dealt with.

People told us there had previously been staff shortages but now felt there were enough staff to meet their needs. There had recently been new staff employed at the service. There were enough staff on the day of the inspection.

People told us staff were kind and caring. People looked well kempt and were dressed appropriately for the weather. People felt respected and valued. However, we noted some interactions that did not demonstrate people were always supported in a respectful way.

People were involved in their care planning. They were provided with person-centred care which encouraged choice and independence. Staff were aware of people’s preferences in how they wanted to be cared for. People were supported to maintain their health and were referred for specialist advice as required.

Some aspects of the service required improvement to ensure it always met the needs of people living with dementia. This was in relation to the activity provision and decoration of the units where people were living with dementia.

People enjoyed the food and were supported to have their nutritional needs met. People were complimentary about the food and were given choice and variety. However, people who remained in their rooms were not always supported to drink outside of mealtimes.

The home 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 2008 and associated Regulations about how the service is run. The registered manager was supported by an area manager.

People were complimentary about the registered manager. However, there was not adequate leadership on the individual units which resulted in poor communication and confusion over delegated tasks between nursing and care staff. This put people at risk of not receiving their care in a safe, effective or responsive way.

We have made a recommendation about leadership.

We found two breaches 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 this repo

In this report the name of a registered manager appears who was not in post and not managing the regulated 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.

We carried out this visit following non-compliance regarding respecting and involving people and the care and welfare of people. At this visit we noted that people with dementia did not always benefit from meaningful engagement and people were not always treated with dignity and respect. We found that the provider had taken appropriate action.

People were given choice and their choices were respected. Care workers, nurses and activity co-ordinators offered people choice over their care. People benefitted from meaningful engagement with care staff.

We spoke with four people and one person’s relative about how they were involved in their care. Everyone we spoke with told us they were involved in their care. One person said ‘’I’m very happy. I get choice of food, drink and activities. I was involved in choosing the lounge curtains”. People were complementary about the home and felt there had been a number of improvements to the care they received.

People were protected from the risks associated with their health and welfare because care workers were responsive to their needs. The provider acted on guidance received from occupational therapists and care workers were given clear guidance on people’s care needs.

In this report the name of a registered manager appears who was not in post and not managing the regulated 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.

People were not always treated with dignity and respect. For example, we observed two care workers and an activity co-ordinator providing one to one activities to people in a lounge on the dementia unit. We observed that these care workers talked over people and did not engage with people when they were talking.

People did not always benefit from meaningful engagement from care workers or nurses. For example, we observed one care worker sit with a person. While the care worker had a crossword book they did not engage with the person, did not talk to them or engage them. We saw that the care worker left the person without to talking to them.

Care workers and other staff were supported appropriately. We spoke with eight members of staff and looked at eight employee files. All staff had received regular supervision and an appraisal.

Accidents and incidents were managed appropriately. We looked at the home’s accident folder and saw all accidents and incidents were recorded and the provider took appropriate action.

We spoke with six people who used the service. When asked about consent they all said that care workers asked permission before administering care. One person said “oh yes, they always ask me if it alright to assist me”.

People did not always experience care, treatment and support that met their needs. The home provided a service for people with dementia, but did not always provide a service that met these people's mental health needs.

Care workers told us that the staffing levels allowed them to meet people’s needs. Another care worker told us, “sickness aside I would say we have enough staff”. We spoke to a nurse who told us, “I have the right number to do what we need to do”.

Care workers, nurses and ancillary staff received appropriate professional development. Care workers and the nurse we spoke with felt that they were supported by the provider and had access to both mandatory and, specific training and a structured supervision and appraisal programme.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. In April 2013 a catering survey was conducted for people who used the service. We saw this survey and noted that people had asked for more traditional and local food on the menu. As a result roast meals were put on the menu twice a week, and recipe’s such as 'bacon clanger' were included.

We made an unannounced visit to Brookfield, and looked at the care and welfare of people who use services. During our visit we were unable to get the views of most people who live at the home, because of different levels of complex needs, which meant some were unable to tell us about their experiences. However, we did speak to three people who lived at the service, and spoke with three families who were visiting the home. We spoke to six members of staff, and reviewed the home's records. We also observed people being given care, and observed activity during lunch and dinner at the home.

We found the home to be well decorated, clean and tidy. The manager told us that the home had "just been refurbished." We saw that resident’s rooms were clean and tidy, and that some residents had personalised their rooms. A resident who had lived at the home for some years told us, "things are much better here since MHA took over, the atmosphere is much lighter than it used to be." A member of a resident's family told us, "the staff have been very helpful and kind." Another resident told us "the staff help me to do as much as I can for myself.”

We inspected Brookfield care home on the 21 and 24 November 2014. This was an unannounced inspection. The previous inspection of this service was a follow up inspection carried out in December 2013. The service was found to be meeting all of the standards inspected at that time.

Brookfield is a purpose-built modern home that provides care for up to 66 people. At the time of our visit 61 people were living at the home. The ground floor was used to support people with general nursing needs and the first floor was used to support people living with dementia.

There was a registered manager in post at the service. 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 did not receive consistent care across the home. People living on the nursing unit were more satisfied with the care they received than those living on the floor for people with dementia. Our observations supported these comments. Nurses were responsible for planning the staffing across the home. However, there was no system to ensure the skills and experience within the team was shared across the home to ensure every person in the home benefited from safe, effective and compassionate care. We also found that there were systems in place to monitor the quality and safety of the service but they were not always effective.

Whilst staff received training, it was not always delivered in a way that supported staff to embed their learning into practice. Staff gave varying feedback on the support and supervision they received. Some felt well supported, but others told us the supervision and appraisal system did not support them to improve.

People and their relatives told us staff were kind and caring. Comments from people included, “they treat me well and are very caring”, “The care is the best thing about the home, they look after the patients”, “The staff have infinite patience, they are people that want to care”. However our observations didn’t always support these views. We observed interactions on the first floor dementia unit that were not caring.

People on the general nursing floor told us they felt safe and supported by staff. Care plans identified risks to people's health and welfare. Risk assessment and support plans were in place to enable staff to deliver care safely. However, on the floor for people with dementia when peoples support needs changed, risk assessments were not always updated to reflect this.

People told us the service was responsive. One person told us, “the service support me well, they know when I need the doctor”. Another person told us, “they are very responsive, they keep an eye on me through the day as well”. Staff recorded and monitored people’s health and wellbeing and sought appropriate healthcare professional support promptly when people needed it. People benefited from activities they could engage with. People enjoyed a quiz, playing board games and were also entertained by a guest singer.

Staff spoke positively about the team and the leadership. They described the registered manager and other senior staff as being supportive and approachable. Staff described a culture that was open with good communication systems in place. Staff were confident that the management team and organisation would support them to raise concerns. One person told us, “the home may not be perfect but it has come an awful long way under this leadership”.

We found that there were systems in place to monitor the quality and safety of the service but they were not always effective.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.