The inspection took place on the 18 September 2018 and was unannounced.

Brookfield Residential Home is registered to provide accommodation for up to 29 older people. There were 29 people, some living with dementia, at the home at the time of the inspection. It is situated in a residential area of Alverstoke. The home is an adapted building with single occupancy bedrooms provided over two floors. A passenger lift provides access between the floors. There are three communal lounges, two dining rooms and appropriate toilet, bathing and shower facilities. At the front of the home there is a non-enclosed garden adjacent to the car park.

Brookfield Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Effective quality assurance process had not identified areas for improvement found during this inspection and most quality monitoring was informal. Risks to people were not always managed effectively as not all risks had been assessed and staff did not always follow actions required to minimise risks. Some medicines were not always managed safely and systems to protect people for the prevention and control of infection were not always followed.

The manager took immediate action to assess and manage the areas of concern around risks which we identified to them.

The premises and equipment were safely maintained. Incidents or accidents were reviewed and action taken to reduce the likelihood of any reoccurrence.

Sufficient numbers of care and ancillary staff were deployed to meet people's needs. Checks were made to ensure staff were suitable to work in a care setting. Staff were trained and supervised and felt supported and valued.

People's nutritional needs were assessed and people were supported to eat and drink. There was a choice of food. Health care needs were monitored and referrals made to other services to ensure there was a coordinated approach to people's care.

People were treated with kindness, respect and compassion. People's privacy and dignity were promoted. People were supported to have choice and control of their lives and staff promoted independence where possible.

Care and support were centred on the individual needs of each person and staff responded promptly when people's needs changed. People and external health professionals were positive about the service people received.

Staff supported people to receive end of life care that helped ensure their comfort and their dignity.

Activities were provided seven days per week offering a range of mental and physical stimulation.

There was an effective complaints procedure and people and their relatives confirmed they were listened to and changes made when requested.

Staff were organised, motivated and worked well as a team. They felt supported and valued by their managers.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an unannounced inspection of this home on 9 March 2016. Brookfield Residential Home provides accommodation and care for up to 29 older people some of whom live with mental health conditions or dementia. Single room accommodation is arranged over three floors of the home. Lift access is available throughout the home and there are several communal areas inside and outside the home which can be accessed by people. At the time of our inspection 25 people lived at the home.

The registered provider for this location was an individual registered with the commission to provide this service. 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 who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes to recruit staff were in place which ensured people were cared for by staff who had the appropriate checks and skills to meet their needs. Staffing numbers were sufficient to meet the needs of people.

Medicines were administered, stored and ordered in a safe and effective way by staff who had received appropriate training.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People’s nutritional needs were met in line with their preferences and needs. People who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

A complaints process was in place and people new how to use this, although the home had not received any recent complaints.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People, their relatives and staff spoke highly of the registered provider and manager who were very actively involved in the home. Audits and systems were in place to ensure the safety and welfare of people.

There were twenty six people living in the home at the time of our visit. We spent time with people in their private bedrooms, in communal areas during coffee time and during an activities session. People that use the service told us they were happy living in the home and comments included. “For me it is perfect. The staff are very good, very kind and if I am feeling off colour they call the doctor for me."

Processes were in place that ensured that people were supported to make informed choices about the care and support they received.

People had their individual needs and wishes recorded in a plan of care that was kept under regular review. Risks to people's safety were assessed and recorded.

We spoke with staff and reviewed records which showed us that people were protected from risk of abuse. Staff had received safeguarding training and were aware of their responsibilities.

The staff team were well supported and received regular supervision and appraisal. They received training relevant to their role.

Complaints and concerns were recorded, investigated and fed back to complainants in a timely manner.

Comments from two healthcare professionals that spoke with us included. “The care provided is always excellent. The manager knows the needs of residents well and they are very caring and supportive to people."

Brookfield is a home for older people and they are registered for up to 29 people. On the day we inspected there were 28 people living at the home, many of whom had memory impairment and or a mental health diagnosis. During our visit we spoke with four people who live at the home, three visitors, three staff and the manager. People told us they were able to give their opinion, for example about the food and they felt they were respected and the staff listened to what they said. “Staff tell me what is for lunch and if I do not like it then they make me something else, nothing seems too much trouble for them”. A relative told us, “We have been concerned about our relative’s health and how they were settling here; staff have kept us informed of any concerns”.

Staff we met on the day told us about the training they had attended recently and that they were able to speak openly with the manager and provider about any concerns.

As not everyone who lived at Brookfield was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent 30 minutes in the lounge and a further 15 minutes in the dining area. We saw that the staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or needed something.