The inspection took place on 30 May 2017. Brookland House is registered to accommodate up to 3 people who require support with personal care. They specialise in caring for people with a learning disability who may also have associated needs in relation to conditions such as Autism. On the day we visited two people were living in the service.

Since the last inspection the service had a new registered manager in post. 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.

We met and spoke to both people during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures and sign language. We therefore spent some time observing people.

At the last inspection on 10 and 11 November 2015 we rated the service as Requires Improvement overall. This was because systems for recording and reporting incidents did not ensure people were safeguarded from abuse or unsafe practice. There was often a high use of agency staff, which meant there were times when people were supported by people who did not work in the home on a regular basis. There was no written induction programme for staff employed by the service and therefore no evidence to demonstrate how the registered manager had assessed new staff to be competent to work unsupervised in the home. Information on people’s care plan did not reflect the actual activities people were involved in. Care plans in relation to people’s health needs did not in all cases reflect the complexity of people’s needs or the type of support being provided. We found some gaps in the monitoring of records could mean people were not protected by the service. The registered manager undertook a monthly audit of how many incidents had taken place but did not in all cases have an overview of what had happened or a system for checking the action taken by staff was appropriate or safe. The provider sent us an action plan detailing how they would make improvements.

At this inspection we found improvements had been made.

People were encouraged and supported to make decisions and choices whenever possible in their day to day lives. A staff member said; “Things have improved so much, more regular staff and people go out more.” A relative recorded on a completed quality assurance questionnaire; “I think the overall service is very very good.”

People who lived at Brookland House were not able to verbalise their views and used other methods of communication, for example sign language or pictures to assist them, therefore people’s relative’s opinions were sought. There were quality assurance systems in place. Feedback was sought from relatives to assess the quality of the service provided. All significant events and incidences were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff.

People’s risks were well documented, monitored and managed to ensure people remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed while maintaining a healthy diet. People had input in preparing some meals and drinks.

People’s care records were detailed and personalised to meet their individual needs. Staff understood people’s needs and responded promptly when needed. People were not all able to be fully involved with their care plans, therefore family members and professionals supported staff to complete and review the care plans. Pe

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and management and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people’s support plans were being updated to ensure that the information was based on what people wanted and needed. This information was detailed and easily accessible to the staff team. We observed the care being provided and saw that staff had a good understanding of people’s needs and communication methods. Staff were able to use their knowledge and skills to support people promptly and appropriately when they became agitated or distressed. We observed that people who used the service had positive and trusting relationships with the staff team and this helped create a relaxed and happy atmosphere in the home.

Systems were in place to ensure that people’s health needs were closely monitored, and prompt action was taken when people became unwell or if health needs changed. Records confirmed that when a person lacked capacity to make decisions about their health the service had acted appropriately to protect their rights and to ensure their rights and best interests were protected.

Sufficient staffing levels were in place to meet people’s assessed needs and staff said they felt well supported by colleagues and management. The staff we spoke to had a good understanding of safeguarding and understood their responsibilities to protect the people they supported.

Although auditing processes were under review at the time of the inspection we still found that some records in the home were not completed as required. Incident reports had not in all cases been signed off by a manager, and the homes auditing processes had not picked up these gaps in a timely manner.

Is the service effective?

The staff we spoke to were knowledgeable about the people they cared for, and felt well supported in their roles. People's care plans were individualised and considered all aspects of their health and social care. The service monitored people’s health needs and liaised appropriately and promptly with healthcare professionals when required.

Is the service caring?

We observed that people appeared relaxed and happy within their environment. We saw that people looked to the staff to support them when they wanted help or if they were confused or distressed. Staff were familiar with the way people communicated and were able to use their skills and knowledge of each individual to provide reassurance and to prevent difficult behaviours from escalating.

Staff recognised the importance of enabling people to maintain contact with their family and other relatives. Records showed that the service supported people to visit their family as well as keeping family members informed of any important issues concerning their health and care needs.

Changes had been made to the management structure whilst the Registered Manager was absent from the home. The General Manager who was overseeing the service said that these changes would ensure that the staff continued to feel supported and to have someone to talk to at all times. Staff told us that they felt supported and that some recent changes had had a positive impact on the staff team and how people worked.

Is the service responsive?

Support plans were based on people’s individual health and social care needs. The service liaised regularly with external professionals and updated care plans to reflect any new guidelines or changes in need. Staffing levels were organised to meet the needs of individuals and these were reviewed regularly to ensure they remained appropriate and safe.

Staff we spoke to had a good understanding of people’s communication methods and were able to use their skills and knowledge of each individual to respond promptly and sensitively to any requests or changes in mood. We observed one person’s behaviour change as they finished a morning activity. We saw that staff recognised these changes in mood and sounds and responded quickly offering a music activity. This was clearly what the person wanted and resulted in them becoming calm, happy and settled.

All the staff we spoke to said that they would know what to do if they witnessed any poor practice or if they felt that a person was at risk of harm or abuse. Staff said they would not hesitate to report any concerns and felt that the service would act swiftly to ensure people were safe and protected.

We saw that people’s health needs were closely monitored and any changes or concerns were promptly addressed.

Is the service well-led?

Staff told us that they understood their roles and responsibilities and felt confident to seek advice from their colleagues and management.

At the time of the inspection staff were being supported by the general manager for the service who had been overseeing the running of the home during the temporary absence of the Registered Manager. All the staff we spoke to said that they had felt well supported during this time.

The General Manager said that part of their role during this time had been to review some of the systems and records in the home. This had included a review a people’s support plans and daily monitoring forms. We saw an example of an updated support plan, which included clear guidelines for staff about how people chose and preferred to be supported. The General Manager said that they would also be looking at how the service could further develop staff involvement in people’s support plans, particularly the planning and monitoring of activities.

We saw that a range of audits were carried out in the home to assess and monitor the quality of the service. This included the auditing of records, environment and people’s finances. However, we did find that there were some gaps in records, such as incident charts, which had not been signed off by management. In addition to this we found that the service did not have a system for monitoring and reviewing people’s activities and community involvement and staff did not in all cases have a clear plan for future training needs.

People using the service had a high level of care needs. This meant that it was difficult for people to tell us what they thought about the home and the care they received. We spent time in the home speaking to staff, looking at records and observing the care being provided. We also spoke to relatives who were visiting the home at the time of our inspection.

A relative we spoke to said “Staff have a good understanding of people’s needs” and “I am kept well informed as we discuss what is in X best interests, such as holidays”

We saw that staff had a good understanding of how people communicated and used this knowledge to encourage people to make choices when possible.

Some of the information relating to people’s behaviours was not sufficient in detail to ensure that behaviour was managed appropriately and safely.

People were supported to lead an active lifestyle. On the day of our visit one person was enjoying the sunshine in the garden and another person went out for a walk and lunch with staff.

Staff we spoke to said that they felt well supported by their colleagues. Records confirmed that new staff had undertaken a thorough induction programme, which prepared them sufficiently for their role within the home. One staff member said “I am still learning, but the induction gave me the information and skills I needed to support people when I first started”

Parts of the environment were in need of updating and repair.

People using the service had a high level of care needs. This meant that it was difficult for some people to tell us what they thought of the home and the care they received.

We spent time in the home speaking to staff, looking at records and observing people while they were being supported by staff.

During our visit we saw that staff treated people respectfully at all times. The staff had a good knowledge of people’s needs and how they communicated, and used these skills to encourage people to make choices whenever possible.

The management and staff were aware of people’s rights and we saw examples of when meetings had taken place to ensure that decisions were being made in people’s best interests.

Information about people’s needs was clearly documented and step by step guidelines were available to staff to ensure that support was provided in a way that was consistent and safe.

Sufficient staffing levels were in place to ensure that people’s social and leisure needs were met. People were supported to maintain positive relationships with their relatives and visits home were planned and supported by staff.

Systems were not in place to formally review peoples care plan arrangements or to ensure that the environment was maintained to an appropriate standard at all times.

None of the people living in Brookland House were able to communicate with us but we did meet both the people currently living in the home. We also observed some of the interaction between them and the staff working in the home. This was for only short periods due to the needs of both people who could become upset or challenging with an unknown person sat with them. We were able to sit and hear interaction between the people living in the home and the staff due to the home being a domestic home.

During our visit we observed and heard people enjoying their activities, going about their everyday routines and interacting positively with the staff supporting them.

We read two relative surveys sent to the home and no issues of concern were raised on either. All sections of the survey were ticked appropriately.

The inspection took place on the 10 and 11 November 2015 and was unannounced.

Brookland House provides accommodation and support for up to three people. On the day of the inspection two people were living at the home. Brookland House provides care for people with a learning disability who may also have associated needs in relation to conditions such as Autism.

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 2008 and associated Regulations about how the service is run.

Since the last inspection in November 2014, some improvements had been made to the quality of the service. We saw parts of the home had been decorated and renewed and this provided a safer and more comfortable environment for people who lived there. The recruitment process had been improved to include more robust checks of agency staff, and temporary staff. This helped further ensure people were supported by staff who were safe and fit to work in the service.

At this inspection we found systems for recording and reporting incidents and accidents did not keep people safe. The process for documenting incidents and the auditing of this information by management did not allow for analysing and learning from incidents and did not ensure correct reporting procedures were followed.

Staff told us there were always enough staff to meet people’s daily needs such as washing and dressing. Staff rotas confirmed staffing levels as agreed between the Local Authority and the service were in place. However, all the staff we spoke to expressed concern about the high use of agency staff and frequent changes in the staff team. Staff told us people needed support from staff who knew them well and who worked with them on a regular basis. They said without this consistency episodes of difficult behaviour would often increase, which was potentially unsafe. Staff said people would often choose not to go out or do an activity with staff they were unfamiliar with, which meant their needs may not always be met.

We saw people enjoying activities in the home and staff said they tried to take people out each day. However, staff said it was not always possible to take people out due to inconsistencies in the staff team. Daily activity records did not provide a clear picture about how activities were planned or analysed to help ensure they continued to meet people’s needs.

People’s health needs were monitored closely and support was provided when people needed to attend routine or emergency health checks. However, some of the information in people’s health records did not provide sufficient detail about the support people needed to attend health appointments. The absence of this information could mean people would not receive the appropriate help when being supported by staff who did not know them well.

Staff said they were well supported by the registered manager and colleagues. However, there was no formalised induction programme for new staff employed by the service and therefore no evidence to demonstrate how the registered manager had assessed new staff to be competent to work unsupervised in the home.

It was apparent from speaking to the registered manager that he cared, and was passionate about the people who lived at Brookland House. Regular checks were completed to ensure the on-going quality of the service. Since the last inspection changes had been made to the management structure, which had resulted in clearer and more formalised roles and responsibilities for the staff team.

People were treated with respect and staff were compassionate and caring. Staff were friendly, patient and discreet when providing support to people. We saw many positive interactions where staff supported and enhanced people’s well-being. Relatives told us the staff were kind and thoughtful. Comments included, “The staff are caring, I am happy with the care and support provided and as far as I can see, [….] is happy too. Staff said they felt all the staff team had people’s best interests at heart.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff told us they undertook training and understood the importance of safe administration of medicines.

People were supported to maintain a healthy and balanced diet and any needs associated with their diet and health were understood by the staff supporting them.

CQC monitors the operation of the Deprivation of Liberty Safeguards, (DoLS) which applies to care homes. We spoke to the registered manager and staff about their understanding of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. The registered manager and staff recognised the need to support and encourage people to make decisions and choices whenever possible. We saw relevant applications had been made to the local authority when the service had assessed they could be depriving a person of their liberty.

People’s relatives and friends were able to visit at any time. Staff recognised the importance of people’s relationships with their family and promoted and supported these contacts when appropriate.

We saw that staff regularly checked with people to see if they were happy with the care and support being provided. We heard staff saying, “Are you ok?” and “Are you happy”? Staff were familiar with people’s changes in mood and behaviour, which could indicate people were unhappy or needed reassurance. A formalised complaints system was in place and the organisation responded appropriately to any complaints or concerns raised about the service.

We found 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 the report.