The inspection visit at Brooklands House Rest Home took place on 10 November 2016 and was unannounced.

Brooklands House Rest Home is a large detached residential home situated in an area of Lytham St Annes overlooking parkland. At the time of our inspection visit, there were 26 people at Brooklands House Rest Home who required accommodation with nursing or personal care. The home is situated on three floors accessed by a passenger lift and stairs. There are a range of aids and adaptations in place to meet the needs of people who lived there. There are outdoor seating areas to the front and rear of the home.

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.

At the last inspection on 27 October 2014, we asked the provider to take action to make improvements with regard to assessing and monitoring the quality of the service, consent to care and notifications. These actions have been completed.

During this inspection, we received comments that demonstrated people were extremely satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing an outstanding standard of care and support to people who lived at the home.

People, their relatives and health professionals consistently told us the care delivered was exceptional. We were told repeatedly during this inspection people felt the support from the registered manager and staff was extremely caring and their dignity and privacy were respected at all times. Staff spoke fondly of people they cared for. It was evident people mattered and staff had developed exceptionally positive, kind, and compassionate relationships with the people they supported. A regular visitor told us, “I see what goes on here, as far as I am concerned the care is excellent.”

Records we looked at indicated staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure and knew what to do should they witness any abusive actions at the rest home.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the home. This was confirmed from discussions with staff.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who lived at the home.

Staff responsible for assisting people with their medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and appropriate arrangements for storing medicines were in place.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

Care plans were organised and had identified the ca

This unannounced inspection took place on 27 October 2014.

Brooklands House Rest Home is run by Mr. Patrick Joseph Gilligan and Mrs. Carol Josephine Gilligan. There was a registered manager in place at the time of our inspection. 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.

We last inspected this service on 09 May 2013 and the home was found to be meeting all of the essential standards that we assessed.

Brooklands House Rest Home is a large detached residential home situated in a residential area of Lytham overlooking parkland. The home is situated on three floors accessed by a passenger lift and stairs. There are outdoor seating areas to the front and rear of the home. The sea front is within easy walking distance and public transport links are nearby. The home can cater for up to 30 people.

During this inspection we found the service had a locked front door, and people’s capacity to leave the building without asking the staff for help, had not been fully assessed in order to determine if their freedom to leave the building was not unfairly restricted.

This was a breach of Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010. In order to ensure the service complies with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, a registered person must ensure suitable arrangements are in place for obtaining, and acting in accordance with, the consent of people in relation to the care and treatment provided for them.

We found that more robust quality assurance and, where appropriate, governance systems were needed as audits and periodic checks on systems operated within the home were not frequently being made. The service provider did not have a system in place to analyse incidents and accidents such as falls and hospital admissions. Establishing such a system would assist the service provider to understand why incidents took place, and then put measures in place to minimise or eliminate the risks associated with providing care and support.

This was a breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010. The registered person must protect people against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems designed to identify, assess and manage risks relating to the health, welfare and safety, and the analysis of incidents that resulted in, or had the potential to result in harm.

This was a breach of Regulation 18 HSCA 2008 (Registration) Regulations 2009. We found that the service provider had not notified the Commission of a recent hospital admission where a resident had undergone treatment from healthcare staff. The registered person must notify the Commission without delay of all relevant incidents such as hospital admissions and incidents where residents require treatment from a healthcare professional.

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

People were supported to understand what keeping safe meant and were encouraged to raise any concerns they may have about this. Staff at the service understood that people's safety had to be balanced with people’s right to make choices and to take risks. However, people’s freedom to leave the home was potentially restricted. Staff recognised the important role that safeguarding people from abuse had in enabling people to live a positive life. The care and support offered to people at the home was personalised and put the person at the centre in identifying their needs and choices.

People received their medicines as prescribed, because they were stored, administered and disposed of safely, in line with current and relevant regulations and guidance.

Staff were provided with effective support and training. People told us they had enough to eat and drink throughout the day, and at night if required.

We spoke with a range of people about the home. They included the registered provider, acting manager, some of the staff members on duty and people who lived at the home. We also had responses from external agencies including social services in order to gain a balanced overview of what people experienced living at Brooklands Residential Home.

People were seen to be cared for in ways that suited them. We saw that people were given opportunities to inform staff of their personal support requirements. Staff were involved in assessing people's needs, and there were systems in place to monitor how those needs were met. One person told us, “It’s been a stressful time for me, but staff have been wonderful. They have helped me settle in”.

We observed some of the staff working alongside people in positive ways. This included, sitting with residents and helping them to carry out tasks, including crossword puzzles and talking with people on a one to one basis.

People living at the home told us that they felt safe. One person said that staff were always there when you needed them. Another person told us, "It is always the same, very relaxed with staff around.”

We visited this home unannounced on Thursday 19th April 2012. During the course of the site inspection we spoke individually with the assistant manager, a number of people living at the home, a visitor and staff on duty at the time of the inspection. Time was spent in the main lounge area where people spoke to us at various points of the visit.

People living at the home told us staff were respectful and treated them with dignity, one person said, "I can only say, they are very caring and have all the time in the world for us,” another said, "The staff are always around when you need them.” All the people we spoke to said good things about the way they were treated by all members of staff.

When asked, one person we spoke with said, "I feel safe and comfortable living here.” A relative told us that they felt their relative was, "Getting all the care they needed.”

Responses from staff and residents were all very positive and reflected how the home is run in the best interest of the people who live there. Other comments from people included, "I like the way I can do all the things I want to do and they encourage it.” Also, “It’s just a lovely place to live, I like my room and the staff are very caring.”