The inspection took place on 17 October 2017 and was unannounced.

Brooklands Nursing and Residential Home provides residential and nursing care for up to 70 older people. The service is delivered over three floors one of which is dedicated to people living with dementia. At the time of this inspection there were 64 people living in the home. It is purpose built and all floors are serviced with a lift. A number of communal areas are available to those living there as well as an enclosed and accessible garden.

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 service had procedures in place that minimised the risk of employing people not suitable to work at Brooklands Nursing and Residential Home. New staff received an induction and spoke of being well supported in their roles. Training was delivered that met the needs of those people who used the service.

Staff morale was good and people benefited from receiving support from staff who were happy in their roles. Staff felt valued, included and listened to. Good team work was evident and this benefited those that used the service. The home was welcoming and friendly and we saw that it ran smoothly and efficiently. There were enough staff to meet people’s individual needs.

Care and support was delivered in a professional, considerate and compassionate manner. People’s dignity, privacy and confidentiality were maintained and choice was encouraged and supported. Staff understood the importance of ensuring people were in control of their own decisions.

Procedures were in place to help protect people from the risk of abuse. Staff had knowledge of how to prevent, protect and identify potential abuse and all had received training in this. The management team liaised with the local safeguarding team as required and reported concerns, as instructed by law, to CQC.

The risks to individuals had been robustly identified, managed and reviewed and staff had knowledge of these. Risks relating to the environment, equipment and working practices had also been appropriately managed and mitigated. Accidents and incidents were recorded and used to minimise future risk. People received their medicines as the prescriber intended and the service followed good practice guidelines. Medicines records were accurate and complete.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service adhered to the principles of the MCA and the care delivered reflected this.

People received care and support that was individual to them and staff knew their needs and preferences well. Care plans were person centred and demonstrated that people had been involved in the development of them. They considered the person throughout.

People enjoyed the activities the service provided and told us they met their needs. The service had recognised the need for more activities and was recruiting new staff to support this. Staff knew the people they supported well and had built trusting, respectful relationships that used humour as appropriate.

The healthcare professionals we spoke with talked positively about the way the service met people’s health and welfare needs. The people who used the service, and their relatives, agreed. People had prompt and appropriate access to health care and the service was proactive and preventative in their approach to this.

People’s nutritional needs were met and they had enough to eat and drink. They told us they had choice and that they enjoyed the food provided. The service had recognised the importance of social interaction over food and encouraged and supported this.

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We carried out an unannounced comprehensive inspection of Brooklands Nursing and Residential Home on 15 and 16 November 2016. Breaches of legal requirements were found. After the comprehensive inspection, two warning notices were served relating to the management of medicines and the governance of the home.

We undertook this focused inspection in March 2017 to check that the service had met the warning notices and whether they now met legal requirements. This report only covers our findings in relation to the warning notices. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brooklands Nursing and Residential Home on our website at www.cqc.org.uk.

Brooklands Nursing and Residential Home provides care and support for to up to 70 older people, some of whom may be living with dementia or requiring nursing care. The home is over three floors with the top floor dedicated to providing support to those living with dementia. At the time of this inspection, there were 60 people living in the home.

There was a manager in post although they had not yet applied to register 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. The manager had only been in post for a few weeks prior to our inspection. However, the manager had worked for the provider for a number of years and had previously managed the home.

At the last inspection carried out in November 2016, we asked the provider to take action to make improvements in the management of medicines and governance of the home. These actions had been completed although a period of sustained improvement is required in order for us to have confidence that these changes have been imbedded into everyday practice.

The service had an effective system in place to assess and monitor the quality of care people received. This system helped to drive development and improvement in the service which was noted at this inspection.

A system was in place to ensure people’s medicines were obtained in a timely manner to ensure they received them as prescribed. Additional audits were in place to monitor this.

A number of audits had been introduced since our last inspection and these helped to monitor the standard of care delivered. These included audits around fire prevention and management, care plans, staffing levels and the competency of staff to perform their roles effectively.

At this inspection, sufficient improvements had been made by the service and they were no longer in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 15 and 16 November 2016. The first day was unannounced.

Brooklands Nursing and Residential Home is a service that provides accommodation, personal and nursing care for up to 70 people. The home is split over three floors, one of which is dedicated to providing care to people living with dementia. During the inspection visit, there were 67 people living within the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the home is run. The registered manager was not present during our inspection.

At the last inspection on 14 May 2015, we asked the provider to take action to make improvements in respect of the quality of care that was provided to people. At this inspection, we found that the necessary improvements had not been made. People’s medicines were still not being managed safely and risks to people’s safety in the event of a fire had not been managed effectively. The systems in place to assess, monitor and reduce the risk of people receiving poor care were not always effective. You can see what action we have told the provider to take at the back of our report.

There were enough staff to meet people’s care needs. However, they were often very busy and therefore did not always have time to spend with people interacting with them or providing them with stimulation to enhance their wellbeing.

Systems were in place to protect people from the risk of abuse. Staff had received training and this was monitored to make sure it was up to date. Most staff were kind, caring and compassionate. However, some staff demonstrated poor practice which resulted in some people not being treated with dignity and respect.

Staff provided people with choice so they could make decisions about how they wanted to be cared for. People’s individual care needs had been assessed and were being met.

People had access to a good choice of freshly prepared meals and snacks. Staff sought advice from other healthcare professionals and acted in a timely manner when they identified any concerns about people’s health.

The staff requested people’s consent before they provided them with care. Where people were not able to give consent, the staff made sure that they took any decisions they made on their behalf in the person’s best interests.

There was an open culture where people and staff could raise concerns if they wanted to. Staff were happy working in the home.

The provider had identified that they wanted to improve the quality of care being provided to people living in the home, the ultimate aim of which was to improve people’s quality of life and wellbeing. The chefs had received external training in how to improve the food people were offered. Improvements were planned which involved staff receiving further training regarding supporting people living with dementia and making changes to the environment.

Brooklands Nursing & Residential Home is registered to provide accommodation, nursing care and personal care for up to 70 older people. The home is on three floors, the upper floor provides care and support specifically to people living with dementia. There are various communal areas for people to sit and meet with relatives. There were 63 people living at the home at the time of our inspection.

This unannounced inspection took place on 14 May 2015. At a previous inspection on 31 July 2013 we found the provider was not meeting all the regulations that we looked at. We found concerns in relation to care and welfare of people. The provider sent us an action plan detailing when the improvements would be made by. At a further inspection in December 2013 we found that improvements had been made.

At the time of this inspection the home had a registered manager. 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 and associated Regulations about how the service is run.

Staff treated people in a way that people preferred. Staffing levels were not adequate to the needs of people who used the service to ensure they received care and support when they needed it.

Medicines were not always managed safely and some of the records were not accurate so it was unclear whether medicines had been administered.

Ineffective quality assurance systems were in place to monitor the service and some audits did not pick up any trends and identify any learning from incidents.

Staff respected people’s privacy and dignity and asked for their consent before providing personal care.

People were offered a limited variety of hobbies and interests to take part in and people were able to change their minds if they did not wish to take part in these.

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 the report.

We conducted this inspection to follow up concerns identified at our previous inspection which was carried out on 31 July 2013. These concerns related to care plans not being reviewed on a monthly basis on the 'Treetops' floor and to problems with the application of a nutritional screening tool and a dementia toolkit.

As a result of the July 2013 inspection we required that the provider supply us with an improvement action plan, which we received. This plan told us what improvements would be made and when they would be completed by. This inspection established that improvements had been made.

In July we identified that care plan reviews, due monthly, had not been completed for two months for 9 of the 14 people living on the top floor of the home, known as 'Treetops'. During this inspection we reviewed a sample from 'Treetops' and the other two floors and found that all care plan reviews were up to date and complete.

A new care plan format had been introduced at the time of our previous inspection. The new documentation utilised MUST (Malnutrition Universal Screening Tool). However, the new format was not familiar to staff as it did not follow the original methodology to assess risk. This had caused confusion and the new methodology was not being fully adhered to. This inspection established that guidance had been given to staff about the implementation of this screening tool.

Implementation of the dementia toolkit had been put on hold.

We spoke with 12 people living at Brooklands, all of whom were very complimentary about the home. One person told us, “My daughter visited the home before I came here and all that she was told has happened for me, so I am in a happy place.” Other people said, “I need help with my personal care and I have a female carer, because I was asked if I wanted a male or female carer to assist me.” “This is my home and I feel happy here.”

We found written consent within people’s care plans to show that either they, or their family members, had agreed with and were happy with the care plans in place.

Detailed risk assessments and care plans were in place. However, some had not been reviewed in recent months. The provider had introduced new care record formats. Two areas that required further improvement were the MUST (Malnutrition Universal Screening Tool) that is used to assess the risk of possible malnutrition and a dementia toolkit that needed further consideration and staff training in order to implement them effectively.

The premises and gardens were well maintained and clearly appreciated by people living at Brooklands. One person told us, “Nice summer days as we have been having makes going into the garden a real treat.”

We were satisfied that the recruitment processes in place meant that staff employed were of good character. Subsequent checks and audits demonstrated that staff suitability was kept under review.

During this inspection visit on 15 May 2012 we spent a lot of the five hours in the home listening, asking questions and observing the interactions between the staff and people who live in the home.

The comments we received from people who use this service and their family members were very positive. We were told how good the staff team were. How the meals were usually good. That the care team were competent in carrying out their roles and that the rooms were kept very clean and free from odours by the housekeeping staff.

Comments such as,” I would not want to live anywhere else”, and “I looked at lots of homes before moving here. I would not want to live anywhere else”. The girls and lads are great. I get all the support I need and the manager is easy to talk to” were just some of the many positive remarks made.

Throughout the day we were also given positive signs from those people who were living with dementia and unable to verbally tell us their thoughts. We saw relaxed expressions, smiles when interacting, appropriate tactility and activities that were enjoyed. People were dressed appropriately and looked smart in appearance.