About the service:

• Brownhill Care Limited is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

• This service provides rehabilitation and support to people with mental health care needs. Approximately half the people using the service also have a mild learning disability and behaviours that might be considered challenging. The service specialises in helping adults with mental health care needs develop the necessary independent living skills to ‘step down’ and live in accommodation where they will need ‘less support’. The service is registered to support 14 people in two seven bedded adapted houses that are connected via an internal door. At the time of our inspection 14 people were using this rehabilitation service.

People’s experience of using this service:

• At this inspection the evidence we found continued to support the overall rating of ‘Good’.

• People were supported to take their prescribed medicines safely and when they should.

• However, although the service ensured people received their prescribed medicines as intended, which included more general ‘as required’ medicines; staff did not have easy access to sufficiently detailed guidance about when and how to use ‘as required’ PRN medicines safely.

• We discussed this medicines records issue with the registered manager who agreed to introduce guidance for staff regarding the safe use of ‘as required’ medicines. Progress made by the provider to achieve these stated aims will be assessed at their next inspection.

• Most people told us they continued to be satisfied with the support they received from the service. This quote we received from a person using the service summed up how most people felt, “I want my own place and don’t want to be living here, but its fine for now, and at least the staff are all nice.”

• People received support from staff who were kind and compassionate. Staff treated people with dignity and respect their privacy.

• People were encouraged and supported to develop their independent living skills with the long-term aim of moving on.

• The service had safeguarding procedures in place and staff had a clear understanding of these procedures.

• Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met.

•Appropriate staff recruitment checks took place before staff started working for the service.

• There were enough staff available to meet people’s support needs.

• The service had procedures in place to reduce the risk of the spread of infection.

• Staff routinely sought the consent of the people they supported ensuring they had maximum choice and control over their lives.

• Assessments of people’s support needs were carried out before they started using the service.

• Staff were suitably trained and supported to meet people’s needs and wishes.

• People were supported to maintain a nutritionally balanced diet.

• People received the support they needed to stay healthy and to access physical and mental health care services as and when required.

• Staff met people’s spiritual and cultural needs and wishes.

• People’s care plans were personalised and routinely reviewed to ensure they remained up to date.

• People had been consulted about their support needs and involved in helping staff develop their care plan.

• People were supported to participate in meaningful activities at the service and in the wider community that reflected their social, educational and vocational needs and interests.

• People were supported to maintain relationships with their relatives and other people that mattered to them.

• People's concerns and complaints were dealt with by the provider in an appropriate and timely way.

• People nearing the end of their life received compassionate and supportive care fro

This inspection took place on 14 July 2016 and was unannounced. Brownhill Care Limited is registered to provide accommodation for up to 14 people who require support with their mental health needs. At the time of the inspection there were 13 people living at the service.

The last time we inspected this service in September 2015, they were rated requires improvement. We found a breach of regulations related to meeting nutritional and hydration needs. Staff provided people with access to food and drink to meet their needs. The service sent us an action plan that described the actions they would take to meet the regulations.

We undertook a comprehensive inspection to follow up on the action plan and to check that the service now met the regulations. At this inspection we found the registered provider took actions to make improvements to the service and met the regulations we inspected. People had access to a small kitchen and the main kitchen when they chose to make meals, snacks and drinks for themselves. People had an individual risk assessment to assess whether they could use the kitchen independently and safely. The deputy manager had arranged for people to have a key to access the kitchen.

The service has 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 deputy manager provided daily management support to staff and people using the service.

Staff protected people from harm and abuse. Staff demonstrated their understanding of the signs of abuse and knew how to raise an allegation of abuse with the local authority safeguarding team. The registered provider had safeguarding processes and procedures in place to support staff to keep people safe from harm and abuse.

Risks to people were identified with the support from staff. Risk assessment management plans were developed to support people and staff to manage those risks to ensure people were kept as safe as possible.

There were sufficient numbers of staff available to meet people’s support needs. The staff rota showed that there was enough staff on duty during the day, evening and night shifts to care for people. The service had a robust recruitment process in place and had recently recruited new staff to support people. Once their pre-employment checks were complete the new staff will be allocated shifts and working with people.

The management and administration of people’s medicines were safe. People received their medicines according the prescriber’s instructions. People had regular reviews of their medicines to ensure they were appropriate to maintain their health. Staff had systems in place to re-order medicines on a regular basis to avoid medicines running out for people. Staff carried out safe administration, storage, and disposal of people’s medicines.

Staff were supported by the registered manager. Staff had access to regular training, supervision and appraisal to support them in their caring role. The registered manager supported staff to undertake training that was relevant to their role and improved their knowledge on how to care for people effectively. Supervision and appraisal meetings supported staff to identify their training and professional development needs.

People were supported to provide consent to care and support they received. Care records were recorded in a way which people were able to understand. People signed their care records to demonstrate that they understood their assessments and associated care and support in place for them. Staff were aware of their role and responsibilities in providing support to people within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s heal

We carried out an unannounced comprehensive inspection of this service on 18 November 2014. We found two breaches of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the management of medicines but they failed to tell us how they would improve with people’s nutritional needs.

We undertook this focused inspection on 25 September 2015 to check that they had followed their plan and to check that they now met the legal requirement inspected. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brownhill Care Home on our website at www.cqc.org.uk.

At our previous inspection we found that medicines were not always managed and administered safely. There were unexplained gaps on the medicine administration records (MAR). People did not always have access to food and drink of their choice and they were restricted to what they can have.

At this our focused inspection, we found that people’s medicines were administered and managed safely.

The provider had not taken all necessary steps to ensure people had access to food and drink throughout the day and had food and drinks of their choices. The deputy manager told us that they had involved the dietician to in reviewing the menu.

Brownhill Care Home provides accommodation and support to 14 people with mental health needs. The service comprises of two houses linked to each other. It is located on a main street with easy access to shops and community facilities.

This inspection was carried out on 18 November 2014 and it was unannounced. The service was compliant in all outcome areas inspected at the previous inspection of 16 October 2013.

The service has a registered manager who has been in post for several years. 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.

Medicines were not always managed and administered safely. There were unexplained gaps on the medicine administration record (MAR) chart. This was a breach of Regulation 13 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.

People did not always have access to food and drink and they were restricted to what they can have. People could not always change their minds once they have made an order for food. The kitchen was locked so people could not easily help themselves with food and drink. This was a breach of Regulation 14 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.

People were encouraged to maintain their independence and were supported to develop their skills for daily living. People were involved in activities of their choice within and outside the service to enable them learn new skills, for example computer skills.

Staff understood the needs of the people they supported. They had knowledge of the preferences, likes and dislikes of the people using the service. Assessments took place to identify people’s support needs and there were support plans which showed how people wished to be supported to achieve their goals. People had keyworkers (staff responsible for their day-to-day care and support). People had regular sessions with their keyworkers to discuss and develop their care and support.

Staff were able to recognise signs of potential abuse and knew and understood the reporting processes to keep people safe. Risks to people were identified and plans were in place to manage them.

The staffing level was sufficient to meet people’s needs. There were processes in place for responding to emergencies and staff knew about these. Incidents and accidents were reported appropriately and further actions taken to ensure learning.

People were supported to access healthcare services to ensure they got the specialist support they required to manage their physical and mental health needs. Any concerns regarding a person’s health and well-being were discussed with the relevant healthcare professional including the person’s GP.

Staff had the skills and knowledge to support people. Staff received regular training and were supported by the managers through supervision and appraisal processes.

There were processes to gather the opinions of people using the service, staff and visiting professionals about the quality of service provided. Appropriate action was taken, where there were areas that required improvement. The management team were visible and approachable.

At the time of our inspection on 16th October 2013, there were 14 people accommodated at Brownhill Care Limited. Four of them wanted to speak with us and share their experiences of the home. People told us they liked living in the home. They all spoke very well of the staff. One person told us, "I can talk to the staff and they never tell me to go away or anything." People told us there were enough staff on duty during the day and that they felt safe with the two waking night staff. They said that there were plenty of activities available and that staff were kind and helpful.

The home was found to be suitably maintained, clean and arrangements were in place to monitor the environment.

The people we spoke with said they were involved in decisions about their care and they consented to care and treatment. Care was delivered in a way that ensured people's safety and welfare.

There were effective recruitment procedures in place to ensure that only suitably skilled and experienced staff were employed.

We saw examples of ways in which the providers had changed the way they delivered care to accommodate individual needs of residents as well as changes following learning from untoward incidents.

At the time of our inspection on 22 August 2012, there were 12 people accommodated at Brownhill Care Limited.

Five of the residents were on a day trip outing to Brighton, which had been organised by the home. The other residents had not wanted to go along on the day trip.

Three of the remaining residents wanted to speak with us and share their experiences of the home.

People told us they liked living in the home. They all spoke very well of the staff.

One resident told us, "I get on with the staff very well. I can talk openly with them."

People told us there were enough staff on duty during the day, but some felt the service would benefit from additional night staff. One resident also told us it would be better if there was an additional staff member on each side of the home.

The home was divided into two areas. The first older area accommodated the male residents and one female resident, whilst the second area was newly opened at the end of 2011 and accommodated female residents. We found that the older part of the home was in need of repair. The premises, furniture and fixtures were old and worn.