This inspection took place on 20 and 21 November 2018 and was unannounced.

Brownhill lodge is a ‘care home’ providing residential care for older people with dementia. People in care homes receive accommodation and nursing or 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. Brownhill lodge accommodates up to 21 people. There were 18 people using the service at the time of our inspection.

At our last inspection of this service on 21 June 2016 the service was rated Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards. The last inspection rating of the service was displayed correctly in the communal area of the service.

The service had 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.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks.

The service had an effective system to manage accidents and incidents, and to prevent them happening again. The provider recognised people’s need for stimulation and social interaction. People had end-of-life care plans in place to ensure their preferences at the end of their lives were met. Staff completed daily care records to show what support and care they provided to each person.

The provider carried out comprehensive background checks of staff before they started working and there were enough staff to provide support to people. Medicines were managed safely and people were receiving their medicines as prescribed. Staff received medicines management training and their competency was checked. All medicines were stored safely. The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely.

The provider trained staff to support people and meet their needs. People told us that staff were knowledgeable about their roles and that they were satisfied with the way staff looked after them. The provider supported staff through regular supervision and yearly appraisal.

The registered manager and staff understood their roles and responsibilities under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards . People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before they were delivered.

Staff assessed people’s nutritional needs and supported them to maintain a balanced diet. Staff supported people to access the healthcare services they required, and monitored their healthcare appointments. The registered manager and staff liaised with external health and social care professionals to meet people’s needs.

People or their relatives, where appropriate, were involved in the assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, caring, and respectful. Staff protected people’s privacy and dignity.

The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary. The provider sought the views of people and

This inspection took place on 21 June 2016 and was unannounced.

Brownhill Lodge is a residential care home for up to 21 people. At the time of the inspection the service was providing support to 20 people.

The service did not have a registered manager at the time of the 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.

People in the service were safe because staff had the training and knowledge to identify abuse and take steps to protect people if they suspected they were at risk. Staff assessed people’s risks to ensure they were safe from preventable harm. People were assessed for their risk of pressure ulcers and action was taken when people’s skin integrity was threatened. There were enough staff available at all times to support people and they were recruited using robust procedures to ensure they were safe to work with potentially vulnerable people. Staff ensured that medicines were administered safely and that mobility equipment was safe to use.

People who lived in the service were safe because staff had received training to safeguard people from abuse. People’s risks of avoidable harm were managed by detailed and regularly reviewed risk assessments. People received medicines safely and their risks of infection were managed by good hygiene practices within the service.

People were supported by staff who were supervised, supported, appraised and trained. People gave consent to the treatment they received in relation to mental capacity legislation. People received nutritious food and were supported to access health and social care professionals whenever they were required.

Caring and kind staff delivered care and support to people. Staff respected people’s privacy and dignity and promoted their independence. People at the end of their lives were treated with compassion to ensure they had a dignified death.

People received personalised care based upon individual needs assessments. People participated in the development of their care plans which stated their preferences. The service offered a range of activities for people to choose from and participate in. The provider obtained and acted upon feedback from people and their relatives and dealt with complaints appropriately.

The service did not have a registered manager but the acting manager had commenced the process of registering with the regulator. The acting manager led the service well. The views of staff were sought and the service collaborated with local health, social care, cultural and religious organisations to meet people’s needs. There were robust quality assurance processes in place to drive improvements in the care and support people received.

Our inspection team was made up of one inspector. They answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with four people who used the service, the registered manager and three care staff. We also reviewed records relating to the management of the home which included four care plans and four staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us and the records we looked at.

Is the service safe?

Staff were knowledgeable in safeguarding vulnerable adults procedures and were able to recognise signs of potential abuse. The service had a system to respond to allegations of abuse and had details of the local safeguarding team.

The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted.

Is the service effective?

The staff had the skills and experience required to meet the needs of people who used the service. The team had access to training courses to update their knowledge and become familiar with any changes in policies or procedures.

The service undertook assessments with the person who used the service or a relative to identify their support needs.

Is the service caring?

People who used the service or a relative were involved in decisions about their care and support. Staff supported people and advised them, but allowed the person who used the service to make the final decision. Staff told us, "we always ask [people who used the service] what they want."

Is the service responsive?

The service liaised with other health professionals to meet the needs of people who used the service. People’s individual needs were assessed and staff were aware of their needs.

Is the service well-led?

The service was using the skills and knowledge of staff members to provide the required service to meet people's needs.

We saw evidence of staff meetings being held regularly and the staff we spoke with confirmed that they felt able to make suggestions and voice concerns.

There were processes to monitor and improve the quality of service delivery.

People using the service that we spoke with told us the care and support they received met their needs. One person told us, "They're very supportive. I've got used to the people here. I like to be among people, not on my own. If I was living on my own, it wouldn't be like this." Another person told us, "I've got used to it here although it was strange at first. It's alright. If I wanted anything, I expect they'd get it for me." Another person told us, "I find it very pleasant here."

There were effective systems in place to reduce the spread of infection including availability and use of gloves and aprons. The environment was kept clean and tidy.

There were appropriate arrangements in place to ensure medicines were managed properly in the home.

Our last inspection of 25 May 2012 found that appropriate levels of training in mental health and care of people with dementia was not provided for all care staff. The provider told us they would ensure their care workers and other staff attended a training day in dementia and other mental health conditions by 24 July 2012. When we inspected the service on 24 April 2013, we found that the training had been delivered as planned to the staff team.

Suitable arrangements were in place to monitor the quality of the service. This included regular audits, recording and responding to incidents, and holding meetings with people using the service and their representatives to obtain their views.

People we spoke with who used the service said they knew there was a care plan for them. Visiting relatives also said that they had been asked by the home about their relatives care needs and that they knew there was a care plan for staff to follow. Some people were not aware of what we meant by a care plan, but said they may have forgotten and that the staff did speak with them about their care needs regularly. They said they were very satisfied with their care, and the way that they were treated by staff. All said that they felt safe in the home.

People who lived there told us there was always a good variety of food on offer and, if they didn’t like something that had been cooked, they weren’t given it again.

Overall, the feedback we received from people who lived at the home was very complimentary about the way staff respected their rights and encouraged them to get involved in the running of their home. They said the staff knew what care was needed and they do things the way people who used the service wanted them to.

People told us staff enabled them to say what they felt and respected their privacy and dignity. They said that staff knew what they were doing and that they feel safe in the home. We observed staff to be respectful when speaking with people. People told us that they were asked about activities they would like to do, such as going out to the shops and church visits. People said that their families visited regularly and were made to feel welcome.