This inspection was carried out on the 8 and 10 October 2018 and was unannounced.

Brownlow House is a ‘care home’. 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.

Brownlow House is registered to provide accommodation, support and personal care for up to 31 people. The home provides support for people living with dementia, have a mental health issue and people who have had a history of abusing alcohol.

At the time of our inspection 29 people were living at Brownlow House. Brownlow House is an older building with three floors, accessed by a lift. People used shared bathrooms on each floor. There is a dining area, main lounge and two smaller lounges which are quieter. There is a large well-tended garden to the rear of the property.

Brownlow House was last inspected in August 2017 where we found a breach in regulation 12 as medicines were not always managed safely. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well led to at least good.

At this inspection we found medicines were now safely managed and administered as prescribed. Detailed guidelines were in place for medicines that were not routinely administered and staff recorded when thickeners were added to people’s fluids to reduce the risk of choking. We have made a recommendation for good practice guidelines to be followed for recording variable dose medication.

A registered manager was in place at Brownlow House. Since our last inspection the registered manager had also registered for a nearby sister home and was responsible for both homes. 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 this inspection we found breaches in regulations for good governance, premises and staff training.

Between December 2017 and May 2018, the registered manager had not had full oversight of Brownlow House. They had spent the majority of this period at the sister home they are also responsible for.

Internal audits from May 2018 showed the home was cluttered, not clean and there was a smell of urine. The local authority visited in July 2018 and found the same issues. An urgent action plan was put in place and improvements were made. However, at this inspection there continued to be a malodour on the first and second floors. The provider had not acted in a timely manner to replace carpets in these parts of the home to manage the odour.

The registered manager had recently introduced additional quality assurance tools to monitor the service.

Pre-employment checks were completed. Evidence that gaps in two candidate’s employment histories was not available in the staff files on the day of our inspection. Undated interview notes explaining the gaps in employment for one person were sent following the inspection and we were told they had also been made for the other employee, but the service was unable to locate them. Existing staff received the training they required to carry out their role. However, new staff started working at the home before completing training and with minimal induction shifts to get to know people and their needs.

Our inspection in August 2017 found improvements had been made following our inspection in July 2016. However, the service had not been able to sustain these improvements with the issues with training for new staff and maintenance at the home again found at this inspection, as they had been in July 2016.

Care plans and risk assessments were in place that reflected people’s current needs

This inspection took place on the 16 and 17 August 2017 and was unannounced. The service was last inspected in July 2016 and was rated as requires improvement.

Brownlow House is registered to provide accommodation, support and personal care for up to 31 people. The home provides support for people living with dementia or a mental health issue. The home works with people who have had a history of abusing alcohol.

At the time of our inspection 29 people were living at Brownlow House. Twenty eight people had their own room and two people wished to share one room. Brownlow House is an older building with three floors, accessed by a lift. People used shared bathrooms on each floor. There is a dining area, main lounge and two smaller lounges which are quieter. There is a large well-tended garden to the rear of the property.

The service had a registered manager in place as required by their Care Quality Commission (CQC) registration. 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 registered manager was supported by a deputy manager.

At our last inspection we found two breaches of the Health and Social Care Act 2008 regarding medicines management and the maintenance and decoration of the home. Following this inspection the provider was required to submit an action plan to the Care Quality Commission (CQC) outlining how they would meet the regulations. An action plan was submitted for the breach in medicines management; however an action plan was not submitted upon request, regarding the maintenance and decoration of the home. The CQC wrote more formally to the provider, at their request, following their initial response to clarify for them the legal position in relation to the submission of action plans. A response to this was received and improvements implemented.

At this inspection we found improvements had been made within the home. Repairs had been completed, new carpets and flooring laid and rooms re-decorated. New furniture had been purchased for the lounges and people’s bedrooms. The doors on the lift at the home were damaged, although it had been passed as serviceable by a specialist lift company. Following the inspection the provider told us they were planning to replace or repair the lift doors.

People received their oral medicines as prescribed and the medicine administration records (MARs) charts were fully completed. We found prescribed topical creams were applied by the care staff but the MAR was signed by the senior staff. Where people had been assessed as at risk of choking thickeners were added to fluids. The staff did not sign a MAR or other chart to state that they had done this. The deputy manager said they would design and implement charts for topical creams and thickeners for staff to sign when they applied the cream or added the thickener to fluids.

Protocols for when ‘as required’ medicines should be administered were not always in place. Liquid medicines and creams were not dated on opening as per good practice guidelines.

People we spoke with said they liked living at Brownlow House and felt safe. They were complimentary about the staff team. People said the staff treated them with kindness and respect and knew their needs well. We heard and saw positive interactions between people and staff members throughout the inspection.

People said there were enough staff to support them within the home, but they were not supported to access the local community very often. The registered manager told us they ensured people were supported to attend medical appointments.

We saw the number of activities arranged within the home had increased since our last inspection. A weekly programme of activities was available and exte

This inspection took place on the 13 and 15 July 2016 and was unannounced. Brownlow House was last inspected in April 2014 and was found to be meeting all the regulations we reviewed.

Brownlow House is registered to provide accommodation, support and personal care for up to 31 people. The home provides support for people living with dementia or a mental health issue. The home works with people who have had a history of abusing alcohol.

At the time of our inspection 30 people were living at Brownlow House. Twenty eight people had their own room and two people wished to share one room. Brownlow House is an old building with three floors, accessed by a lift. People used shared bathrooms on each floor. There is a dining area, main lounge and two smaller lounges which are quieter. There is a large garden to the rear of the property.

The service had a registered manager in place as required by their Care Quality Commission (CQC) registration. 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 told us they felt safe living at Brownlow House and had no concerns about the care and support they received. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the registered manager would act on any concerns raised.

Existing staff received the training and supervision they required to be able to deliver effective care. Staff were supported to complete a nationally recognised qualification in health and social care. However we found new staff were not always provided with the mandatory training as soon as they joined the service. They were supported by experienced colleagues and the deputy manager was their mentor to guide them about the support people required.

A robust system of recruitment was in place to ensure staff were suitable to support vulnerable adults. We saw there were sufficient staff on duty to meet people’s daily needs. However the staff did not have time to organise regular activities for people or to support them to access their local community. Some people were independent and could go out of the home by themselves.

We saw medicines were administered by trained staff. However we saw that creams had not been dated when opened which meant people may be administered creams that had been open longer than the manufacturer’s instructions. The registered manager said all opened creams were returned to the pharmacy every four weeks. Two people had run out of ‘as required’ pain relief medicine. We were told the GP did not want to prescribe additional medicines; however this had not been recorded. Homely remedies were used when ‘as required’ pain relief had not been prescribed; however no homely remedies were available at the time of our inspection.This meant they may have been in pain and discomfort because the required pain relief medicines were not available. Guidelines for when people needed ‘as required’ medicines were being written during our inspection.

We found the home to be in need of maintenance and re-decoration. The home was clean. One bedroom had a malodour; all other areas of the home were free from odours. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were in place for fire systems and equipment.

People told us they received the care they needed. Care records were personalised and identified risks and people’s needs. Guidance for staff was included in the care plans. Information about people’s background, likes and dislikes were recorded in a

Our inspection team was made up of one inspector. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and well cared for.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Consent was sought before any intervention was carried out. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Comments made were positive about the service.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People were actively involved with their local community.

People were aware of how to make a complaint about the service.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The people who used the service were happy with the care they received and had no complaints to make. We observed staff treated people with respect and people appeared relaxed in their company. Their comments included:

“The carers are good to me. I’m looked after very well. My brother picks me up every Wednesday to go to his house, and he thinks this is a good place for me to live.”

“They look after me well. I can go out when I want to. I have nothing to complain about. I couldn’t wish for a better place.”

“I know what’s going on, the staff tell me, and I can join in with any activities if I want to. They are really good to me.”

A relative of one of the people who used the service said, “My relative gets on really well with the staff. They show that they are concerned about her.”

People’s care needs were recorded in an individual plan of care. This was reviewed regularly to ensure it accurately reflected people's current care needs. A range of helath care professionals were consulted with to ensure people's holistic care needs were met.

A complaint procedure was available so the people who used the service knew what to do if they were unhappy with the standard of care they received.

Some improvements needed to be made to the fabric of the building to ensure a more comfortable environment was provided for the people who used the service.

We spent time with six people who were living in the home. Three people told us about their views and experiences of Brownlow House. Overall, people expressed they were happy with the care and support provided to them. One person said “I’ve been here for four years now and it is great here. It is much better than when I lived in a flat on my own.”

We observed people eating their food at lunch time. People who needed assistance were appropriately supported by members of staff. The people we spoke with at lunch time told us they enjoyed the food. One person said “I like the food. We get a choice in the morning now of what we want to eat for lunch. It is usually ok.”

People told us there are often activities to do. One person said they liked to keep busy and enjoyed sometimes helping with tasks in the home, which they were supported to do by the staff.

We spoke to a number of people living at the home. One person living at the home said: “The staff are all really nice, they speak to me properly and treat me well.”

Another person told us: “I am very happy here. I have lived here a long time and it is very good. I get up and go to bed when I want and can decide how I spend my day.”

We were told by one person living at the home that: “The staff help me with all the things I can’t do for myself any more, they are really nice and friendly.”

Another person living at the home said: “I have no complaints about the way I am cared for here, and my family are very happy too.”