This unannounced inspection took place on 20 January 2017. Forest Brow Care Home provides accommodation and personal care for up to 32 people. On the day of the inspection, 31 people were using the service.

At our previous inspection of October 2013, the service met all the regulations we inspected.

There was a registered manager in post as required. A registered manager is a person who has registered with the 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 identified and managed risks to people’s health and safety. Staff followed guidance in place to manage the risks whilst respecting their rights. The registered manager monitored incidents and accidents and had put plans in place to prevent a recurrence. The lack of proper storage at the service meant that some equipment was not always stored appropriately. This could be unsafe for people with reduced mobility or who were at risk of falls.

People received the support they required with their medicines. Staff knew how to protect people from abuse. The provider used a safe process to recruit suitable staff. There were sufficient numbers of appropriately skilled staff on duty to meet people's needs.

Staff received training and support that enabled them to plan and deliver people’s support safely and competently. The registered manager carried out regular supervision and appraisal and took action to address any knowledge and skills gaps.

People gave consent to care and treatment. Staff supported people in line with the principles of the Mental Capacity Act 2005. People’s rights were upheld. Staff appropriately supported people whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards. The registered manager involved people, relatives and healthcare professionals to help people to make decisions that were in their best interest.

People had sufficient food and drink and enjoyed the meals provided at the service. Staff made referrals to healthcare professionals about people’s dietary needs and monitored their food and fluid intake as required. People accessed the healthcare services they required for advice, treatment and support.

Staff treated people with dignity and respect and provided their care and support in a caring and compassionate way. Staff knew people well and understood their communication needs.

People took part in activities they enjoyed at the service and in the community. Staff encouraged people to try new things based on their individual interests, hobbies, preferences and abilities.

Staff assessed and reviewed people’s needs regularly and managed their changing needs in a flexible way. Staff had sufficient guidance on how to deliver people’s care. People and their relatives, where appropriate were involved in planning for people’s care. People received their care and support as planned.

People and their relative’s views about the service were sought and acted on. People knew how to make a complaint. The registered manager responded and investigated complaints in line with the provider’s procedure.

People, their relatives and staff were positive about the quality of care and support provided at the service. The registered managed used audit systems in place to monitor the quality of the service and addressed shortfalls to develop the service.

People were happy with the care and support provided. They said "It's a nice place and they take care of you, " and "I couldn't fault it." A visitor described staff as "impeccable."

There was clear information to guide staff in how people liked to be cared for and supported and this was consistently followed.

There were policies and procedures in place to safeguard people from abuse and people felt confident that any concern they had would be listened to and addressed.

There were robust systems in place to reduce the risk of spread of infection.

The service was well led and people were supported by competent and suitably trained staff who were employed in sufficient numbers to meet their needs.

On the day of our visit there were 31 people residing in the home. The majority of the people who used the service were suffering from dementia.

We looked at the issue of consent to care and treatment by people and their relatives, and found that the provider had processes in place to gain consent, although this was not always been taken up by people or their relatives.

We looked at the care process, and found that people who used the service were happy with their level of care. We found there were proper assessment, care management and risk assessment systems in place and that these were reviewed regularly.

We looked at safeguarding and found that staff had been properly trained this area and felt able to report any instances of abuse if necessary. We were also able to seek clarification on a number of potential safeguarding issues that had been raised prior to our visit.

We looked at staffing and found there were sufficient numbers of properly qualified staff to provide an acceptable level of care, although we identified one particular issue regarding lunchtime staffing.

We looked at how the provider assessed and monitored quality in the service and found it had effective processes for doing this.

During lunchtime at this home we used our SOFI (Short Observational Framework for Inspection) tool to help us see people’s experiences at mealtimes. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 40 minutes watching at lunchtime and found that people had different experiences dependent on which staff were supporting them with their meal. Two of the staff clearly knew the residents they were helping really well, the staff took their time, explained what they were doing and chatted. These two staff encouraged and used appropriate humour, they offered choices about food and drink and they maintained the residents’ dignity. However we saw that two staff were assisting two residents each during the meal. We saw the staff turning between the residents and hardly speaking with them. The staff offered large mouthfuls of food and did not wait for the residents to finish before offering more food. One member of staff put a drink to a resident’s mouth while turned away and without any explanation.

Other residents, who were able to tell us about their experiences, said the staff were good at helping them, and were caring and kind. These residents said they were able to make choices and there were activities for them to do if they chose.

The staff said they worked well as a team and they got the support they need to carry out their roles.