The Brookland is registered to provide accommodation and personal care for one person with a learning disability. The person who used the service needed support to develop and maintain life skills and be safe in the community.

At the last inspection in August 2015, the service was rated Good. At this inspection we found the service remained Good.

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. The registered manager was also the provider of the service.

The registered manager and staff understood their role in keeping people safe and their responsibilities in reporting any concerns. Risks to the person and the environment continued to be identified and plans were in place to give staff the guidance required to minimise risks. The person’s medicines continued to be managed safely and in the way they preferred. However, medicine refresher trainings needed to take place annually. We have made a recommendation about this.

There continued to be enough staff to meet the person’s needs. Staff were recruited safely and had the training and support they needed to fulfil their role. They told us the registered manager, who is also the provider, was accessible and open to new ideas. There was a complaints procedure in place. The person, staff and relatives told us they knew who to speak to if they had any concerns and they were confident they would be addressed promptly.

The person continued to be supported to have maximum choice and control of their life and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff treated the person with dignity and respect. The person’s privacy was protected and promoted by staff. The person was supported to maintain relationships with their family. There were a wide variety of activities, in and out of the service.

The person continued to be supported to have food they enjoyed, which supported them to stay healthy. The person was involved in menu planning and they told us if they did not like what was on the menu they were able to choose something different. The person was supported to attend regular health care appointments as required.

The person continued to be involved in planning their care. Their care plan gave staff information about their life and what was important to them. Care plans detailed what the person could do for themselves and the best way to encourage them. Staff knew the person well and supported them in line with their care plans and preferences.

The registered manager continued to audit the quality of the service. The person, staff and relatives were asked their views on the service through surveys and meetings.

Further information is in the detailed findings below.

One inspector visited the home, during this visit we were able to 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 the person who used the service, the staff supporting the person and from looking at records.

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

Is the service safe?

The person who lived at Brookland was treated with respect and dignity by the staff. We spoke with the person and they told us they like the staff. They said “The staff are all OK, some are funny they make me laugh”. We saw that they were comfortable and happy with the staff. Safeguarding procedures were in place and staff understood how to safeguard the person they supported. We saw that the home had a safeguarding and whistleblowing policy and followed the safeguarding protocols supplied by the local authority. There were systems in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. The home worked alongside the social services care managers in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager confirmed that it had not been necessary to put in an application under Mental Capacity Act and Deprivation of Liberty Safeguards. .

The service was safe, clean and hygienic. The registered manager sets the staff rotas, they took people’s care needs into account when making decisions about the numbers of staff required. However, we found that not all staff had received the required training as set by the skills for Care council when they started to work at the home. Therefore the person’s safety and well fare could have been at risk.

We also found that medicines had not been given as prescribed and the medication administration policy had not been followed. The lack of medication audits meant this had not been recognised by the Manager.

The premises had been sensitively furnished and decorated to meet the needs of person who lived there.

Is the service caring?

The person was supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting them. The person’s preferences, interests, and diverse needs had been recorded and care and support had been provided in accordance with the person’s wishes. The person told us, “The staff help me, I forget sometimes but they remind me, they are kind to me”. We were able to see that the person was happy with our presence and comfortable with doing what they wanted during the visit. Staff only guided the person; they promoted them, and were very patient with them.

Is the service responsive?

The staff at the home had been aware of the person’s health needs and had worked with other health professionals to reduce recurring health problems. From the care plan we saw that staff had arranged for doctor’s appointments when necessary.

Is the service effective?

The person’s health and care needs were assessed with them and their family. They were involved in writing their plans of care. Prompts had been agreed in order that the staff could enable the person to maintain their life skills and their quality of life. The person’s needs were taken into account and the layout of the home enabled the person to move around freely and safely. Although the care plans had not been reviewed regularly by staff monthly, we saw that the care plans had been reviewed six monthly with the person, family, staff and care manager when they were available. A recent survey completed by the person who lived at the home showed that care matched their expectations.

Is the service well-led?

The service worked well with other agencies and services to make sure the person received their care in a joined up way. The service had quality assurance systems in place, however records had not been completed as the manager was about to introduce a new system. Therefore shortfalls were not identified and addressed promptly. As a result the quality of the service was not being robustly monitored.

We visited the service, spoke to the person who lived there, staff and looked at records such as the care and support plan.

We were told that there were different activities to do and that they could choose what they wanted to do. They said they were happy with the support they received, and that the staff looked after them well. They said they knew who to speak to should they have any concerns, but said they had no complaints.

We observed that the home was relaxed and comfortable, and the person could choose where they wanted to be in the home. We saw that the person who lived in the home was able to express their choices for example about activities and what their choice of food and drinks they would like.

We saw that support plans were tailored to the person’s needs, and were updated and maintained.

We looked at staff recruitment procedures, and found that these were carried out appropriately.

We viewed all areas of the home during the inspection visit and saw that they were visibly clean and well maintained.

We inspected this home on 28 August 2015. This was an unannounced inspection.

The Brookland is registered to provide accommodation and personal care for one person who needs 24 hour care who prefers to live on their own. The person who uses the service needed support to undertake life skills and be safe in the community. At the time of our inspection, the person who lived in the home appeared fairly independent; however gentle prompting had been necessary to complete everyday tasks.

At our last inspection on 3 August 2014, we found the person was not always protected because the provider had not made sure that medicines were administered safely. The provider did not have an effective system in place to regularly assess and monitor the administration of medicines in the home. We set compliance actions and the provider wrote to us telling us how they would become compliant with the regulations. At this inspection we found the provider had completed all the actions they told us they would take to improve the service provided.

There was a registered manager at the home who was also the provider. 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 person who used this service was protected against the risk of abuse; they felt safe and staff recognised the signs of abuse or neglect and what to look out for. They understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting the person’s needs. There were risk assessments related to the person’s day to day care and details of how these risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to the person.

There were sufficient numbers of suitable staff to meet the person’s needs and promote their independence and safety. Staff had been provided with relevant training and they attended regular supervision. Staff were aware of their roles and responsibilities and the lines of accountability within the home.

The registered manager followed safe recruitment practices to help ensure staff were suitable for their job role. Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs.

We observed that staff had developed very positive relationship with the person who used the service. Staff were kind and respectful, we saw that they were aware of how to respect the person’s privacy and dignity. They told us that they made their own choices and decisions, which were respected by staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements

The systems for the management of medicines were followed by staff and we found that the person received their medicines safely. They also had good access to health and social care professionals when required.

The person had been involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

The person was always motivated, encouraged and supported to be actively engaged in activities inside and outside of the home. For example, the person went out to their local community at least five days of the week for activities, one of their favourite activity was window shopping.

A health action plan was in place and the person had their physical and mental health needs regularly monitored. Regular reviews were held and the person was supported to attend appointments with various health and social care professionals, to ensure they received treatment and support as required.

Feedback was sought from the family and the person and used to improve the care. The person knew how to make a complaint and a copy of the ‘how to complain’ was available in the home. No complaints had been received but it was evident that there was a very inclusive relationship with the person’s family.

The registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the commission.