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Inspection carried out on 29 January 2019

During a routine inspection

About the service: Brook View is a care home with nursing that was providing personal and nursing care to 52 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The service met the characteristics of good in all areas, and there were some aspects of practice that approached outstanding.

People told us they felt safe at Brook View. Staff felt comfortable to raise any concerns about their own or other people’s safety. There were checks to ensure new staff were of good character and suitable for their role.

People praised the caring manner of staff. Interactions between people and staff were kind, respectful and unhurried. People’s privacy, dignity and independence were upheld.

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 supported this practice. Staff involved people, and where appropriate their relatives, in decisions about their care.

Care was delivered in line with current standards and good practice. People were happy with their or their loved one’s care. Medicines were managed safely. Staff liaised as necessary with people’s healthcare professionals. When people were unwell, staff made timely referrals to their GP. People were supported to have a comfortable and dignified death when the time came.

Care plans varied in their completeness, consistency and level of detail. The management team had already identified care planning needed to improve and had made plans accordingly.

There was an emphasis on the importance of eating and drinking well. People enjoyed a choice of freshly-prepared meals and snacks, and people’s dietary preferences and needs were catered for.

There was a range of activities based on people’s ideas and interests, including regular trips out. Activities staff worked on a one-to-one basis with people who were unable to leave their rooms. There were strong links with the local community and people who were able often went out on trips.

There were enough appropriately qualified staff on duty to provide the care and support people needed. Any gaps in the rota were covered by agency staff. Staff had the skills and competence they needed to care for people safely and effectively. They were supported through training and regular supervision. The provider’s Admiral nurse, a specialist dementia care nurse, gave practical and clinical support to staff as well as people’s families.

The premises were clean and well maintained. The building and garden were adapted for people with impaired mobility. There was a range of communal areas for people to spend time together and alone. Equipment was regularly serviced. Effective infection prevention and control procedures were in operation.

People and relatives told us they would feel able to raise concerns or complaints with the manager if they felt the need to do so. Staff understood their responsibility to report concerns and near misses. Action was taken to ensure people were safe and improvements made where necessary.

The provider had good oversight of the service through its established management and accountability arrangements. Although there had been changes in manager, people and staff were confident in the leadership of the service. People and staff described managers as approachable and supportive, but that they would address poor practice. Staff came across as motivated and worked as a team. People commented, “The staff seem very happy and cheerful; they do seem to like their jobs here”, and, “The staff get on well together. There is a very good atmosphere”.

Rating at last inspection: At the last inspection the service was rated good (report published 5 August 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Inspection carried out on 15 June 2016

During a routine inspection

This inspection took place on 15 June 2016 and was unannounced.

Brook View is a 56 bedded, purpose built, care home that provides accommodation and nursing care. At the time of the inspection there were 48 people living at the service.

The last inspection of the home was carried out on 17 January 2013. No concerns were identified with the care being provided to people at that inspection.

There was a new 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. People and staff said they were looking forward to getting to know the new registered manager and were aware they had many years of experience to bring to the home.

People living at Brooke View told us they were very happy with the care and support provided. They said the registered manager and staff cared about their personal needs and preferences. One visitor told us “There are always plenty of staff around, bells seem to be answered quickly”.

The risk of abuse to people were reduced because there were effective recruitment and selection processes for new staff. This included carrying out checks to make sure new staff were safe to work with vulnerable adults. Staff were not allowed to start work until satisfactory checks and employment references had been obtained.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of people’s personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care and/or a relevant representative. People’s needs were discussed with them regularly as the ‘resident of the day’ and any changes agreed. All care plans included the person’s written consent to receive care. One care plan had a section that had been written by the person, informing staff how they wished to be supported if they no longer had capacity.

The mealtime experiences were seen as positive for people living in the home. Throughout the day, snacks and hot and cold drinks were offered to all. If people wished to receive alcoholic beverages, these were provided before the lunch was served. There were smaller lounges and a café where people could have more intimate meetings with their visitors.

People were able to take part in a range of activities according to their interests. Activities included trips out, arts and craft, signing and cooking. One person said “There is always something going on here”. A staff member said “We have some amazing days out”.

Medicines were administered safely. Medicines were administered by staff who had received suitable training. Safe procedures were followed when recording medicines. Medicines administration records (MAR) were accurate. There were no unexplained gaps in the medicines administration records. Audits of medicines had been completed and appropriate actions taken to monitor safe administration and storage.

People had access to external health professionals. Where people's health needs had changed, staff worked closely with other health professionals to ensure they received support to meet their needs.

All incidents and accidents were monitored, trends identified and learning shared with staff and put into practice. The registered manager was supported by a regional operations manager who supported them with their one to supervision and identifying day to day issues in the home.

Each person received a copy of the complaints policy when they moved into the home. None of the people we spoke with had any complaints about the quali

Inspection carried out on 17 January 2014

During a routine inspection

During our visit we spoke with three people who lived in the home, and a person�s relative who was visiting the home.

The registered manager told us that the home had appointed a new head of care in the week of our visit. The home was working towards the gold standards framework for end of life care (GSF) accreditation.

People told us that they felt positive about the quality of care they received; and with their relationships with the staff. We observed residents moving freely around the home and interacting with the staff in a relaxed way.

People who live in the home, and a visiting relative, told us that they were asked for their consent when making choices and decisions about their daily lives; and that people's choices and decisions were respected by the staff. A person told us, "The activities are quite good, I enjoy the craft activities. There is enough to keep me occupied � They ask me what I would like; you do get choices."

The home maintained appropriate standards of cleanliness and hygiene. A person told us, �Everything is always clean.�

We found that staff were properly supported to provide care and treatment to people who live in the home. A person told us, �On the whole the staff know what they are doing.�

The home was taking account of people's comments or complaints. People, who lived in the home, and their relatives, told us that they could be sure that their comments were responded to appropriately.

Inspection carried out on 15 March 2013

During a routine inspection

We used a number of different methods such as reviewing records, we talked to staff, people that used the service, the manager and we talked with a relative to help us understand the experiences of people using the service.

The satisfaction surveys that we saw showed us that people�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People rated the quality of their care between good and excellent.

People experienced care, treatment and support that met their needs and protected their rights. The care plan that we looked at was person centred and documented the people�s wishes in relation to how their care was provided. People that we spoke to said that the quality of care was excellent and that their privacy and dignity were respected.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We spoke with staff and staff demonstrated an understanding of the safeguarding procedures and the different forms of abuse. People told us that they felt safe at Brook View.

We observed that people were dressed appropriately and kept active within the service as there were a number of different activities for people to be involved in. People told us that they were supported to make choices about activities they took part in and what they wore each day.