This inspection took place on 26 September, 4 & 14 October 2016 and was unannounced. Birchwood Grange care home is a 150 bedded purpose built facility in Preston Hill, Wembley. The home provides accommodation and personal care for up to 150 older people, including people with dementia. On the day of our inspection 143 people were using the service.

The service had a registered manager in post. He had been in post since October 2014. 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 service was owned by a different provider when we last inspected it in December 2013. The service met all legal requirements we checked.

Prior to this inspection we received feedback from the local authority contract monitoring team. They gave us their latest quality monitoring report from February 2016, which showed the service had made significant improvements since Avery Homes (Nelson) Limited took over. At this inspection, we also noted the significant improvements, as did the majority of professionals we spoke with.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people's daily life were assessed and planned for to minimise the risk of harm. We saw evidence that concerns regarding people's safety had been appropriately managed and staff displayed a good knowledge of safeguarding principles.

When staff started employment they had a four week induction programme which covered mandatory training. The induction included the opportunity for new staff to shadow more experienced staff until they felt confident. Staff also had the opportunity to sign up for vocational qualifications in health and social care.

Staff supervisions, appraisals and staff meetings all happened regularly. Staff told us they were well supported. They spoke highly of the support they received from management and were confident they could raise any issues or concerns, knowing they would be listened to and acted upon.

We saw that sufficient numbers of staff were on duty to meet the needs of people who used the service. Staff underwent a range of pre-employment checks to ensure they were suitable for the role. Checks had also been undertaken to ensure that all the nurses who worked at the home had a current registration with the Nursing and Midwifery Council (NMC).

We raised concerns about a prescribed supplement (complan) of one person, which the service investigated and rectified. People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff had completed training in the safe handling and administration of medicines, which was refreshed annually.

We raised concerns about the calculation of people’s nutritional risk, which the service rectified. Overall, we saw that people received on-going healthcare support from a range of external healthcare professionals and their health and nutrition were monitored and responded to in line with nationally recognised practice. We also saw the registered manager took a pro-active approach to ensuring people who lived with a dementia related illness received care based on best practice.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People had access to healthcare services. They received regular visits from healthcare professionals, such as occupational therapists, chiropodists, and speech and language therapists. We saw if staff had