The inspection took place on 22 November 2016 and was unannounced.

The home provides accommodation for a maximum of 46 people requiring nursing and personal care. There were 34 people living at the home when we visited. A manager was in post when we inspected the service who told us she had applied to become the registered manager. 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 and associated Regulations about how the service is run.

People were comfortable and relaxed around staff working at the home. Staff supporting people understood what it meant to protect people from harm and to keep them safe. Staff received training on keeping people safe, and were encouraged to discuss any concerns with the registered manager. The registered manager understood their obligations and ensured concerns were recorded and relevant authorities notified where appropriate. People were supported by staff that understood the risks to people’s health and the steps they needed to take to support their health and wellbeing.

Staff recruited to work as the home underwent employment background checks to ensure it was safe for them to work at the home. The registered provider had a system for ensuring all the necessary checks were completed prior to staff commencing work.

People were supported to receive their medicines and staff undertook regular checks to ensure people received their medicines appropriately. Staff also ensured they had access to sufficient stocks of medicines so people received the appropriate support.

People had confidence in the staff supporting them. Staff had access to supervision and training so that they understood their own personal development needs. Staff were able to access additional support and training if they required it.

The manager understood their legal obligation with respect to ensuring people’s ability to make decisions was recorded appropriately and any necessary action taken to protect them. Staff understood which decisions people were not able to make for themselves and how to appropriately support them in their best interests.

People were offered choices in the meals and drinks they were offered. Where people required additional help from specialists, people had access to these. People were supported to see the dentist, chiropodist as well as other healthcare professionals.

People developed friendships and an understanding with the staff supporting them. People were encouraged to share ideas about how they would like to be supported by staff. People were visited by friends and families at times that were convenient to them and had a consistent experience of the home, regardless of when they visited.

People were supported to take part in a variety of activities. Staff supporting people had knowledge of people’s preferences. People’s care was reviewed and updated based on people’s individual circumstances. The registered manager was a new to the home and was working to improve systems at the home to meet the registered provider’s expectations of care. Whilst improvements were noted, we could not yet test how rigorous the systems for reviewing the quality of care were.

This inspection took place on 6 August 2015 and was unannounced.

The provider of Bluebrooke Residential Home is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 31 people lived at the home.

The manager was appointed in June 2015 and has made an application to be registered with us. 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.

Although people received their medicine as they should, the administration of people’s medicines was not delivered within a timely way to ensure there was sufficient time between doses. The medicine round was not fully staffed which meant that it took longer than necessary for people to receive their medicines.

Although people received their medicine as they should, care staff did not always know what symptoms people would display should they require extra pain relief. There could therefore be a risk that some people did not receive extra pain relief when they required it.

People lived in an environment where despite some major improvements; some areas were unpleasant. The manager had recognised that carpets needed replacing and caused an odour but these had not yet been removed.

People were cared for by staff who understood how to identify and report potential harm and abuse and who to report their concerns to. Staff told us they had received training and would speak to a manager if they were unsure of anything.

Care staff underwent a recruitment process that included background checks to ensure it was safe for staff to work with people at the service.

Care staff did not always understand the full implications of the Mental Capacity Act and what it meant to obtain people’s consent. Where people received their medication hidden in food, the correct procedures had not been followed.

Care staff were supervised and received regular training. Care staff had undertaken some specialised training and understood the circumstances for when this should be used. Care staff were comfortable in raising questions about things they were unsure about.

Care staff despite working hard, did not always apply their understanding of Dementia care to the examples they faced in their day to day work. Care staff did not always provide people with reassurance and distraction when they began to show signs of anxiety.

People’s care was not in response to their individual needs. People’s activities and interests in some cases were supported by the activity coordinator. If people’s needs were more complex, their interests were not supported as sufficient understanding of their needs was not understood by staff.

People were offered choices at mealtimes and were offered drinks throughout the day. People’s meals were monitored by a nutritionist to ensure people had their nutritional needs met. People’s weights were also monitored regularly to ensure people maintained a healthy weight.

People and families knew understood how to complain if they needed to although. People and their families preferred to speak to staff and discuss any issues they had directly with them.

Systems for measuring people’s care were not embedded which meant that people’s care was affected. Changes in management meant high quality care was not being monitored to ensure people’s experience was positive.

During this inspection we spoke with three people who lived at the home and three relatives. We also spoke with six staff and the deputy manager.

We observed how staff cared for the people who lived there. We saw that people had been given choices around what they wanted to do. We found people had received care that met their health and welfare needs. One of the people we spoke with said: "I’m looked after".

The three relatives of people who lived there gave us positive feedback about the standards of care and support that the staff provided. One person said that: "I know the care is good”.

We saw that people who lived there had been treated with dignity and respect.

The provider had systems that checked on the quality of the service that had been delivered.

We carried out this inspection as a follow up review of the service to check on areas where we had concerns at our last inspection in September 2012. We had concerns that the provider had not always detected and acted upon the health needs of the people who used the service, and that systems had not been used effectively to manage the risks associated with medication. We found that improvements had been made for all these concerns.

During the inspection we spoke with three people who used the service, three relatives and with staff. We also looked at how staff cared for the people who used the service. We saw that people were receiving care that was meeting their heath and welfare needs. A pharmacist inspector from the Care Quality Commission also visited the home. This was in order to look at medicine management. We found that improvements had been made to ensure that there were appropriate arrangements in place to manage the risks associated with the unsafe use and management of medicines.

Forty people were living at the home when we inspected. We talked with two people who lived at the home, two relatives, the home manager and two staff during our inspection. We also looked at the care records for four people who lived at the home.

Many of the people were not able to talk to us directly due to their communication needs. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We observed staff acting in a friendly and respectful way with the people living at the home. However, staff did not always respond to people’s needs in a timely way.

One relative told us that, "The care couldn't be better." Another relative told us the people living at the home were, "Always given choice.’’

People living at the home did not always receive their medicines in the right way to meet their health needs.

People living at the home did not always receive care that met their individual care and welfare needs.

The staff had the relevant knowledge and skills to meet the needs of the people living at the home. One staff member told us they had "access to further training’’.

We used a number of different methods to help us understand the experiences of people who used the service. We spoke with six people who used the service and visiting relatives of three people. We carried out observations in the communal areas of the home.

We observed the care provided and saw that people who used the service were given choices which supported and enabled them to make their own decisions. We also observed that care staff spent meaningful time with people and that care workers were aware of particular individual needs.

People expressed their views and were involved in making decisions about their care and treatment. People told us “I take myself to bed when I want”, “I like living here” and “they talk to me and are friendly and kind”. People told us about the activities offered in the home and said “we are raising money for a mini bus and looking at where we can go on outings” and “I can go out, but don’t go very often”.

People told us that visitors were able to come and see them "at any time" and we saw that visitors spent time with their friend or relative. The communal areas of the home offered visitors comfortable surroundings with a quieter area available in the activities room, which included a small kitchen for people who used the service and their visitors to make their own drinks.

People we spoke to told us that they were happy, they enjoyed living there and that the staff were ‘lovely’. They felt that they were looked after and did not have to wait if they wanted anything.

Relatives we saw visiting people living in the home were happy with the care provided. One relative said they had raised a question about the facilities in the home and felt that it had not been adequately addressed. We raised this matter with the manager during our visit for them to address.

People we spoke to told us they were happy with their rooms and that they had things to do during the day. There were four lounge areas, a separate dining room and a secure garden that people were free to access.

The decoration of the home was worn and would benefit from redecoration and new chairs and carpets. The provider had identified this in their audit but there were no details of when or which chairs would be replaced. The manager told us they are in the process of getting the chairs reupholstered.

The inspection took place on 13 and 16 February 2015 and was unannounced.

Bluebrooke Residential Care Home provides accommodation for up to 43 older people who require personal care who may have a physical illness or are living with dementia. There were 42 people living at the home.

When we visited a new manager, who had previously worked at the service had taken over. The manager was in the process of applying to become the registered manager. 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 and associated Regulations about how the service is run.

There were some systems in place to monitor the infection control at the service but these were not always effective. Staff were seen using a bathroom with no access to a sink.

People were positive about the care they received and about the staff who looked after them.

People told us that they felt safe and staff gave us examples of how they kept people safe. During our inspection we observed that staff were available to meet people’s care and social needs. People received their medicines as prescribed and at the correct time and medications were safely administered and stored.

We saw that privacy and dignity were respected. Throughout the inspection people were supported to do things which were important to them. Staff showed a good understand of how to ensure that people’s right were maintained. Where people did not have capacity to make such decisions, staff knew how to support people and the processes to the follow to ensure their rights were not compromised.

We found that people’s health care needs were assessed, care planned and delivered to meet those needs. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs. Families told us that they felt that further help was sought when needed.

People had access to choices at mealtimes. However, were support was required, this was not always provided because of the way the staff were deployed to cover the mealtimes.

People received support from staff who received regular training and understood their needs. The registered manager told us that all staff training was regularly reviewed and regular checks were made to ensure that everyone received the right training.

People and staff told us that they would raise concerns with senior staff and the registered manager or the provider and were confident that any concerns would be dealt with. The operations manager for the service regularly met with the manager to discuss the service and ways to improve it.

The manager undertook regular checks to ensure that the quality of the care could be monitored and improvements made where required. However, not all systems were effective to ensure that service delivery was consistent throughout the home.