The inspection took place on 4 April 2017 and was an unannounced inspection. The home is registered to provide accommodation with personal care for 25 older people. At the time of our visit there were 16 people living at the home.

There was 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 home is run.

People and their relatives told us that they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. The risk assessments recorded what action staff should take if someone was at risk. Referrals were made to appropriate health care professionals to minimise risks and meet people’s health needs.

There were sufficient staff to keep people safe and meet their needs. The registered manager had followed safe recruitment procedures. Medicines were given to people on time and as prescribed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. Staff understood the processes in place for ensuring decisions were made in people’s best interests. Staff and the registered manager were ensuring these steps were taken for people living at the home. Staff sought people’s consent and recorded this.

Staff were caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and they had positive working relationships with them.

People and their relatives were involved in the assessment and reviews of their needs. Staff had knowledge of people’s changing needs and they supported people to make decisions or changes to the way their planned care was delivered. Staff offered choices to people regarding all aspects of their care and support, and upheld these choices. People told us that they had access to activities and hobbies.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people and relatives were sought as part of the service’s quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

We carried out an unannounced comprehensive inspection of this service on 1 October 2015 when we found that there were three breaches of legal requirements. We found that the registered persons had not robustly ensured that some people were eating and drinking enough to stay well. We also found that people were not being sufficiently supported to promote their autonomy, independence and involvement. In addition we found that people had not been protected against the risk of inappropriate or unsafe care because the quality of the service was not always being robustly assessed and monitored.

After our inspection on 1 October 2015 the registered persons wrote to us to say what they would do to meet legal requirements in relation to the breaches. The said that all of the necessary improvements would be made by 1 January 2016.

We completed the present inspection on 26 May 2016 to check that the improvements had been made so that people could safely and reliably receive all of the care they needed.

This report only covers our findings in relation to the breaches. You can read the report from our last comprehensive inspection and focused inspection, by selecting the 'all reports' link for Braceborough Hall Retirement Home on our website at www.cqc.org.uk

Braceborough Hall Retirement Home is registered to provide accommodation and personal care for up to 25 older people. The service is in a rural location that is approximately six miles from Stamford.

There was 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.

During the present inspection we found that the registered persons had made the necessary improvements to address the shortfalls we had previously identified. There were arrangements in place to support people when they were at risk of not eating and drinking enough to stay well. People were being offered sufficient opportunities to express their autonomy by following their hobbies and interests. In addition, the registered persons had strengthened the way in which quality checks were completed in relation to the assessment and delivery of care, the recruitment and training of staff and the maintenance of the accommodation.

The inspection took place on 4 April 2017 and was an unannounced inspection. The home is registered to provide accommodation with personal care for 25 older people. At the time of our visit there were 16 people living at the home.

There was 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 home is run.

People and their relatives told us that they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm, or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and carried out by staff that were competent to do so. The risk assessments recorded what action staff should take if someone was at risk. Referrals were made to appropriate health care professionals to minimise risks and meet people’s health needs.

There were sufficient staff to keep people safe and meet their needs. The registered manager had followed safe recruitment procedures. Medicines were given to people on time and as prescribed.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005. Staff understood the processes in place for ensuring decisions were made in people’s best interests. Staff and the registered manager were ensuring these steps were taken for people living at the home. Staff sought people’s consent and recorded this.

Staff were caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and they had positive working relationships with them.

People and their relatives were involved in the assessment and reviews of their needs. Staff had knowledge of people’s changing needs and they supported people to make decisions or changes to the way their planned care was delivered. Staff offered choices to people regarding all aspects of their care and support, and upheld these choices. People told us that they had access to activities and hobbies.

People and staff knew how to raise concerns and these were dealt with appropriately. The views of people and relatives were sought as part of the service’s quality assurance process. Quality assurance systems were in place to regularly review the quality of the service that was provided.

This summary is based on information we obtained when we inspected the service on 15 December 2014. We completed this inspection to check that the provider had made the improvements that we said must be made when we inspected the service on 17 July 2014.

At our inspection on 17 July 2014 we found that improvements needed to be made to make sure that people reliably received safe care. This was because the arrangements to support people who had a particular medical condition were not robust. In addition, staff were not carefully monitoring some people who were at risk of not eating enough.

We also found that the provider had not given staff all of the induction and on-going training they said was needed. The provider said that the training was necessary to contribute to staff having the competencies they needed to care for people in the right way. We found that some staff did not have all of the knowledge and skills they needed to care for people in an effective and responsive way.

Our inspection noted that the provider had not completed rigorous quality checks. This had resulted in some fire safety checks not being completed. Also, the provider had not identified and resolved the problems we noted in relation to the delivery of care and supporting staff. These problems had reduced the provider's ability to ensure that people consistently received the assistance they needed in a safe setting.

After our inspection the provider wrote to us and said that they had made the improvements that were necessary to address our concerns.

Our inspection on 15 December 2014 examined the way in which people who had a particular health care condition or who were at risk of not eating enough were assisted to stay well. We also checked the knowledge and skills staff had and the training they had received. In addition, we looked at the quality checks completed by the provider. We found that the provider had introduced all of the improvements that were necessary to ensure that people’s care needs were reliably met.

The summary is based on our observations during the inspection, speaking with six people who used the service, two relatives, the deputy manager who oversees the day to day running of the service and six staff. In addition, we looked at care records, the arrangements to keep people safe from abuse, the systems used to maintain good standards of hygiene, staff training records and quality assurance processes.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We found that the service was responsive. This was because staff knew about each person’s choices and preferences about the care they wanted to receive. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person’s changing needs and wishes.

However, we have said that the provider may find it useful to make some improvements to further develop the service. These included increasing the opportunities people have to participate in social activities. In addition, we noted that people considering using the service need more information about the terms and conditions that apply. This is necessary so that people can reach an informed decision about whether the service is right for them.

Is the service safe?

We found that the service was safe. This was because staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse.

However, we have said that the provider may find it useful to make some improvements to further develop the service. These involved strengthening the systems used to guide staff in the correct application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. These measures are designed to support people to make decisions that are in their best interests. In addition, they safeguard people when they need to have their liberty restricted to keep them safe from harm.

Is the service effective?

We found that the service was not effective. This was because some people's individual needs for care had not been properly assessed and met. We looked at the care four people had received. We found that there were inadequate arrangements to assist people to maintain a healthy body weight. In addition, staff had not been given the support they needed to effectively care for two people who lived with a particular medical condition. Although the shortfalls had not resulted in people experiencing actual harm, they foreseeably increased the risk of this happening. This was because staff were not consistently using the correct systems to identify and respond to some people’s care needs.

In addition, we found that staff had not received all of the training the provider said they needed in order to effectively care for people.

We have told the provider that they must make improvements to resolve these shortfalls.

Is the service well led?

We found that the service was not well led. This was because some quality checks had not been completed in an effective way. This had resulted in shortfalls in the delivery of care, staff training and health and safety not being quickly identified and resolved. These problems reduced the provider’s ability to ensure that people consistently received the assistance they needed in a safe setting.

We have told the provider that they must make improvements to resolve these shortfalls.

During our inspection we spoke with seven people who lived at the service, two visiting relatives and two visiting friends. We also spoke with the registered manager, a senior care worker, three care workers, a cook and a maintenance worker. We looked at three people’s care records and a range of documentation relating to staff support and the management of the service.

People told us they enjoyed living and receiving care at Braceborough Hall. One person said “The staff and food are wonderful.” Another said they had never heard staff say “I can’t be bothered or I don’t have time.” Visiting friends and relatives compared the service favourably with others they had knowledge of”

People told us they felt safe, trusted care staff and felt confident in raising concerns or complaints. One person said “If there is anything wrong I tell them.”

We observed positive respectful and warm interaction between staff and people who received a service, their friends and relatives. We noted staff knocking before entering people’s rooms, and asking people’s views and opinions in relation to the care and support they received.

Assessments and care plans we looked at included the views of people receiving a service, close relatives and health and social care professionals. Records included consideration of circumstances where people may need help to make decisions due to memory and awareness problems associated with ageing.

Staff told us that they enjoyed working at the service and felt generally well supported by the provider. We saw staff had not within the past year been offered 1:1 supervision or annual job appraisal. The manager was unable to provide clear information regarding the provision and planning of essential staff training.

We saw that the provider had sought the views of people who used the service. We saw that the collection of information required to assess and manage risk was limited in areas including fire safety, water safety and accidents/incidents.

As part of our inspection we spoke with two people who used the service. We also spoke with staff and looked at records. Overall we observed that people were supported by skilled and experienced staff. We saw staff had received the appropriate checks before commencing employment and subsequently received training and support.

We saw people were treated with dignity and supported to make decisions about their care.

People told us they liked living at the home.

People said the food was good and were given a choice at mealtimes.

One person told us if they needed help staff come very quickly.

We observed staff being supportive and reassuring people.

During our visit we looked at infection control issues. We found people were protected from the risk of infections as procedures and training were in place to support staff with this issue. Overall the home was clean and well furbished.

We did not get people’s views directly from them about the two outcomes we looked at. However their experiences were captured through records and other information we received from the manager.

Comments on the questionnaires we looked at showed that people liked living at Braceborough Hall and were happy with the care they received. People living in the home were supported by staff who knew how to keep they safe and where to report issues.

We spoke with four people who lived at the home, one person told us, “Everything is good here, the food is very nice, we get to choose what to eat but we usually like the food that’s on the menu for that day. We like to have a chat and a laugh. It’s a pleasure to be here.”

Another person said, “I would say I’m very well looked after, everything is clean and the food is very good.” And, “You wouldn’t get food like this in a top restaurant.”

We spoke with a district nurse who was visiting the home who told us, “The people seem to be very well looked after, the carers always let us know if a district nurse is needed. It’s seems like a lovely home.”

One person told us, “If you stick to the rules your ok.” Another said, “Matron likes things done in a certain way.” We observed that although people were very well looked after, we saw that at times the home was run in a rigid way and some people had felt that they had to comply with certain routines.

The provider/manager told us that she was not aware of any ‘rules’, however she told us that she would be more aware of how she communicates with people in the future as she may be giving them the wrong impression.