Bracken Ridge Manor is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Bracken Ridge Manor is an adapted building in Loftus. It is an established nursing home for up to 17 people who live with a mental health condition. Each person had their own bedroom on the first and second floor with access to several communal areas on the ground floor. At the time of inspection, there were 13 people using the service.

This inspection took place on 19 and 26 November 2018.

A registered manager had not been in post since 17 August 2018, however the new manager did have their interview with the CQC registration team to become registered manager on 26 November 2018. They became a registered manager on 27 November 2018. 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.'

At the last inspection on 23 March 2016 we rated the service to be Good.

At this inspection, we found the service had deteriorated to be rated requires improvement.

This is the first time the service has been rated to be Requires Improvement.

We found three breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to requirements relating to safe care and treatment, good governance and staffing.

Staff understood and managed the risks to people, however records did not reflect this. Accidents and incidents had taken place and action taken to reduce the risk of reoccurrence. The health and safety of the building was managed; however, one certificate was out of date. There were enough staff on duty at all times. One staff member with regular contact with people did not have a disclosure and barring services certificate needed to work with vulnerable people. Fire training and some fire records were not up to date. Although the building was clean, improvements were needed to effectively manage infection prevention and control. Not all water temperatures were within safe levels. Medicines were safely managed, though some records needed to be reviewed. There were no systems in place to ensure lessons were learned.

All staff were experienced in supporting people who lived with a mental health condition. Staff followed nationally recognised guidance for supporting people. Staff worked closely with mental health teams to ensure people lived fulfilled lives. Staff were not supported with regular review or training during their induction. Established staff had not received regular supervision or training and policies for these were not effective. People were supported with their nutritional needs and were involved in menu planning. Everyone using the service had capacity to consent and staff involved them in all aspects of their care, yet Mental Capacity Act assessments had been carried out. Some areas of the building needed to be updated.

An experienced and knowledge team was in place who supported people with their mental health. This support varied depending on the needs of people each day and support was dignified at all times. Staff actively encouraged people to be fully involved in their care. Staff used therapeutic interventions to support people when needed. Staff worked hard to make the service a home and people told us there were a family. All had regard for one another.

People received the care and support which they needed. Staff had extensive knowledge of each person, the history of their mental health condition and the strategies which were effective in providing the most appropriate support for people. However, records

We inspected Bracken Ridge Manor on 23 March 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

Bracken Ridge Manor is registered to provide care and accommodation to a maximum number of 17 people with mental health conditions. The service is also registered to provide nursing care. The home is a converted property on three floors with the majority of bedrooms being on the first floor and second floor and the usual living accommodation on the ground floor. The home is situated on the High Street at Loftus with easy access to local amenities and directly on a bus route.

The home had a registered manager in place. 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 provider had some systems in place to monitor and improve the quality of the service provided, however at the time of the inspection formal auditing of care plans and medicines had not taken place. After our inspection the registered manager sourced and completed both audits and sent them on to us. The registered provider visited the service on a regular basis to speak with people, staff and monitor the quality of the service provided; however they did not keep a record of these visits. We could not determine what actual check had been made.

Records showed that meetings with staff and people who used the service were infrequent. The registered manager told us they spoke with people and the staff team at other times but didn’t keep a record of this.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and the action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were completed to ensure health and safety. However, we did note that some fire doors identified by the fire authority in December 2015 as needing repair had not been repaired at the time of the inspection. The registered manager told us this repair was scheduled for the day after the inspection.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as nutrition, behaviour that challenged, smoking, self-neglect and vulnerability when out in the community. Staff supported and encouraged people to take responsible risks. This enabled staff to have the guidance they needed to help people to remain safe.

We saw that staff had received supervision on a regular basis and an annual appraisal. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. People told us that there were enough staff on duty to meet people’s needs.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. S

During this inspection we looked at the care records for two people, spoke with the manager and two members of staff. We also spoke with three people who used the service. People we spoke with told us that they were always treated with dignity and respect by the staff. One person said that it was better for them at Bracken Ridge Manor. They said, “It is the way the staff treat me, they show me respect and you can have a laugh.”

We found that in the main care plans provided staff with the information they needed to meet people's needs, although there was the need for some to be updated.

We found that a range of health and care professionals were involved in meeting people's needs.

We saw that the environment was clean and generally well maintained. There were effective systems were in place to ensure safety.

There were sufficient staff and appropriate skill mix to meet people's health and social care needs.

Records were accessible and stored securely, however some care plans needed to be dated and some needed to be developed.

Brackenridge Manor had a warm and welcoming atmosphere, it was homely and comfortable. We found that before people received any care or treatment, staff asked for their consent and acted in accordance with people's wishes. We found that people who lived at Brackenridge Manor experienced care, treatment and support that met their individual needs and protected

their rights.

People who used the service told us, "It is lovely here, I have my own room with my personal things in."

Another person told us, "I like the staff here, there is always someone to talk to and also the food is very good".

People were involved in the local community as much as they wanted to be. One person was doing some voluntary work two days a week, helping keep paths clear and repairing stone walls on the North Yorkshire Moors.

Another person was in a walking group and enjoyed the exercise and fitness. There was lots of artwork around the home and a resident was in the process of drawing caricatures, which would then be displayed.

One person attended cookery classes, promoting healthy eating.