About the service: Brackendale House is a care home providing personal to 14 people with mental health support needs. At the time of the inspection 13 people were receiving care and support.

People’s experience of using this service:

People living at Brackendale House participated in activities and involvement in the local community. Staff showed kindness and compassion and placed value on their caring role and involvement in people’s lives. People were offered a choice of meals and staff closely monitored people assessed to be at risk of poor food and fluid intake.

The service had completed end of life care training to ensure people received high standards of care and support and were involved in the planning of their care at that stage of their life. The service had good working relationships with the local GP practice and mental healthcare professionals.

The service worked in partnership with people and encouraged feedback on the care provided. We received mainly positive feedback from people about the staff and service received. Staff told us they enjoyed working at Brackendale House and spoke highly of the support and encouragement provided by the registered manager.

People had their care and support needs met by sufficient numbers of suitably trained staff. The care environment was clean and comfortable throughout. Some decoration was tired, but the service had a rolling refurbishment plan in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service supported this practice.

The service had good governance arrangements in place and completed internal quality checks and audits. Findings from these were regularly reviewed by the registered manager and provider.

Rating at last inspection: Brackendale House was rated overall Requires Improvement, with Requires Improvement for effective, responsive and well-led, and good for the remaining two key questions. The report was published June 2018.

The service was in breach of regulations 9 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service sent us an action plan to provide assurances on how the service would address the breaches. This action plan was reviewed as part of this inspection.

Why we inspected: This was a scheduled, comprehensive inspection, completed in line with our inspection schedule for services rated as Requires Improvement.

Follow up: We will continue to monitor this service and will reinspect in line with our schedule for those services rated as Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection of Brackendale House took place on 11 April 2018.

Brackendale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Brackendale House accommodates up to 14 people in one adapted building. On the day of our inspection there were 14 people living in the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a 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 2008 and associated Regulations about how the service is run.’

At our previous inspection in October 2016 we found that the provider was in breach of Regulations 10, 12, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The provider had addressed some of the concerns and was no longer in breach of Regulations 10, 12 and 18. This was because improvements had been made to the premises and to staffing levels. However, we identified a breach of Regulation 9 and a continued breach of Regulation 17.

People were not given the opportunity to be involved in the development and review of their care plan. Care plans were not always reflective of people’s current needs. Information relevant to people’s care and support was not always included in the care plan. Documentation relevant to people’s mental capacity was sometimes contradictory and the decision making process was not always documented.

The provider had audits and quality assurances in place. However, when deficiencies were identified action to address these was not taken in a timely way with the allocation of appropriate resources. This was a concern which had been identified at the previous inspection.

We have made a recommendation about end of life care planning.

Since our last inspection the provider had made improvements to the environment with the installation of new sanitary ware, curtains and window blinds. This meant that care and support was provided in a way which supported people’s privacy and dignity.

People were protected from abuse and avoidable harm. People living at the service confirmed they were kept safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people. People received their medication as they should. Risks to people were identified and managed to prevent people from receiving unsafe care and support. People were protected by the registered provider’s arrangements for the prevention and control of infection.

People’s nutritional and hydration needs were met and they received appropriate healthcare support as and when needed from a variety of professionals and services. The service worked together with other organisations to ensure people received coordinated care and support.

People were supported to be as independent as possible and engaged in activities both inside and outside the service. Medicines were administered safely and appropriately.

Brackendale House is a residential home that provides care, support and accommodation for up to 14 people with mental health needs. There were 14 people living in the home at the time of this inspection.

The service had 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.

This inspection found that the provider was in breach of four regulations. These related to safe care and treatment, staffing, dignity and respect and governance.

People did not live in a consistently safe environment because there were not enough staff to manage safety hazards appropriately and ensure the premises were always clean and hygienic.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively. However, there were not always enough staff to ensure the guidance to minimise risks was followed consistently.

The manager and staff in the home cared about the people they supported and treated people with respect. However, some aspects of the home’s environment did not always promote people’s dignity and self-respect.

There were a number of systems in place to monitor the quality of the service. Regular audits were also carried out by the manager and provider, in order to identify any areas that needed improvement. However, some of the improvements identified as required were taking a long time to complete and some audits were not effective.

Medicines were managed and administered safely in the home and people received their medicines as prescribed. We identified that some topical medicines such as creams and drops, did not show the dates they had been opened. However, the manager rectified this completely during our inspection.

People were supported by staff who were skilled and knowledgeable in their work and new members of staff completed an induction. Staff were supported well by the manager and the manager was being supported well by their direct line manager. There had been an increase in the level of support from the provider, in respect of improving and maintaining the service, although provider level decisions and subsequent improvement actions were slow.

People were helped to keep safe by staff who knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. In addition, staff received training that was relevant for their roles and appropriate recruitment checks were carried out before staff began working in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and made choices about their meals. People’s intake of food and drinks was monitored and recorded when needed, although there were gaps in some of these records. When any needs or concerns were identified, appropriate action was taken and referrals were made to relevant healthcare professionals.

Assessments were completed prior to admission, to ensure the service could meet people’s needs. People were involved in planning their care so they could receive care and support that was individual to their needs. However, there were not always enough staff to consistently provide individualised support to people.

People living in the home were welcome to have visitors and people were encouraged to be as independent as possible. People were able to voice their concerns or make a complaint if they felt they needed to.

On the day of our inspection 12 people were living in Brackendale House. We spoke with five people and with both staff members who were on duty.

We looked at the care records for four of the people who used the service. Each record showed evidence that people’s wishes had been taken into account when care was planned. However, these care records did not have a space allocated for the person’s signature to indicate that they consented to the plans. This meant that it was not possible to verify the person’s consent without speaking with the person.

Each care plan was based on comprehensive risk assessments and on a detailed assessment of the person’s individual needs. The plans took account of people’s wishes and preferences where possible and were aimed at enabling people to be as independent as possible. People told us that they were happy living at Brackendale House and with the care and support staff gave them. One person told us “The staff are ever so good at looking after me.” Another told us that “The shops are just around the corner. It’s so handy.”

The premises were safe and accessible. They promoted the wellbeing of the people who used the services. The provider's recruitment policy showed that they took steps to recruit appropriately skilled and experienced staff. The records we examined, including care plans and maintenance records, were complete. They could be accessed easily by staff and were stored securely.

People told us that they had 'residents' meetings where they could talk about things in the home and give feedback about the service. We were told that staff responded to any issues or concerns that were raised.

Three people we spoke with told us that they liked going out and about and one person said that they had been to one of their regular clubs that morning.

We spoke with four people during our inspection. Each person told us that they were happy with the support they received and felt their needs were being met.

One person told us that the staff had helped them to get some new medication for their hay fever, which they said was working well and that they felt a lot better since they had been taking it.

Everyone we spoke with said the staff and the manager were very good. One person told us that the staff were always around if they needed help with anything. Another person told us that all the staff were very good and supported them well.

Following the closure of one of Prime Life's other homes, some people have recently moved into Brackendale House. The people who were already living in the home told us that they had been informed about the new people moving in and had met them when they visited.

The new people with whom we spoke told us that the closure of their previous home had been explained to them and that they had a choice about where they wanted to move to. Everyone told us they liked living in Brackendale House and were very happy there.

One person told us how they regularly liked going shopping in town and meeting their friends.

The manager told us that she was hoping to develop the food shopping so that all the people living in Brackendale House could be more involved and, when the new supermarket opens, it is hoped that more people will be able to do their own grocery shopping.

One person with whom we spoke told us how they had recently had an operation on their foot to help them to get around a bit better. During our conversation the person told us quite a lot about the treatment they had received and also said that the staff at Brackendale House were really good and "looked after me really well when I wasn't well". Another person told us how the staff supported them when they needed to see the doctor.

All the people with whom we spoke said they were happy living in Brackendale House and everyone said they liked the staff and got on well with them.

One person said "…it's better than being homeless…" while another told us that they liked their room, which they had their own key for so they could keep it locked when they weren't in it.

A member of staff with whom we spoke, during our visit on 25 May 2011, was very knowledgeable about people's individual care and support needs and the new manager explained that, although she knew the people who had moved in from the other home very well, getting to know the people already living in Brackendale House properly, was one of her top priorities.

All the people with whom we spoke during our visit on 25 May 2011 said the food is really good. One person told us that they didn't like Kiev's but that they could have sausages or fish fingers instead. Another person said that they could always have something different if they didn't like what was on the menu but most of the time they really liked the food.

One person told us their favourite meals were the shepherds pie, chilli or chicken pie, while another person said their favourite was cauliflower cheese.

Three people with whom we spoke said they liked the new layout of the dining room and one person pointed out the kitchenette, in which people can make drinks and snacks as they wish.

The manager told us that infection control audits are carried out regularly for the house and risk assessments are completed for each person's bedroom.

One person told us that they liked to keep themselves to themselves and didn't have a lot to do with the staff but that they (the staff) were all alright. A couple of people said they had liked the previous manager but they liked "this new one too".

A member of staff told us that the new manager supports them well and that they are able to access any additional training that is relevant.

People with whom we spoke told us that they knew who to speak to if they had any concerns and everybody said they knew how to make a complaint. One person told us "…there's a book in the hallway…" that tells people how to make a complaint and people can leave suggestions there as well if they want to.