This inspection took place on 13 and 14 November 2018 and was unannounced. We last inspected the service in June 2016. At that inspection we found the service met all the fundamental standards and attained a rating of Good.

Bracknell Care Home is a care home with nursing that provides a service to up to 30 older people, some of whom may be living with a physical disability. People in care homes receive accommodation and nursing or personal care as a 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. The accommodation is arranged over two floors, with all rooms having ensuite toilet facilities and some also having an ensuite shower or bathroom. At the time of our inspection there were 26 people living at the service.

The service did not have 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. The previous registered manager left the service in October 2017. Since that time there have been various interim arrangements for the management of the service until the present manager took up post on 1 August 2018. His application to become registered is currently being processed by CQC. The manager was present and assisted us during the inspection.

The provider did not ensure the service was managed well because there was no effective system in place for the provider to ensure the service was fully compliant with the fundamental standards (Regulations 8 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). This was particularly apparent where things had not been done in the 10 months period between the previous registered manager leaving and the new manager starting. The new manager had identified most areas that needed improvement to return to full compliance. He was working with the local authority and had developed an action plan to address the areas that needed to be improved.

The service employed an activities coordinator who worked 25 hours a week. However, arrangements for social activities did not ensure that all people were supported to participate in activities that were meaningful to them as individuals.

Premises risk assessments and health and safety audits were mostly carried out as required. Some safety checks had not been carried out when they should have been. For example, water temperature monitoring valves, in place to protect people from the risks of scalding from hot water, had not all been serviced or checked to make sure they were functioning correctly. This was rectified the week after our inspection.

People were not always protected by the recruitment practices in place. Checks were made to ensure staff were of good character and suitable for their role before they were deployed to work with people living at the service. However, audit systems in place had not identified that some required checks had not been correctly completed. This was rectified after the inspection and the manager put in place a monitoring system to be used prior to any new staff starting in future.

Ongoing training was not always up to date and staff felt they received the training they needed to carry out their work safely and effectively. However, staff induction training had not been completed as required by the provider's policy. After our inspection the manager put a system in place to ensure new staff were supported to complete their overdue induction as soon as possible. We have made a recommendation about staff training in writing care plans and determining appropriate goals/outcomes. We have also recommended that future ongoing staff training be updated in line wi

This inspection took place on 20, 21 and 22 June 2016 and was unannounced. We last inspected the service in September 2014. At that inspection we found the service was compliant with the essential standards we inspected.

Bracknell Care Home is a care home with nursing that provides a service to up to 30 older people, some of whom may be living with dementia. The accommodation is arranged over two floors, with all rooms having ensuite toilet facilities and some also having an ensuite shower or bathroom. At the time of our inspection there were 26 people living at the service.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 manager was present and assisted us during this inspection.

For the past year the registered manager and staff had focussed on improving individual people's wellbeing. This had involved working with the person and those important to them to improve all aspects of their life as far as possible. The methods the registered manager and staff had used were frequently innovative and imaginative. The project had led to people engaging in work and activities important to them that utilised their skills and enhanced their life experiences. This had produced very positive results and led to a significant reduction in social isolation and people feeling valued and useful.

Staff were extremely skilled in supporting people to maintain relationships with their family and friends. In some cases the staff had been able to reunite people with family members they had lost touch with. In others, people had been helped to repair a damaged relationship with a family member.

End of life care was exceptional. Staff were skilled, caring and compassionate, delivering care that was extremely personalised and built on people's known wishes. People and their relatives were given strong support when discussing and making decisions about their preferences for their end of life care. Records showed staff went out of their way to ensure those wishes and preferences were respected and fulfilled.

People felt safe living at the service and were protected from abuse and risks relating to their care and welfare.

People were protected by robust recruitment processes and staff were well trained and supervised. Staff had the tools they needed to do their work and provide high quality care. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk. People's medicines were stored and administered safely.

People received effective care and support from staff who knew them well and were well supervised. Staff training was up to date and staff felt they received the training they needed to carry out their work safely and effectively. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans formally reviewed six monthly or as changes occurred.

People received effective health care and support. They saw their GP and other health professionals when needed. Medicines were stored and handled correctly and safely. People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure people's rights to make their own decisions were promoted.

Meals were nutritious and varied. People told us they enjoyed the meals at the home and confirmed they were given choices.

People were treated with care and kindness. During our inspection the atmosphere at the service was calm and happy and people were chatting and laughing with each other and the care staff. People's wellbeing was protected and all interactions observed between staff and peop

An adult social care inspector carried out this inspection. The focus of the inspection was to check the provider had taken action to reach compliance with concerns relating to equipment identified at our last inspection on 6 May 2014.

As part of this inspection we spoke with the registered manager, the maintenance person, the chef and two of the care staff. We spoke with people who use the service but what they told us did not relate to the equipment provision at the home. We also reviewed records which included, four care plans, daily care plan notes, daily shift handover sheets, staff training records and the manager's monthly audit tool.

We found the home had taken the action they had told us they would take to reach compliance. Action had been taken to ensure people were provided with equipment to promote their independence and comfort. Systems had been put in place to ensure pressure relieving equipment was used correctly.

During our inspection we spoke with seven of the 26 people living at the home and two visiting relatives. We also spoke with people in the dining room as they had their lunch and throughout the home as we looked around.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

- Is the service safe?

- Is the service effective?

- Is the service caring?

- Is the service responsive?

- Is the service well led?

This is a summary of what we found-

Is the service safe?

People experienced care and support that was planned and delivered in a way that was intended to ensure people’s safety and welfare. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were protected from unsafe or unsuitable equipment because there were systems in place that ensured all equipment was properly maintained, tested, serviced and replaced.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a 'deprivation of liberty' is determined. The manager planned to review all people at the home that the ruling may apply to and was aware of the process to follow should an application be required under DoLS legislation.

Is the service effective?

People were protected from unsafe or unsuitable equipment but systems were not in place to ensure pressure relieving mattresses were used correctly. Equipment used to support people was clean and in working order but there was a lack of equipment that could support people with dementia in their day to day living and promote their independence.

Staff we spoke with demonstrated a good understanding of people's rights to make their own decisions and their individual responsibilities under the requirements of the Mental Capacity Act 2005.

Is the service caring?

People experienced care and support that was planned and delivered in a way that was intended to ensure people’s safety and welfare. People’s privacy, dignity and independence were respected. People we spoke with confirmed they had been involved in making decisions about their care and support. One person commented: "They do a wonderful job, nothing is too much trouble."

Is the service responsive?

People we spoke with told us they were provided with care that met their needs and their care was delivered in the way they preferred. One person commented: "Very much so, no trouble at all." Another person told us: "If I ask, they come and do it."

Systems were in place to monitor and record incidents. There was evidence that learning from incidents took place and appropriate changes were implemented as a result of any investigation.

Is the service well-led

The provider had an effective system to regularly assess and monitor the quality of service that people received. The home held meetings three times a year for people living at the home and their relatives. This was confirmed by people we spoke with who told us they were encouraged to raise concerns or suggestions at those meetings if they wanted to.

The provider took account of complaints and comments to improve the service. All people we spoke with were aware of how to raise concerns and all felt their concerns would be listened to and acted upon. When asked if there was anything else they wanted to tell us, comments from people living at the home included: "No, this is a superb home.", "We are quite happy, they all make a fuss of us." and "The staff are very good."

During our inspection we spent time with eight of the 27 people living at the home and three visiting relatives. We also spoke with people in the dining room as they had their lunch and throughout the home as we looked around during the day.

We found before people received any care they were asked for their consent and the staff acted in accordance with their wishes. One relative told us "They take their time with my relative's care and do not rush them. The good thing about this home is people are encouraged to socialise. The staff make sure people are not left on their own, they are encouraged to come into the lounge and join in the activities."

People were protected from the risks of inadequate nutrition and dehydration and their personal records were accurate and up to date so staff knew what care people needed.

The provider had taken steps to ensure staff knew how to recognise the possibility of abuse and prevent it from happening. Staff were aware of the procedure to follow if they had any concerns and people living at the home told us they felt safe living there.

We saw there was an effective complaints system available. People living at the home knew who to speak to if they had any concerns. They felt any comments or complaints would be listened to and acted on. One person told us "They make it as close to home as possible, they are so good".

We spoke with seven people living in the home. Six people told us that staff were polite and respectful. One person told us that most staff were polite but some staff were not.

We saw that people were able to give feedback on the service through regular residents meetings. One person told us “they are useful meetings – we can talk things over with the managers”.

All seven people spoken with were happy with their care and told us that staff were aware of their care needs. We spoke with two relatives of people living in the home. Both told us they were very happy with the care their family members received.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

The people who use this service prefer to be referred to as residents. This preference is respected within this report.

Residents we spoke with told us they had helped to plan the care they received and felt they were involved in making decisions about their care. They felt their needs were being met and that their care was delivered in the way they preferred. They told us the staff always respected their privacy and dignity and helped them to remain as independent as possible.

Residents told us they felt safe living at the home. They felt staff were available when they needed them and that staff had the skills they needed when providing their care and treatment.

Residents we spoke with felt that their views were actively sought by the home and that their opinions were listened to and taken into account by the management and staff.