This inspection took place on 9 and 11 November 2016. It was an unannounced visit to the service.

We previously inspected the service on 16 May 2014. The service was meeting the requirements of the regulations at that time.

Bradbury House is a care home for older adults. It is located in Beaconsfield, Buckinghamshire. It is registered to provide accommodation for up to 41 people. At the time of our inspection 39 people lived at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

We received positive feedback about the service. Comments included, “It is not just known for high quality care by well-trained carers, but also for the quality of the activities offered, the outings in the mini-bus, the friendly welcome from the staff, and the warm and homely atmosphere” and “I think Bradbury House provides a very good service for the elderly community and it enables them to keep their independence plus having the care of the dedicated staff.”

People told us they liked living at the home. One person told us “I have come here to live.” The paid staff were supported by a dedicated and committed team of volunteers. This enabled people who required assistance to have greater access to activities away from the home.

We found some improvements were required around the safe administration and storage of medicines. We have made a recommendation about this in the report.

People felt safe from abuse and staff were knowledgeable on how to recognise signs of abuse and what to do if concerns were reported.

There was very stable and well established staff team. Many members of staff had worked at the home for a long time and had progressed to more senior positions. There was good communication across the whole staffing group.

There was a clear management structure which was understood by people who lived at the home. Audits conducted by the provider and registered manager demonstrated a clear programme of driving improvements.

Staff were well trained and knowledgeable about the people they supported. We saw that appropriate professional relationships had developed between staff and people.

The home had a relaxed and informal atmosphere, people, relatives and staff told us how friendly, warm and homely Bradbury House was. This was enhanced by the resident dog Ben. Several people told us how they liked having Ben around as they had always lived with dogs.

People had access to a wide range of activities both within the service and away from the service. Regular activities included trips out to garden centres, theatres, mystery tours. The home had an adjoining activities centre. It held a variety of activities, based on what people wanted to do; this included making homemade jams, crafts and quizzes. The management committee held regular fund raising events. Bradbury House was well known in the local area and was involved in the various clubs and societies in Beaconsfield.

The inspection was carried out by one inspector who gathered evidence to help answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and support was planned and delivered in a way which ensured people’s safety and welfare both within the home and in the wider community. We saw any risks to providing people's care and support had been considered. Guidelines were in place to inform staff what measures were to be taken to manage the risk safely whilst maintaining people's independence.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The manager confirmed they worked collaboratively with the local authority to safeguard and protect the welfare of people who used the service by reporting any concerns and attending any safeguarding meetings.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People told us they felt safe and knew who to speak to if they had concerns. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) although no applications had needed to be submitted. Staff were provided with training on an annual basis. This provided them with the skills and knowledge so they understood when such an application should be made. We noted refresher training sessions had been booked to take place in June and July 2014.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs before they moved into the home. They told us they were involved in the process as well as family members. This enabled the home to access any equipment prior to them moving in and to write an initial care plan according to people's preferences and wishes.

Where people lacked the capacity to make decisions and consent about particular aspects of their care and support, suitable arrangements were in place. This was to ensure the service acted in accordance with legal requirements and appropriate consultation had taken place to ensure people's best interests had been taken into account.

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required. Where there had been a change in people's care and treatment, their care plans had been updated accordingly. This showed staff worked jointly with other health care professionals to meet people's needs in the most appropriate way.

Is it caring?

People we spoke with told us they were consulted with about the care and support they were provided with and their views and choices were acted upon.

People told us they were happy with the care and support they received. One person told us ''I like living here...the staff look after me well.'' Another person told us ''I have been here six months and visited before I moved in. The staff are very kind, I can't complain about it at all. It is better than living at home on my own.''

Staff showed they had a good understanding of people’s needs and knew them well. We observed staff were gentle and patient with people and provided assistance to those who required help. They were respectful when they spoke with people and did not hurry them but enabled them to answer at their own pace.

Is the service well led?

People we spoke with told us they were consulted with about the care and support they were provided with and their views and choices were acted upon. We were told their views were sought through regular resident and sponsor meetings, annual surveys and on a general day to day basis.

There were a range of audits and systems in place to monitor the quality of service. The results of the audits were then collated and where any shortfalls were found an action plan was put in place to address them. This ensured they had a continuous regular system to assess and monitor the service and make changes to improve outcomes for people who used the services.

Care plans were in place and documented people's individual needs. They were individualised and described what the person was able to do themselves and what they required support with. We found them to be detailed, reviewed and updated regularly.

This showed people's needs, preferences and their care plan had been discussed, planned and agreed with them.

Risk assessments had been written to identify and reduce the likelihood of injury or harm, with guidelines in place for staff.

There were safe systems in place for the management of medicines. People were supported to take responsibility for their own medication where they were able to do so safely within a risk management process.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well. An account of visits and actions to be taken were documented. This ensured staff met people's needs in the most appropriate way.

Daily activities were provided for those who wished to take part. These included trips out into the community as well as in house activities and entertainment.

People told us they felt safe and knew who to speak to if they had concerns. People told us they were happy with the care and support they received. Comments included ''I feel I belong here'', ''they are looking after me very well indeed.'' and ''I feel we are all part of a big family.''

People who use the service told us that staff were good at respecting their privacy and would knock on doors before entering. They said they were encouraged to be independent and do as much for themselves as possible and felt consulted on and involved in life at Bradbury House.

People said they had been able to visit the service to see if it was suitable for them. They said they had been asked about their needs and staff displayed a good awareness of their needs. They told us there were plenty of activities arranged for them which they were encouraged to participate in and visitors were made welcome.

They told us they had no concerns about their safety and wellbeing at Bradbury House and that staff were good at responding to call alarms when they needed them. They said that a member of staff could always be located when needed and were always able to do what was required of them. People said that staff were courteous and respectful to them.

The people we spoke with said they had never had the need to raise a concern, but if they did they would feel confident and comfortable in approaching the manager or other staff. They told us there were meetings they could attend to discuss their views on the service and staff.

One person summarised her experience at Bradbury House by saying: “I am perfectly happy here. I have no concerns and feel able to talk with everyone here”. Another person said: “Living here is very good. Staff are attentive and listen. I have a critical eye and know how things should be and everything here is just fine”.

People told us someone from the home had visited them to discuss and assess their care and support needs before they moved into the home. This was to ensure both parties could be confident their needs could be met appropriately.

Although people supported by the service received the care and support they needed, the lack of accessible information, in some cases, had the potential to place people at risk of inappropriate or unsafe care because information about them was insufficient.

We saw records were kept of appointments with healthcare professionals, such as doctors, ophthalmologists, and district nurses. A brief account was written to provide a record of the appointment and any action required to ensure staff were aware of treatment provided.

We observed how staff interacted with people during the lunch time period. We saw staff were gentle and patient with people and provided assistance to those who needed help. They were respectful when they spoke with people and enabled people to enjoy their meal in an unhurried manner.

Comments from people who used the service included; ''I am very happy here and well provided for.'' ''They do a wonderful job.'' ''They have many activities, something different everyday...I'm very much at home here.''

Staff told us they were provided with a good level of training to assist them in their roles. They said the manager was very proactive in ensuring their training was up to date.