About the service:

Bradeney House is a nursing home which can accommodate 101 people. It provides a service to older people, some of whom may be living with dementia. Bradeney House is also registered to provide personal care to people living in their own homes which are situated in the grounds of the home. At the time of this inspection there were 94 people living at the home. There was currently nobody receiving the regulated activity of personal care in their own home.

People’s experience of using this service:

•People and their relatives were very positive about the service and care provided. A person who lived at the home said, “The staff are very nice, very helpful and very friendly. They deserve every accolade you give them. They put themselves out to keep us happy. You can’t fault them.” A relative said, “I am here all day every day so I know my [relative] is safe and they are looking after them. It’s a lovely home.”

•Risks to people were monitored and procedures were in place to help keep people safe.

•People’s physical and mental health needs were monitored and understood by staff and referrals to healthcare professionals were made in a timely manner when required.

•There were safe systems for the management and administration of people's prescribed medicines.

•People were protected from the risk of harm or abuse.

•People were supported by adequate numbers of staff who were safe and competent to work with them.

•People were protected from the risks associated with the control and spread of infection.

•The environment and equipment used by people was well-maintained.

•The registered manager ensured people received a service which met their needs, aspirations and preferences.

•People’s views were encouraged and responded to.

•People benefited from a staff team who were motivated and supported to provide the best care possible.

•There were effective procedures to monitor the quality and safety of the care people received.

•There was an ethos openness and transparency and learning when things went wrong.

Rating at last inspection: In January 2019, the service was rated good.

Why we inspected: This focused inspection took place because we received information of concern about the care of people who exhibited behaviours which may challenge. We focused on the key questions is the service safe? And is the service well-led?

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection took place 15 January 2019 and was unannounced.

Bradeney House Nursing and Care Home 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.

Bradeney House Nursing and Care Home is registered to provide accommodation with nursing and personal care to a maximum of 101 people, most of whom are living with dementia. There were 93 people living at the home on the day of our inspection. The home consists of units, which are all connected to each other. People's rooms are situated over three floors with stairs and passenger lift access to each floor. People have access to communal areas inside and outside the home.

Bradeney House Nursing and Care Home is also a domiciliary care service. It provides personal care to people living in their own houses. This service provides care and support to people living in purpose-built bungalows within the home’s grounds and is the occupant’s own home. The accommodation is bought. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care service.

Not everyone using Bradeney House domiciliary care service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. No one was receiving a personal care service at the time of our inspection.

No registered manager was in post. The previous registered manager had left in November 2018. We are aware the provider and home manager have applied to become registered managers and will be registered shortly. 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 our previous inspection on 12 and 14 July 2017, we found areas where the provider needed to make improvements, but had not breached any regulations. At this inspection, we found the provider had made all the required improvements.

The provider had made improvements in all areas of the service, since our previous inspection and continued to build on these. Quality systems were effective and were used to ensure the improvements were sustained.

Staff practice helped to keep people safe and systems and protocols helped to protect people from danger, harm and abuse. The provider and staff assessed and managed any potential risks to people from their medical conditions, equipment and the environment to help ensure they remained safe.

People received their prescribed medicines when they needed them and were supported safely by sufficient and experienced staff.

The provider followed safe recruitment practices and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home.

Staff were aware of the need to gain people's consent to their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They made choices about their food and drink, and meals were prepared appropriately where people had dietary needs or associated risks.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and encouraged to

This inspection took place on 12 and 14 July 2017 and was unannounced on our first day.

Bradeney House Nursing and Care Home is registered to provide accommodation with nursing and personal care to a maximum of 101 people, some of whom are living with dementia. There were 95 people living at the home on the day of our inspection. The home has five ‘units’ which are all connected to each other. There is one female only ‘unit’ and one ‘unit’ which supports people with their advanced dementia. The other units support people who have nursing or residential needs, both with or without dementia. People’s rooms are situated over three floors with stairs and passenger lift access to each floor. People have access to communal areas inside and outside the home.

A registered manager was in post, who was also the provider and was present during our inspection. The provider had recently appointed a manager who confirmed they had applied to register with us. 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 home was last inspected on 5 July 2016, where we gave the service an overall rating of requires improvement. At our last inspection, we found one breach of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the provider's failure to ensure their last inspection rating was conspicuously displayed at the home and on their website. We asked the provider to send us an action plan of how they intended to address this breach. At this inspection, we found their inspection rating was displayed conspicuously at the home and on their website.

The provider had made improvements since our last inspection in the processes they used to monitor the quality of the service provided. However, although the provider had these systems in place to ensure people were protected from the risk of harm, these were not always followed by staff. People also had a varied experience of the support they received at lunchtime and we had some concerns in practice in two units. The provider had already identified shortfalls in the leadership and staff supervision within two of the home’s ‘units’ and the provider was taking steps to address this.

People felt safe living at the home and with the support they received from staff. Staff were aware of the risks associated with most people’s care and understood how to keep them safe. However, there were isolated incidents in two units where staff practice needed improvement to support people safely and effectively with their eating and drinking. In addition, the assessment of risk for some people had not been completed or kept up to date by staff. This had led to staff practice not being consistent with what some people’s risk assessments stated, such as with their mobility. The provider took action to make improvements to this during our inspection.

People and relatives gave us a mixed response about the staffing levels at the home. Although there were enough staff to meet people’s needs, the deployment of staff at certain times of the day needed improving to make sure staff were always available to support people when they needed it.

People’s right to make their own decisions about their own care and treatment was supported by staff. However, at our last inspection we found staff did not always seek people’s consent before they placed clothes protectors on them prior to their meal. At this inspection, we found this was again the case in one unit.

People were supported to take their medicines when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent, were able to support people with their medicin

The inspection was carried out on 5 July 2016 and was unannounced.

Bradeney House is registered to provide accommodation with nursing care for up to a maximum of 97 people. There were 95 people living at the home on the day of our inspection. People were cared for in five units over three floors. Some people were living with dementia.

There was a registered manager in post who was present during the inspection. 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 checks the provider had in place to monitor the quality and safety of the care were not always completed. Therefore they had not identified inaccuracies in care records or the inconsistencies in the quality of care across the home.

The provider did not ensure that all staff had the necessary communication skills to support people effectively. Staff had mixed views on the quality of training provided but felt they could approach their seniors for support when needed.

People did not receive adequate support to eat their meals in a dignified manner. There were charts in place to monitor what people ate and drank but these charts were not always accurately completed. This placed people’s health and wellbeing at risk.

People were not always responded to appropriately or in a timely manner when they were distressed. People’s privacy was not always protected.

People’s preferences were not always known or respected. Although there was a range of activities on offer these were not always suited to people’s needs or preferences. On one unit staff were working with a new approach on how best to support people living with dementia to positive effect.

There was a complaints process in place but this was not always followed. Concerns were not always dealt with to the satisfaction of the complainant. People were asked for their views on the services but recommendations for change were not consistently applied by all staff.

People were supported by staff who were able to recognise the different signs of abuse and knew who to report concerns to. Staff were aware of the risks associated with people’s needs and how to minimise these risks. Staff demonstrated they would take appropriate action in the event of any accidents or incidents. The management analysed the information to identify any trends and action required to prevent reoccurrence.

People were supported to take their medicines as prescribed and accurate records were maintained. Staff received regular competency assessments to ensure the ongoing safe management of medicines. Staff monitored people’s health and arranged medical appointments as required to maintain good health.

People were involved in decisions about their care and treatment. Where people were unable to make decisions for themselves these were made in their best interest by people who knew them well.

People and their relatives found staff and management friendly and caring. Staff promoted people’s independence.

Staff found the management team approachable and supportive of them in their roles. Staff were asked their opinion on how the service could be improved and felt listened to.

You can see what action we told the provider to take and the end of the full report

The inspection took place on 15 May 2015 and was unannounced.

At our last inspection on 15 and 16 September 2014 we asked the provider to take action to make improvements to protect people who lived at the home. The provider was not meeting four Regulations of the Health and Social Care Act 2008. These were in relation to people’s care and welfare, cleanliness and infection control, staffing and supporting workers. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. We found that the actions required had been completed and these Regulations were now met.

Bradeney House Nursing and Care Home is a care home that is registered to provide personal and nursing care for up to 101 people. Care and support is provided to people with dementia, nursing and personal care needs. Bedrooms, bathrooms and toilets are situated over three floors with stair and passenger lift access to each of them. People have use of communal areas including lounges, conservatory and dining rooms. A registered manager was in post at the time of our inspection. 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.

Staff were caring and respectful towards people with consideration for people’s individual needs when chatting with people. Whilst we saw positive communications we also saw some occasions where this could have been better to show staff had been thoughtful and respectful to people who needed their support in order to express their feelings.

Although staff were knowledgeable about people’s needs and how to meet those needs care records did not always reflect the care people received. This included supporting people with their skin care needs so that care provided promoted people’s sore skin to heal. Staff did not always show they were thoughtful when responding to people’s needs so that people received support which was centred on them.

People and their relatives told us that they felt safe and staff treated them well. Staff knew how to identify harm and abuse and how to act to protect people from the risk of harm which included unsafe staff practices. Staff practices in infection control and prevention had improved as equipment was clean and hygienic which protected people from the risk of cross infections.

People and their relatives did not raise any concerns about how their medicines were administered and managed. People’s medicines were stored securely and available at times when they needed these. Staff had the knowledge to support people with taking their medicines and checks were in place so that people could be assured of receiving their medicines as prescribed.

People told us there were sufficient staff on duty who knew how to meet their needs and keep people as safe as possible. This was an improvement made by the provider since our last inspection. Staff had received the training they needed to fulfil their roles and felt supported by the registered manager. All new staff had been checked for their suitability to work at the home.

Staff respected people’s rights to make their own decisions and choices about their care and treatment. People’s permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well.

People’s care and support needs were met by staff in the least restrictive way. Where it was felt people received care and support to keep them safe and well which may be restricting their liberty the registered manager had made applications to the supervisory body. These actions made sure people’s liberty was not being unlawfully restricted.

People told us they were supported to access health and social care services to maintain and promote their health and well-being which had not always been the case at our previous inspection. This included when people needed support to meet their dietary and hydration needs so that people remained healthy and well.

Staff offered people the opportunity to have fun and interesting things to do. People’s right to private space and time to be alone with their relatives and friends was accepted and respected.

People knew how to make a complaint and felt able to speak with the staff or the registered manager about any issues they wanted to raise. People were encouraged to give their views and experiences of the home through meetings but the provider had also considered other ways of gaining people’s views through advocacy support.

There was evidence that the leadership team was looking at ways of enhancing the quality of life of people who lived at the home. This included the décor of the environment to make it more stimulating and interesting for people and plans for people with dementia to have a larger lounge space.

People felt that the management team were approachable and visitors to the home felt that the environment was friendly and welcoming. Staff understood their roles and responsibilities and felt that they were supported by the management team.

People benefited from living in a home where quality checks were completed on different aspects of the service to drive through improvements. The leadership team were open and responsive to making further improvements so that people consistently received good standards of care and treatment.

People we spoke with were satisfied with the service they received. They told us that the atmosphere was, "Very friendly and caring". One person said, "It's a good place to live and I feel safe with the staff that help me".

People told us that they attended reviews to ensure that the care they received continued to reflect their needs. People were supported to meet their individual needs in ways that promoted their health and wellbeing. This meant that the care was responsive to people’s needs.

Staff were knowledgeable about people's individual needs. Staff told us they had attended a range of training courses to equip them with the knowledge and skills to carry out their duties effectively. The staff had the opportunity to regularly meet with their line manager to review their performance and address any induction, training and development needs.

The provider had a suitable system in place to monitor the quality of the service it was providing. This meant the service was effective and well led.

We visited Bradeney House to check on the care and welfare of people living at the home.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs which meant they were not able to tell us of their experiences. We used the Short observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent 1 hour in one of the lounges to carry out this short period of observation of activity.

The general mood of people in the lounge at this time was calm and we observed staff interact with people in a relaxed and unhurried manner. Staff were seen to be kind and courteous.

We spoke with eleven people who used the service, seven staff, a relative and two unit managers.

People who used the service who spoke with us said that they were well looked after. One person told us that they were comfortable and everyone felt safe. They told us that the staff always asked them how they would like things to be done, always respected their privacy and treated them with respect. Staff told us that care plans were currently being updated with their involvement.

People who used the service told us that staff always came promptly when they needed help. They said staff talked to them about how they liked their care to be provided.

People said there was always enough staff on duty and they never felt rushed. They said that the staff were competent and always acted professionally.

One person said, “I feel safe in the home and staff listen to any concerns I might have. I would not hesitate to make a complaint if I had one”. Staff spoke of their awareness of how to keep people safe from harm.

People told us that the home was clean and comfortable. The manager told us that a recent visit by the infection control nurse had concluded that cleanliness in the home had improved. The manager showed us the improvements she had implemented and the training provided for staff.

The provider could assure people who use the service that relevant checks had been carried out when they employed staff. People were cared for by staff that were trained to do their work and carry out their roles once employed.

We spent some time talking to people who lived at the home and the staff who cared for them. We also spoke with visitors. The general mood of people in the home was calm but with a good level of activity and interaction. We observed staff interact with people in a calm, dignified and unhurried manner. There was clearly affection between the people and staff. We observed laughter and fun in the communal areas during the visit.

Peoples’ relatives stated they were consulted about the care. They said their views were taken into account in the way the service was provided and delivered. They considered peoples’ privacy and dignity was respected and their independence promoted.

People said they wouldn’t hesitate to ask questions or request help with any aspect of their relatives’ care.

We carried out this inspection in response to concerns we had received about Bradeney House.

Two inspectors carried out this inspection over two days. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with five people who used the service, six relatives, four staff, the registered manager, deputy manager and the provider.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Prior to this inspection we had received information about low staffing levels and their lack of skills. The registered manager was confident that there were sufficient staffing levels to meet people’s care and treatments needs. We saw that staff were nearby by to assist people when needed. One care staff and four relatives told us that there were insufficient staffing levels to meet people's needs. We found that records and systems relating to staffing levels provided conflicting information. This meant the provider was unable to demonstrate that there were sufficient staffing levels provided at all times.

We saw that wheelchairs were unclean and placed people at risk of cross infection. Concerns about the cleanliness of wheelchairs were also shared with us by relatives. Immediate action was taken by the provider to ensure all wheelchairs and hoists were cleaned.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that mental capacity assessments had been carried out and where necessary DoLS were in place. The staff we spoke with were unable to tell us which people had a DoLS in place. This meant people were at risk of receiving inadequate support.

Is the service effective?

Prior to this inspection we had received information that people were not provided with sufficient drinks. We spoke with three people who used the service who confirmed that they had access to drinks at all times. We saw that people who required support to have a drink were assisted by staff.

The home provided a service for people living with dementia. We found that not all staff had received dementia awareness training. This meant that people living with dementia could not be confident that all staff would have the skills to support them. The registered manager said that arrangements were in place to provide dementia awareness training in the near future.

Is the service caring?

We observed that staff were attentive to people’s needs. We spoke with two relatives who said they were happy with the care provided to their relative. However, we spoke with a further three relatives who were dissatisfied with the care and support provided to their relative. We shared these concerns with the registered manager who said that this would be investigated.

One person who used the service said they had to wait a long time to be assisted with their personal care needs and when staff arrived it was too late. The registered manager said that the support provided to this person would be reviewed.

Is the service responsive?

Prior to this inspection we received information relating to the lack of access to routine health screening. Discussions with one person who used the service confirmed that they did not have access to a dentist. The care record we looked at confirmed this. The registered manager said they had experienced difficulties in obtaining a dentist.

Is the service well-led?

The home was run by the registered manager, a deputy manager and a team of nursing staff to ensure people’s assessed needs were met.

The registered manager told us that meetings were carried out with people who used the service and their relatives and this was confirmed by the people we spoke with. This gave people the opportunity to have a say in the way the home was run.