Bradley House Care Home is registered to provide residential care for up to 48 older people, some of whom may be living with dementia. All the accommodation is provided on the ground floor. The home is situated on the outskirts of the town of Grimsby. On the day of the inspection there were 30 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with 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 undertook this unannounced inspection on the 26 and 27 September 2017. The last full inspection took place on 21 and 22 February 2017 and we found concerns in relation to: person centred care, medicines, consent to care and quality monitoring. The service was rated ‘Requires Improvement.’

We received an action plan from the provider about how improvements were to be made. At this current inspection, we looked at the previous breaches of regulations and the action plan to check that improvements had been made and sustained over a period of time. We found significant improvements had been made in all areas, although there was one area that required further improvement.

The overall management and governance of the service had improved, although we found audits of medicines systems needed strengthening in some areas to ensure staff were consistently following best practice guidance. We received information after the inspection that more detailed checks and records were in place. The culture of the service was more open and inclusive.

The service was operating within the principles of the Mental Capacity Act 2005 (MCA). We found improvements in records when people were assessed as not having capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Improvements had been made with the standard of recording in the care files. A new recording format had been introduced and care plans had been reviewed and updated to reflect the person’s current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. Supplementary records to monitor areas such as food and fluid intake, repositioning support and personal care were completed in detail and up to date.

Staff knew how to protect people from the risk of harm and abuse and had completed risk assessments in order to minimise concerns. Equipment used in the service was maintained and any repairs were completed in a timely way. The service was clean and tidy.

People’s health and nutritional needs were met. Records indicated people had access to health care professionals and staff arranged for visits from GPs and district nurses when required. They also made referrals to specialist health care professionals such as speech and language therapists and dieticians when required.

Menus provided people with choice and alternatives; drinks and snacks were served in between meals. People had special diets catered for and staff were knowledgeable about these. They completed additional monitoring charts when people had any nutritional concerns.

People who could talk with us told us staff were kind and caring and relatives were pleased with the care delivered to their family member. During the day we observed staff were attentive to people and knocked on doors before entering bedrooms.

Staff were recruited safely and full employment checks carried out before new staff started work. There were sufficient staff on duty to meet people’s needs during the day and at night. We saw staff had access to a range of training, supervision and support. Staff spoken with said both training and management support had improved since the last inspection. They felt confident su

Bradley House Care Home is registered to provide residential care for up to 48 older people, some of whom may be living with dementia. All the accommodation is provided on the ground floor. The home is situated on the outskirts of the town of Grimsby. On the day of the inspection there were 34 people using the service.

The service did not have a registered manager in post. A new manager had been appointed in August 2016 and they confirmed they had submitted their application to register with the Care Quality Commission (CQC) the previous week. A registered manager is a person who has registered with 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 undertook this unannounced inspection on the 21 and 22 February 2017. The last full inspection took place on 22 and 23 October 2015 and the service was compliant in all areas although we rated the service, ‘Requires Improvement’ to ensure the improvements were sustained. At this inspection we found breaches in four regulations and the service rating remains ‘Requires Improvement.’

We found there was inconsistency regarding the application of the Mental Capacity Act 2005. The registered provider and acting manager had not always followed best practice when assessing people’s capacity and discussing and recording decisions made in their best interests.

We found not everyone had a full and up to date care plan and risk assessment to guide staff in how to meet their needs in a person-centred way. Staff had not responded to changes in one person’s health care needs and action was taken to access a medical assessment following direction from a social care professional during the inspection.

There were shortfalls in the administration and recording of some people’s medicines. We also found the medicines for some people admitted for short term rehabilitation support, had been out of stock for a period of time, due to delays in obtaining the medicines. One person had not received their medicines for three days and this was addressed during the inspection. There was no guidance for staff around the use of ‘as needed’ medicines to ensure consistent administration.

The above areas breached regulations in person centred care, consent to care and safe administration of medicines. You can see what action we have asked the registered provider to take at the back of the full version of the report.

The quality monitoring system had not been effective in highlighting areas where improvement was needed such as the care records, consent to care and the management of medicines. We found action had not been consistently taken or identified in order to address these shortfalls. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We saw there were sufficient staff on duty to meet people’s needs. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. They had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff received an appraisal and recent gaps in the supervision programme were being addressed.

Relatives gave us positive feedback about the care and support their family members received. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Staff demonstrated good communication skills and distraction techniques when managing people who may need additional support to manage their behaviours.

People liked the meals provided to them and there was sufficient quantity and choice available. We saw people’s weight, t

We undertook this inspection because we had received concerns about staff getting people up early in a morning against their will. There were also concerns about the quality and quantity of the food, medication and the quality of the bed linen.

We found no evidence to substantiate the allegations made.

People we spoke with told us, “I like it here, the staff are great and they treat me ever so well.” Another person told us, “I have just had some cereal but the cook has gone to fetch me a bacon sandwich.”

Staff told us, “I always tell people what time it is and ask if they want to go back to bed but sometimes they prefer to get up. It’s all about respecting their choices and wishes” and “If we had concerns about someone’s weight we would contact the dietician.” The chef told us, “I have the details of everyone’s dietary needs. Some people can’t eat certain things and other people need soft diets.”

We saw that staff handled medication safely and they had received training; we also saw the quality of the bed linen was acceptable.

Visiting health care professional told us they were happy with the way staff cared for people and that any instructions given by them were followed. They also commented on the staff being professional and caring. We spoke with the senior nursing officer from the placing authority who told us, “We are happy with things at the home. We meet up weekly to discuss any issues and find that they deal with things quickly when needed.”

During our inspection we found people were protected from the risks of inadequate nutrition and dehydration. We spoke with five people who told us that they enjoyed the food at the home. One person told us, “I have what comes and I enjoy it. I can eat as much as I like.” Another person said, “If I want more food I only have to ask.” We observed the tea trolley rounds which offered a choice of fruit as well as tea, coffee and biscuits. People told us that they had been asked what their likes and dislikes were.

We saw evidence that people's care plans had been updated. Since our last visit their nutrition and hydration was being monitored. Where new people were admitted to the home, nutritional risk assessments were completed within 12 hours of their arrival and we found these were reviewed in accordance with nutritional assessment scores.

We observed there was sufficient staff supporting people in the dining room with eating their food and making sure they had sufficient hydration. Staff were also observed prompting people to eat food and offering second helpings. Special supportive cutlery was also made available to those people who wanted to eat independently.

Records showed the provider was carrying out regular nutritional audits and appropriate action was being taken where required.

We spoke with eight people who used the service. They spoke positively about the care and support they received. Comments included, "I have been better since being here, I am more active. I give them 5 stars for treatment" and "It's very nice, the staff are lovely."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People we spoke with confirmed they were able to make choices about their care and treatment.

People were not protected from the risks of inadequate nutrition and dehydration. This was because some people were not receiving sufficient quantities to meet their needs or the support to enable them to eat and drink sufficient amounts.

People were protected from the risk of infection because appropriate guidance had been followed. We found the premises to be clean and tidy.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. One person we spoke with said "I like my room, it's like a hotel." Another person said "They keep my room clean and tidy."

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. People we spoke with confirmed the standard of care they received was good and the staff were caring and kind.

People told us they were happy with the care and treatment that Bradley House Care Home provided. One person who used the service said, “It’s very nice here. I get on very well.” Relatives we spoke with were complimentary about the service. Two relatives told us their views on the service and about the experience of their relative: “We think it is brilliant here. We have a good feel about the place. They are really patient with people. When they bring his tea they ask him each time and they have a chat. The staff don’t walk past without greeting people. He just loves it here and he is quite settled.” Another relative said, “It is really lovely here. My relative is just full of praise. The atmosphere here when you walk in is absolutely lovely.”

Relatives and others spoke positively about the staff working in the service. A relative said, “I think it is very good. The carers talk to everybody in a friendly way. They are very cooperative if there are special needs.” Another relative told us, “The staff are lovely, they always look us up and they are always chatty. We could approach any member of staff.” Another relative said, “Staff are smart looking and are supported. Staff are friendly and polite.” A visiting healthcare professional said, “The staff are always helpful.”

We undertook an unannounced inspection of this service on 24 August 2011 and we observed positive interaction between the staff and people who use the service and saw that people were treated with respect. We talked to a number of people who use the service and they spoke positively about the staff and care received. We received comments such as “staff are very nice” and “staff are really helpful”.

One person told us that they had taken part in a game of boules that morning which they had really enjoyed.

We undertook an unannounced inspection of this service on 6 April 2011 and we observed positive interaction between the staff and people who use the service. We spoke to several people who were residing at the home and they spoke positively about the staff and the care that they received. They told us that they were respected and described staff as being "kind and helpful". People who we spoke to told us that they were able to choose how they spent their time and enjoyed the activities that the home provided although one person said they "wished there were more". We received one negative comment on cleanliness and this was regarding a dirty dressing being left on the floor by staff. One person told us that "staff do not really have time to chat and it would be nice if they had more time". Staff told us that there were times when staffing levels were not adequate.

We undertook this unannounced inspection on the 22 and 23 October 2015. At the last inspection on 5, 6 and 7 June 2015 we found the registered provider was non-compliant in five of the areas we assessed. We issued compliance actions for concerns in person centred care, staffing and governance. Two warning notices were also issued regarding concerns in how the environment was maintained and standards of hygiene. During this follow up comprehensive inspection we found improvements had been made in all areas. We have rated one individual domain, ‘Caring’, as Good; the rating for the domain ‘Responsive’ remained rated as Requires Improvement and we have changed the rating from Inadequate to Requires Improvement in ‘Safe’, ‘Effective’ and ‘Well-led’. We have changed the rating of the service overall to Requires Improvement. This is because we want to monitor the improvements further to be sure they are sustained over a period of time.

Bradley House Care Home is registered to provide residential care for up to 56 older people, some of whom may have a physical disability and may be living with dementia. The majority of the accommodation is provided on the ground floor; there are six bedrooms on the first floor with lift and stair access. There is a good range of different communal space. The home is situated on the outskirts of the town of Grimsby.

The service is required to 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 registered manager had left the service at the end of June 2015. A new acting manager had been appointed and was in the process of collating information for their application to be the registered manager.

We found improvements in the way the service was managed. A new quality monitoring system had been started which included audits and meetings to seek people’s views. We are keeping this area under review and monitoring it to make sure the improvement is consistent over time.

We found significant improvements had been made to the quality of the environment, new furniture, furnishings, flooring and décor had been provided. Significant improvements were seen to have been made to the standards of cleaning and hygiene and the service smelled fresh. We are keeping this area under review and monitoring them to make sure the improvements are consistent over time.

There was a better range of activities for people to participate in and a new activity co-ordinator had been appointed.

We found staff were recruited safely and there were sufficient numbers of staff with different skills and experience on duty day and night. Staff received more training and supervision in order for them to feel supported and confident when caring for people.

Although care was planned and delivered in a more person-centred way, further improvements were needed to ensure staff were provided with clear and detailed care directions to meet people’s assessed needs.

We found people were treated with dignity and respect, we observed staff interacted well with people, knew their likes and dislikes and demonstrated a caring and attentive approach.

We found people were protected from the risk of abuse or harm. Staff were aware of how to use the policies and procedures to safeguard people and when to make referrals to the local safeguarding team.

Safe systems were in place to ensure people received their medicines as prescribed and they were held securely.

People were provided with a varied diet that took account of their likes, dislikes and preferences. They told us the meals were good and we saw a choice of food and drink was offered throughout the day.

People had their health needs met and received additional treatment and advice from a range of health care professionals in the community.

We observed staff support people and their relatives in a kind and compassionate way. People

were supported to make their own decisions and choices. When they had been assessed as lacking capacity to make their own decisions, staff acted within the law and held best interest meetings with relevant people present.

People felt able to make complaints. There was a policy and procedure to guide staff.