We carried out an unannounced comprehensive inspection of this service in June 2017. After that inspection we received concerns in relation to how a person was supported with their continence needs. As a result, we undertook a focused inspection to look into those concerns and only looked at the safe and well-led key questions. This report only covers our findings in relation to those key questions. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bradwell Hall Nursing Home on our website at www.cqc.org.uk

Bradwell Hall Nursing 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. Bradwell Hall Nursing Home is registered to provide personal care and accommodate up to 187 people, based in one building. There were six ‘units’. The units were called, Keele & Breward, Tunstall, Chatterley, Chester, Sneyd and Audley & Little Audley. There were 176 people using the service at the time of our inspection.

There was 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.

Quality assurance systems in place were not always effective in identifying when improvements were required. Lessons had not been fully learned following the identification of a risk regarding peoples’ continence care.

Improvements were required about how people were supported to have their prescribed medicines. There was mixed feedback about staffing, but overall staff were not effectively deployed to ensure people did not have to wait for support. Staff were recruited safely and they had their character checked before supporting people.

People felt safe but there was a delay in making a referral to the necessary organisation following two incidents occurring. People were protected as infection control measures were in place and the building was appropriately maintained and checks took place.

People, relatives and staff felt the management team were approachable and were able to give feedback about their care. The registered manager and provider were receptive to feedback and wanted to improve the service.

Notifications were made as required and the previous CQC rating was being displayed as required.

We inspected Bradwell Hall Nursing Home on 27, 28 and 29 June 2017, which was unannounced. At the last inspection on 29 and 30 March 2016 we found that the provider was meeting the legal requirements. However, we found that some areas required improvement to ensure people were receiving a good standard of care.

Bradwell Hall is registered to provide accommodation and nursing care for up to 187 people. People who use the service have physical health and/or mental health needs, such as dementia. Bradwell Hall provided accommodation and nursing care over seven separate units. We inspected all of the units within the service. At the time of our inspection there were 170 people using the service.

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. Each unit also had a unit manager who reported to the registered manager.

Some improvements were needed to ensure that some medicines were recorded and administered safely.

People told us they felt safe and we saw that staff carried out support in a safe way. People were supported to be as independent as possible whilst taking account of any risks to their safety.

We saw that there were enough staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels and the provider had a recruitment procedure in place, which ensured people were supported by suitable staff.

Staff listened to people and encouraged them to make decisions about their care and where able people consented to their care. Where people were unable to consent to their care people were supported to have the 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.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs effectively.

People told us that the food was good and improvements had been made to ensure that people received positive mealtime experiences on all of the units.

People were supported with their health needs and advice was sought from health professionals when required, which was followed by staff to maintain people’s health and wellbeing.

People who used the service and their relatives told us the staff treated them with compassion, dignity and staff listened to and respected their care choices people made.

People had access to interests and hobbies that were important to them. There were dedicated members of staff available to provide these activities alongside care staff and people were supported to meet their emotional and social needs.

People’s preferences were sought and staff understood how people liked their care to be carried out. People’s care needs were regularly reviewed and updated.

People and their relatives understood how to complain and were happy with how complaints were handled. We saw that complaints were managed in line with the provider’s complaints policy.

People and their relatives were encouraged to provide feedback about their care, which was acted upon by the registered manager and changes were made in response to the feedback received.

Effective systems were in place to monitor the quality of the service and actions had been taken to make improvements to people’s care.

People told us that the management team promoted a friendly atmosphere across the service. We saw that the provider promoted an open culture and people and staff told us that the management was approachable and that they listened to them.

We inspected Bradwell Hall Nursing Home on 29 and 30 March 2016, and was unannounced. At the last inspection on 08 and 09 October 2016 breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the way medicines were managed, and improvements to ensure that there were enough staff available to meet people’s needs. We found that improvements had been made to meet the legal requirements, but there were some further improvements needed.

Bradwell Hall is registered to provide accommodation and nursing care for up to 187 people. People who use the service have physical health and/or mental health needs, such as dementia.

Bradwell Hall provided accommodation and nursing care over seven separate units. We inspected the Audley, Breward, Chester, Chatterley, Keele and Sneyd units. The provider had recently registered the Tunstall unit and at the time of the inspection this unit was not providing a service. At the time of our inspection there were 141 people who used the service.

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.

Systems were not always in place to ensure people received their medicines safely. Improvements were needed to ensure that some medicines were stored and administered safely.

Some improvements were needed to peoples’ mealtime experiences to ensure that people on all of the units experienced their meals in a calm and organised environment.

People had access to some interests and hobbies within the service. However, improvements were needed to ensure that when the dedicated member of staff was unavailable to provide these activities, people were still supported to meet their emotional and social needs.

Some improvements were needed to ensure that the systems in place to monitor the quality of the service provided were monitored effectively.

People told us they felt safe and we saw that staff carried out support in a safe way. People were supported to be as independent as possible whilst taking account of any risks to their safety.

We saw that there were enough staff available to meet people’s assessed needs. The provider had an effective system in place to monitor the staffing levels and the provider had a recruitment procedure in place, which ensured people were supported by suitable staff.

Staff listened to people and encouraged them to make decisions about their care. We found that the provider followed the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs effectively.

People were supported with their health needs and were able to access other health professionals when required.

People who used the service and their relatives told us the staff treated them with compassion, dignity and respect and staff listened to their choices in the care they wanted.

People told us that the management team showed them care and they promoted a friendly atmosphere across the service.

People’s preferences were sought and staff understood how people liked their care to be carried out. People’s care needs were regularly reviewed and updated.

People understood how to complain and complaints were managed in line with the provider’s complaints policy.

People and their relatives were encouraged to provide feedback about their care,

We inspected Bradwell Hall Nursing Home as part of our schedule of inspections. The inspection was undertaken by a team of three inspectors, accompanied by an expert by experience. Experts by experience are people with personal experience of these services as service users or family carers. Their knowledge and experience helps us to make a judgement about whether a service meets the essential standards of quality and safety.

Bradwell Hall was divided into five separate units providing nursing and personal care for people with a diverse range of needs. During this inspection we inspected four of the five units and our focus was on the care of people with dementia care needs.

Relatives we spoke with told us, "X has been here for two years, we came to look around and preferred this home to any of the others we had seen. We visit at least every other day and have no concerns. We are told if there are any changes to X's condition and get to talk to the staff or manager if we need to".

During this inspection we observed interactions between staff and people who used the service and noted when interactions were positive or not, to determine what people's experience of care were like. We saw that some people had positive experiences and we were provided with some positive comments about the support provided, but we also saw that the service could make improvements to ensure that quality standards were maintained throughout the service.

We carried out this inspection to check on the care and welfare of people using this service. We visited Bradwell Hall Nursing Home on 04 July 2012 to ensure that the needs of people using the service were being met. The inspection was unannounced which meant the management and staff did not know we were visiting. The inspection consisted of a team of two inspectors and an expert by experience. An expert by experience is someone who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. During our visit they talked to the people who used the service, took some notes and wrote a report about what they found. Their information is included within this report.

We visited five of the six units providing adult nursing and residential care, including care for people who may have a dementia diagnosis or mental health care needs. We spoke with eight people who were receiving a service, four visitors and nine staff from different disciplines.

Everyone we spoke with told us that they were getting the care and support they needed. Comments included, "I feel I have been treated in a dignified manner. The care is absolutely fine, and the staff attitude was professional." Another person told us; "I am very satisfied; they have looked after me very well." " I wasn't sure about this place at first but it seems okay."

Prior to our visit the providers had sent us an action plan explaining action they had taken to bring about improvements to outcomes. They also told us what they were going to do in order to ensure that improvements continued.

We spoke with professionals who had been involved with the service and they told us that they were satisfied with the way the service had "worked with them" to ensure that improvements were made.

People who lived at the home told us that they felt well cared for. A visitor also told us that his relative was well cared for and that he had no current concerns.

Staff told us that improvements had taken place since our last visit and the manager of the service expained how further improvements would continue to be introduced by the service.

We inspected Bradwell Hall Nursing Home on 08 and 09 October 2014 and was unannounced. At the last inspection on 05 September 2013, we asked the provider to take action to make improvements that ensured people’s dignity was respected. We found that some improvements had been made.

Bradwell Hall is registered to provide accommodation and nursing care for up to 171 people. People who use the service have physical health and/or mental health needs, such as dementia.

Bradwell Hall provided accommodation and care over five separate units. We inspected the Chester, Chatterley and Audley units. The Sneyd and Keele/Breward units had been closed to visitors due to vomiting and diarrhoea. We undertook the inspection on the Chester, Chatterley and Audley units so that the risk of cross contamination was reduced. At the time of our inspection there was 164 people who used the service.

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.

Systems were not in place to ensure people received their medicines safely. We could not be assured that people received their medicines as required because medicines were not always ordered, stored, administered or recorded safely.

People told us they felt safe and we saw that staff carried out support in a safe way. We saw that improvements were needed to ensure that assessments of people’s risks were reviewed.

We saw that there were insufficient staff available to meet people’s assessed needs. The provider did not have an effective system in place to monitor the staffing levels and how staff were deployed against the dependency needs of people who used the service.

People who used the service and their relatives told us the staff treated them with compassion, dignity and respect. However, we saw that staff did not always treat people with dignity during mealtimes. Staff listened to people and encouraged them to make decisions about their care.

We found that the provider followed the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs. We found that improvements were needed to the way agency staff were inducted into the service and how their competencies were monitored.

The provider promoted an open culture. People and staff told us that the management were approachable and that they listened to them.

Systems were in place to monitor the quality of the service provided, but improvements were needed to ensure that the systems were assessed and monitored regularly and effectively.

During our inspection we identified breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.