The Inspection took place on the 5th September 2017.

Braemer Lodge provides accommodation and personal care for up to 13 people some of whom may be living with dementia. At the time of our inspection 13 people were living at the service.

At our last inspection the service was rated as Requires Improvement. At this inspection we found the service Good.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. Staff, people and their relatives spoke very highly of the registered manager. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Braemar Lodge Residential Care home provides accommodation and personal care for up to 13 older people. An unannounced inspection was carried out on 6 July 2016 and 7 July 2016. Some people living at Braemar Lodge had care needs associated with living with dementia. At the time of our inspection 8 people were living at the service.

The service was last inspected in February 2016 were the Commission highlighted and number of concerns and we imposed conditions on the service of no further admissions could be made to the service. The provider wrote to us with actions they had taken since to improve the service. The service was previously rated inadequate overall and in special measures. Although vast improvements had been made since our last inspection, at this inspection the service has been rated as requires improvement as the provider will have to show sustained improvement and continued good care for the rating of the service to be changed following another inspection.

The service is required to have a registered manager; the manager was in the process of completing their application to become 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 service had made improvements to ensure staff delivered support that was effective and caring and this was in a way which promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits carried out by the manager and provider, which identified any improvements needed and actions were taken. A complaints procedure was in place and had been implemented appropriately by the management team.

Braemar Lodge Care home provides accommodation and personal care for up to 13 older people. An unannounced inspection was carried out on 1 February 2016 and 2 February 2016. Some people living at Braemar Lodge had care needs associated with living with dementia. At the time of our inspection 13 people were living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had a registered manager in post, however was no longer the manager of the service and was now working as part of the care team. A cancellation application from the registered manager has since been received in the Commission. A new manager had been promoted to this position and was in their first few days of managing the service when we carried out our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered Managers, 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.

Views about staffing levels were mixed and some people felt that there was not enough trained and experienced staff available to meet their needs. We also found that people or their families were not fully involved in planning and making decisions about their care. We found the service not to be responsive in identifying and meeting people’s individual care needs.

The manager and Provider could not demonstrate how the service was being run in the best interests of people living there.

Arrangements in place to keep the provider up to date with what was happening in the service were not effective. As a result there was a lack of positive leadership and managerial oversight. Systems in place to identify and monitor the safety and quality of the service were ineffective as they either did not recognise the shortfalls or when they did there was a lack of action to rectify them.

Staff did not have the skills and experience, and they were not deployed effectively to meet the needs of people. We found that staff did not always have enough time to spend with people to provide reassurance, interest and stimulation. There was a lack of knowledge around supporting and caring for people living with dementia including understanding how it affected people differently and how each individual sho

People we spoke with told us that they were content and well cared for at Braemar Lodge. They told us, "You could not ask for better. All the staff are wonderful."

We saw that care and support for each person was planned and reviewed with their involvement and consent as far as possible. Risks to the health, welfare and safety of people using the service were identified and managed. The service was responsive to people's changing needs and caring in their approach.

People enjoyed the food provided at the service and were able to exercise choice about what they ate and drank. Everyone was complimentary about the food and made comments such as, "The food is wonderful," "There is always plenty of choice," and, "They know what you like." People's welfare in relation to their nutrition was monitored to ensure their wellbeing.

There was sufficient specialist equipment such as hoists available to ensure that the service could meet people's individual needs safely. Equipment in place was kept serviced and maintained to ensure that it was fit for purpose.

People told us that they liked and got on well with all the staff working at Braemar Lodge. Staff were adequately trained and supported to care for people properly and to keep them safe.

The service was well managed and led. There were effective systems in place for monitoring and improving the quality and safety of the service, taking into account the views and suggestions of people living there.

This was a visit to look specifically at one aspect of the service following concerns being raised with us. We spoke with people briefly who told us that they were comfortable and content living in Braemar Lodge.

We saw that works to improve the environment for people using the service had taken place and were ongoing. This was positive. However works had also created extra space and the provider was found to be accommodating too many people in the service. This meant that they were not complying with conditions applied to their registration with the Care Quality Commission.

Steps have now been taken to rectify this situation. An application is being processed to increase the number of people that can be accommodated at Braemar Lodge.

People living in Braemar Lodge were happy with the care and support they were receiving. They told us that staff treated them well and were always pleasant. People said that they enjoyed the food.

People living in Braemar Lodge had a range of needs including those associated with living with dementia. A number of people were not therefore able to tell us directly about their experiences. However, we observed how they interacted with staff and how they were assisted and saw that they were relaxed and had good rapport with staff and the provider. We saw that staff were kind and patient with people.