About the service:

Braeside 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. The home can accommodate up to 36 older people, some of whom were living with dementia. At the time of this inspection there were 35 people using the service.

People’s experience of using this service:

¿The service had an experienced registered manager who had ensured all the issues from the previous inspection had been resolved and systems were in place to drive continued improvement.

¿We received positive feedback about the service from all stakeholders including people who lived at the home, their families, care staff and health and social care staff. One relative told us, “They are friendly and there is a very good atmosphere. They had her up and dancing last week. Mum has a good rapport with staff. I feel they look after mum as if she was one of their family.” A visiting professional told us, “This is one of the good homes. The care and attention given to the residents is very good”. Relatives told us that the good communication and openness gave them confidence and reassurance.

¿Stakeholders were engaged in a meaningful way where consultation led to improvements being made to the service.

¿We observed an open, friendly and caring atmosphere in the home and this was supported by a low turnover of staff.

¿People’s care needs were met safely and we received good feedback about staff being caring and treating people with dignity and respect. There was also good feedback about the cleanliness of the home, the food and the activities on offer.

Rating at last inspection: At the last inspection the service was rated requires improvement (published 23 March 2018). The overall rating has improved at this inspection.

Why we inspected: This was a planned inspection based on the current timescales for returning to re-inspect services rated requires improvement overall.

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

The inspection took place on 30 January 2018 and was unannounced. The last inspection was carried out in April 2015 when the service was rated as Good. At this inspection we found breaches of Regulation 9, 12 and 14 of The Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to lack of measures to ensure good nutrition, poor recording of food and fluid intake, lack of staff engagement with people who used the service and unsafe use/storage of oxygen.

Braeside Care Home is a privately owned residential care home located in the Smallbridge area of Rochdale. Braeside 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.

The care home accommodates 36 people in one adapted building, over two floors. The lower floor accommodates people with nursing or residential needs and the upper floor specialises in providing care to people living with dementia. At the time of the inspection there were 34 people living at the home, there was one vacancy and one person was in hospital.

There was a registered manager in place who had managed the service for a number of years. 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.

There was an appropriate safeguarding policy and procedure in place, staff had undertaken safeguarding training and demonstrated a good understanding of the issues and how to report any concerns.

Staff recruitment was robust at the home and staffing levels were good on the day of the inspection. The medicines systems were safe.

The home was clean in most areas and there were no malodours. However, some areas required attention to ensure they were safe. Health and safety certificates were in place and general and individual risk assessments had been completed, though some of the individual risk assessments had not been not regularly updated.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Care files included a range of information relating to health and well-being. However, some specific care plans and monitoring charts had not been completed.

There was a good induction for new staff and training was on-going. However, a number of refresher training courses had been completed in one day, which undermined the quality of the training.

People told us the food was good and there were choices available. The mealtime experience could have been improved with better interaction with staff. The environment could have been better equipped for people living with dementia.

People we spoke with had mixed views about the care provided at the home. We saw that visitors were made welcome, but staff interaction with people who used the service was poor at times.

There were up to date policies on privacy and confidentiality, equality and diversity, fair access, diversity and inclusion. Residents’ and relatives’ meetings were held regularly so that people’s views could be taken on board.

Information within the care files was person-centred and included people’s preferences and background information. There were some activities on offer, but some people were left with no meaningful occupation through the day.

There was an end of life policy and procedure and staff had received training in end of life care.

There was an up to date complaints procedure and this was outlined in the service user guide and displayed in the reception area of the home.

People we spoke with said the registered manager was approachable. We saw evidence of s

Braeside Care Home is registered to provide personal and nursing care for up to 36 people. It is located in the Smallbridge area of Rochdale. This was an unannounced inspection which took place on 28 April 2015. There were 32 people living in the service at the time of our inspection.

We last inspected this service on 27 August 2014 and found that the service had breached two of the seven regulations assessed. We issued compliance actions that required the provider to make the necessary improvements in relation to cleanliness and infection control and supporting workers.

The home 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.

People who used the service and the visitors we asked told us that Braeside Care Home was a safe place to live and they were well looked after. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm. Staff said they would report poor practice and felt confident that the registered manager would take appropriate action. We found that recruitment procedures were thorough and protected people from the employment of unsuitable staff.

We saw medicines were managed safely and people were supported to take their medicines as prescribed.

The home was clean and appropriate procedures were in place for the prevention and control of infection.

Members of staff told us they were supported by management and received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service. The staff team had also completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

All the people we asked told us the meals were good. Snacks and drinks were available between meals. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

An on-going programme of redecoration and refurbishment of the premises was in place. There were plans for the lounge and dining room on the dementia unit to be redecorated.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences which enabled staff to provide care that was person centred and promoted people’s dignity and independence.

Leisure activities were routinely organised within the home. These included various games and quizzes. Outside entertainers also visited the home.

A copy of the complaint’s procedure was displayed near the main entrance. No complaints had been made to CQC or the local authority during the last year.

Members of staff told us they liked working at the home and found the registered manager approachable and supportive.

We saw that systems were in place for the registered manager to monitor the quality and safety of the care provided.

During our inspection visit we spoke with seven people who used the service, the relatives of three people who used the service, four members of staff and the manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We saw that people were treated with dignity and respect. People told us they felt safe. One person said, “The staff are very good and very nice to us.” Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Relevant staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

We saw that significant areas of the home were dirty. This included the skirting boards, window sills and radiators in most rooms.

Medication was managed and administered by registered nurses who knew how to safely give medicines to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and infection control.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs.

We found that people’s care records included an assessment of their nutritional status so that appropriate action was taken if any problems were identified. One person said, “The food is hot and delicious”. The relative of one person said, “The food is excellent, they’ve got a wonderful cook.”

Discussion with care workers and examination of records confirmed that induction training for new employees and a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

However, there was no evidence to demonstrate that members of staff had regular supervision meetings with the manager. This meant that staff were not given the opportunity to formally discuss their training and development needs and any work related issues.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting workers.

Is the service caring?

We saw that members of staff were attentive to people’s needs and offered appropriate encouragement and assistance when necessary.

People who used the service told us they liked living at the home and received the care and support they needed.

The relatives of one person said, “The care is second to none, there’s a family atmosphere. You’d have to go a long way to beat this place.” One visitor told us their relative was very happy at the home and said, “When the staff come into her room her face lights up. They talk to her about everyday things and they use her name all the time.”

People’s personal preferences, interests and diverse needs had been recorded in their individual care plans.

People who used the service and their representatives were given the opportunity to complete satisfaction questionnaires annually. The manager evaluated these surveys in order to identify any areas for improvement.

Is the service responsive?

Leisure activities were routinely organised at the home. The activities coordinator said, “We play cards and bingo, and make cards. I take people out for a walk and to the local garden centre.” We also saw that one person was given a hand massage and manicure and others were assisted with drawing. One visitor told us that a member of staff read to their relative.

Outside entertainers visited the home every two months and members of a local Church visited monthly for hymn singing and prayers. Local clergy also visited regularly and offered Holy Communion to people who wished to practice their faith in that way.

The manager had an ‘open door’ policy so that people who used the service or their relatives could discuss any concerns. The relative of one person said, “The manager has been very kind and nothing was too much trouble.”

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered most aspects of the service provided. However, these audits had not identified the shortfalls we found during this inspection.

We did not speak with any people using the services as part of this inspection.

We received an action plan in June 2013 with details of how the provider was going to meet the areas of non-compliance. During our inspection we found that the provider had met the areas of non-compliance from the previous inspection in May 2013.

We spoke with two visitors who were visiting a friend on the day of inspection. They told us they were impressed with the attitude of the staff and felt that staff treated the people with respect and dignity.

One person said “The staff always wait patiently for people in a loving way.”

Both visitors felt that people living at the home seemed safe and had no issues or concerns.

Both visitors commented that the environment was pleasant and the home had a nice odour. One visitor said “There are hand sanitizers everywhere you look.”

We spoke with two people who were living at the home. They told us the staff were good and treated them well. Both people confirmed staff asked them for verbal consent before providing treatment and personal care.

One person said “The staff treat me with respect and it’s a fantastic place.”

Both people were positive about the environment and living with the other people. Both people felt safe living at the home and did not have any concerns related to the wellbeing of any of the people at the home.

The people we spoke with told us they felt there were enough staff around and that the staff were friendly and helpful. They told us that they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns or complaints.