About the service: Brailsford House is a care home for up to 20 older people and people living with dementia. On the day of the inspection 18 people were living at the service.

People’s experience of using this service: People told us they received a good service and felt safe with the support they received from staff. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. Risk assessments arising from people’s health and the environment were in place with plans to mitigate the risk. Medicines were not managed safely; fire drill and evacuation practices were not taking place and there was no record of checks on bed rails or window restrictors. One upstairs window did not have a window restrictor in place. The registered manager said this would be fitted the next day.

Care and support were based on assessments and care plans, which were reviewed and kept up to date. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. People's rights were protected by staff who understood the Mental Capacity Act and how this applied to their role. Where appropriate, people were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs.

Care workers had developed caring relationships with people they supported. People were supported to take part in decisions about their care and treatment, and their views were listened to. Staff respected people's independence, privacy, and dignity.

People's care and support considered people’s abilities, needs and preferences and reflected their physical, emotional and social needs. People were aware of the providers complaints procedure.

Although management systems were in place to monitor the quality of the care provided and to promote people’s safety and welfare, they had not identified the concerns we raised.

Rating at last inspection: Good. (report published 18 March 2016).

The overall rating for this service after this inspection is requires improvement.

More information is in the full report below.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Action we told provider to take: We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment and good governance.

Follow up: We will request an action plan from the provider to understand what action they will take to improve the quality and safety of care provided to people. 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.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four people who used the service and three relatives and asked them for their views. We also spoke with the manager and two staff members. We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people were respected and involved. A person who used the service told us they were very happy there and had never had cause to complain.

We found people received care and support that met their needs. A person described their care as “Wonderful. Couldn’t be better.”

We found people were safeguarded from abuse. All the people we spoke with told us they felt safe in the home.

At a previous inspection we had been concerned that there were not always sufficient and suitable staff available. However, since the last visit we made in January 2013, the staff numbers had been increased to ensure there was always a minimum of three staff on each shift during the day and two at night. People we spoke with said they thought the staff numbers were right and they were not left waiting when they asked for help.

We found the staff team were supported through training. Training records we looked at showed us that staff had attended regular training in areas relevant to their work, such as, safeguarding people, moving and handling etc.

We found the provider assessed and monitored the quality of the service. A person told us, “We have residents’ meetings. I find these very useful.”

There were 20 people living at the service when we visited on 15 December 2011. We spoke with three residents, five staff and with others who have regular contact with the home to ask for their comments and observations. We therefore spent a period of time, sitting with a group of people in a communal area. We were able to observe people’s experiences of living at the home and their interactions with each other and with the staff.

Our observations indicated that people had a positive experience at the home, the atmosphere was calm and friendly and the staff were attentive to the needs of the people living there.

We were told, “I didn’t choose to live here but chose to remain here, the staff are good and I’ve only got to use the call bell and they come to help.” And “I’m very happy here.”

A person told us, “I spend my time doing what I want, so yes, I’m very satisfied.”

This inspection took place on 17 and 18 December 2015 and was unannounced.

Brailsford House residential home is situated in the village of Harworth and is registered to provide accommodation for up to 20 people persons who require nursing or personal care. At the time of inspection 16 people were using the service.

The service had 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

People who used the service and staff at Brailsford House knew who to report any concerns to if they felt they or others had been the victim of abuse. People’s care records showed that any risk to their safety had been identified and measures were put in place to reduce these risks. There were enough staff with the right skills and experience to meet people’s needs. We found that medicines were stored, administered and handled safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately

People were supported by staff who had received the training and supervision they needed to support people effectively. People had consented to the care that they received. People spoke positively about the food they received and were able to have choice in what they ate at each meal. People had regular access to their GP and also other health care professionals when required.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Staff encouraged people to remain independent wherever possible and where people showed signs of distress or discomfort, staff responded to them quickly. There were no restrictions on friends and relatives visiting their family members.

Staff were always on hand to respond to people’s needs and a range of activities were available to those that wished to join in. Care plans were written with the involvement of each person and their family. They were reviewed regularly to ensure staff responded appropriately to any change in need a person may have. A complaints procedure was in place and people felt comfortable in making a complaint if needed.

The atmosphere within the home was warm and friendly. People living in the home were asked for their opinions with regard to the service that they received, which meant that their views informed decisions to improve the service. Staff understood the values and aims of the service and spoke highly of the registered manager. The registered manager had clear processes in place to check on the quality of the service and to ensure that any improvements identified were made and sustained