The inspection took place on 12 December 2017 and was unannounced. There were 24 people living at the home on the day we visited.

Bramhall 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.

Bramhall accommodates 38 older people some of who may be living with dementia in one adapted building. Bramhall has recently had a new extension which is joined to the existing home and this has supported them to increase their numbers.

There was a registered manager in place. However, they were in the process of handing over their role to a new manager who had also applied to be registered. ‘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.’

This is the second consecutive inspection where the home has been rated as Good.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People were able to access advocates to speak for them when needed and were supported to be involved in planning their care and able to make choices about their lives. People’s privacy and dignity were respected.

Staff were kind and caring. There were enough staff to meet people’s needs and safe recruitment practices ensured that they were safe to work with people living at the home. Staff received training and support which enabled them to care for people safely. Staff had received training in how to keep people safe from harm and were clear on the actions they should take if they had any concerns.

People received an assessment when they moved into the home and environmental and care risks were identified and action was taken to keep people safe. Care plans recorded the care people needed and were regularly reviewed to stay up to date. Medicines were safely managed and the food provided supported people’s wellbeing. Systems were in place to support the sharing of information across services and people were supported to access appropriate healthcare when needed. People’s wishes for the end of their lives were respected and support from palliative care professionals was available.

The provider had completed a new extension and had provided a bright and pleasant environment for people to live in. They had incorporated the use of technology to keep people safe. The home was clean and staff had received training in keeping people safe from infection.

The home was well managed and there were systems in place to monitor the quality of care provided. Lessons were learnt from any incidents and action taken to stop them reoccurring. The feedback from people living in the home was used to improve the care they received. The provider had put systems in place to support staff to provide care in line with good practice. Staff had received training to enable them to provide support to people which met their cultural and personal needs. Complaints were investigated and responded to appropriately.

The inspection took place on 29 July 2015 and was unannounced.

Bramhall is located in the village of Tattershall. The service is registered to provide accommodation and personals care for 23 older people or people living with a dementia. There were 21 people living at the service on the day we inspected.

There was a registered manager at the service. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect

themselves. The registered manager was aware of their responsibilities under the Mental Capacity Act 2005.

The registered manager calculated staffing numbers based on people’s needs and there was enough staff so they did not have to wait for care. There were appropriate recruitment systems in place to ensure staff were safe to work with people at the service and initial and ongoing training ensured they had the appropriate skills needed. Staff had received medicine training and Medicines were safely administered to people. There were systems in place to ensure medicines were ordered, stored and safely destroyed.

People’s needs were assessed when they started to live at the service and regularly reviewed to ensure care was planned and delivered to safely meet their needs. Risks to their safety were identified and action taken and equipment put in place to protect them. Incidents and accidents were reviewed on an individual basis and changes in care needed to keep people safe were put in place. However, incidents were not reviewed over time to see if they were occurring at a specific time or in a particular part of the service.

There was a warm relationship between people living at the service and staff. Staff were aware of people’s individual communication needs and supported people to make choices. People’s privacy and dignity were respected by staff when providing care. People were supported to maintain their hobbies and interests in the service and were also supported to take part in group activities.

There were systems in place to gather the views of people living at the service and the registered manager took steps to ensure positive changes were put into place. There was a systems of audits in place to monitor the quality of the service provided and the registered manager also engaged with external professionals to ensure quality was maintained.