About the service: Bramley Court is registered to provide personal and nursing care for up to 76 people. Some people may have a diagnosis of dementia. At the time of the inspection there were 71 people living in the home.

People’s experience of using this service:

The feedback we received from people and relatives was good. Staff we met and spoke with were happy and proud; they were loyal and committed to the provider and registered manager. This was reflected in their attitudes and integrity during the inspection. All staff on duty were happy to contribute to the inspection and share their views and experiences.

The service was safe and risks to people were managed well. Staff knew how to protect people from harm and had received safeguarding training. People were living in a safe, well maintained environment. The service was clean and tidy and free from any unpleasant odour. There were enough staff employed to help keep people safe and to meet their needs. We found that recruitment practices were safe and the relevant checks were completed before staff started work at the service. There were systems in place to ensure medicines were managed, stored and administered safely.

The service was effective in meeting people’s needs. Staff received regular supervision and support. The annual training programme was extensive and equipped staff with essential skills and knowledge. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. 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 supported this practice. People were provided with a healthy, balanced diet whilst promoting and respecting choice.

The service was caring towards people. People were treated with kindness, respect and compassion and people were given support when they needed it. Staff were seen to be caring towards people they supported and spoke about people positively. Staff had very good knowledge of the people they supported, including their life histories, the things they liked and didn't like and the people who were important to them.

The service was responsive to people’s health and social needs. People received person-centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People received end of life care that was dignified, respectful and caring. People were encouraged to make their views known and the service responded by making changes.

The service was well led. People received a high standard of care because the management team led by example and had high expectations about the standards of care people should receive. Staff were enthusiastic and happy in their work. They felt supported within their roles and held the management team in high regard. Staff described working together as a team, how they were dedicated to providing person-centred care and helping people to achieve their potential. Systems were in place to monitor the quality and safety of the service and the care people received.

Rating at last inspection: Good (published October 2016).

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

Follow up: We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 31 August 2016 and was unannounced. At our last inspection in August 2015 we found the service did not taken reasonable steps to safeguard people from any invasion of their privacy We saw that the provider had now taken effective action to address this.

Bramley Court is a care home with nursing for up to 76 people, some of whom are living with dementia. At the time of our inspection 75 people were using the service.

There was a registered manager in place who was present during our inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe in this home. Staff were aware of the need to keep people safe and they knew how to report allegations or suspicions of poor practice.

People received their medicines as prescribed. Medication was suitably stored and administered. Staff knew how to dispense medication safely and there were regular checks to make sure this had been done properly.

People were supported by staff who had the appropriate skills and knowledge they needed to meet their care needs. Staff received regular training and updates to maintain their knowledge of good practice and people’s latest care needs.

Meals times were promoted as a sociable and pleasant experience. People were kept safe from malnutrition because they were offered a choice of foods and drinks they liked. Staff knew how to support people to eat and drink enough to keep them well.

People were supported to have their mental and physical healthcare needs met. The registered manager sought and took advice from relevant health professionals when needed.

People said staff were caring and had built up close relationships with the members of staff who supported them. People and, where appropriate, their relatives were consulted about their preferences and people were treated with dignity and respect.

There was a wide range of activities for people to take part in which reflected their individual interests. People’s relatives and friends were made welcome and staff knew how to support people to pursue their cultural heritage and religious beliefs.

People had access to a complaints system and the registered manager responded appropriately to concerns. Where possible action had been taken to prevent similar issues from reoccurring.

There was effective leadership from the registered manager and senior members of staff to ensure that staff in all roles were well motivated and enthusiastic. The registered manager assessed and monitored the quality of care consistently through observation and regular audits of events and practice.

This inspection was undertaken to check for any improvements following our last inspection in October 2013 when we had issued a warning notice. We found the home had not made sufficient improvements to ensure that people received effective, consistent and quality care.

As the majority of people in the home were unable to tell us about their care we spoke with seven relatives and staff from the local authority. We observed the interactions between staff and people who lived in the home. Relatives, we spoke with, told us that they thought their relative was safe in the home and that the care staff were caring but busy. Our observations at meal times and during our SOFI observations indicated that people had brief interactions with staff when they needed some support with personal care tasks, but there were greater spans of time when interactions between staff and people living at the home were infrequent. There was no consistent effective programme of activities or entertainment provided for people living in the home. We observed that people spent their time being neither happy nor sad and at times appropriate support for people was not given to meet their needs.

Care plans did not support the care people received. The relatives we spoke with who acted on behalf of people who lived in the home had not always seen care plans when they had been written or updated. Whilst relatives thought they could raise concerns easily with staff members they were unsure that 'the message got passed on’ and were not always sure of the designation or role of the staff member they spoke with. Records indicated that complaints were not always responded to effectively.

We could not find appropriate systems were in place to ensure that people received consistent care. Since our last inspection another manager had left the home. The service has had six managers since June 2012 and there has been significant turnover of qualified nurses. Systems used by the provider have not been robust enough to ensure that the service was well-led.

At the time of our inspection the provider did not have a registered manager in post.

We visited Bramley Court to undertake a themed inspection in June 2012 which looked at how people's dignity and nutrition needs were met. We had serious concerns and issued a warning notice about nutrition. We visited in October 2012 to follow up these concerns. Our observations, contact with the commissioners of the service and conversations with people who lived in the home and relatives indicated that the home was improving.

Following our visit on 22 October 2012 concerns were raised with us about the care and safety of people living in the home. None of the concerns named specific people, dates or times of incidents for us to be able to track specific events. However, during our visits on 28 and 30 November and 3 December 2012 we identified poor outcomes for people's: nutrition, hydration and skin care, medicine administration and when people were assisted to move. Staff behaviour throughout the organisation and records needed to improve.

We continued to visit the home to check the well being of people. On this visit we found improvements in the identification, action taken and recording of when people's health conditions deteriorated. We also found that care staff were more organised and confident about the care they were providing. Although there remained some risks of poor outcomes for people about: medicine administration, records and development of plans of care that reflected people's individuality these concerns were substantially less than previously.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We visited Bramley Court to undertake a themed inspection in June 2012 which looked at how people's dignity and nutrition needs were met. We had serious concerns and issued a warning notice about nutrition. We visited in October 2012 to follow up these concerns. Our observations, contact with the commissioners of the service and conversations with people who lived in the home and relatives indicated that the home was improving.

Following our visit on 22 October 2012 concerns were raised with us about the care and safety of people living in the home. None of the concerns named specific people, dates or times of incidents for us to be able to track specific events. However, during our visits on 28 and 30 November and 3 December 2012 we identified poor outcomes for people's: nutrition, hydration and skin care, medicine administration and when people were assisted to move. Staff behaviour throughout the organisation and records needed to improve.

We have continued to visit to check the well being of people and our concerns remain. Where areas of non compliance have been identified during inspections they are being followed up and we will report on any action when it is complete.

During our visit on 22 October we met a number of people who lived at the home and spoke with some of them about their experience of being supported and cared for. We also spoke with some visitors who were at the home with their friends or relatives. The majority of people living at the home were unable to tell us about how their care and support needs were being met. We used the Short Observational Framework for Inspection (SOFI) which is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with 4 visitors and 5 people who lived in the home. Some people told us that they were pleased with the service they received and specifically commented about the meals that were provided.

Visitors in one lounge commented on the increased availability of drinks every time they visited, remarking, "My relative always has at least one cold drink within easy reach every time we visit, and this is not like it used to be."

Visitors advised that they had no concerns about the care of their relatives and friends. Some were able to be closely involved in supporting the person living in the home, and positive comments were received about recent changes in the home and increased staffing that was summarised by one person who said that, “Changes have made a difference as the home is a calmer with more predictable timings of daily routines, and more staff present in the main areas of the home.”

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by one of two CQC inspectors joined by an Expert by Experience; people who have experience of using services and who can provide that perspective and a practicing professional.

The majority of people living in this home were unable to tell us about the care and support they receive. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed how people were treated throughout the day and we talked to three people and to three relatives.

People and relatives told us that care workers always ensured that people's personal care was given in a private area such as the person's bedroom or bathroom.

People thought the care workers were good but busy. One person told us that it depended on how many staff were on duty as to how quickly call bells were answered.

This report provides details from two separate inspection visits which took place months apart. The first inspection was in February 2015 and the second inspection visit was in August 2015. We were unable to provide a report from the first visit but felt it valuable to provide summaries of both visits together with the judgements from the most recent inspection visit in August 2015. Both visits were unannounced. Prior to the February visit we had last inspected this service in June 2014 and it was complaint with all the regulations we looked at.

Bramley court provides accommodation with nursing care and support for up to 76 older people who live with dementia. At the time of our August visit 71 people were using the service.

There was a registered manager in place. 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 registered manager was away during our visit however we spoke with them afterwards.

People were kept safe from the risk of harm. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions, although some of these needed to be improved with additional information. Concerns raised at our first visit about medication and hoisting people safely had been addressed when we revisited.

People were supported by the number of staff identified as necessary in their care plans to keep them safe. Initial concerns about a lack of staff to support people to engage socially and respond to care needs had been resolved with action taken by the registered manager to decrease staff sickness and improved continuity of staff. There were robust recruitment and induction processes in place to ensure new members of staff were suitable to support the people who used the service

Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. In response to previous concerns raised the provider had ensured that staff had the skills and knowledge to move and handle people safely.

The care manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. Staff sought consent from people before providing personal care. However the provider had not ensured consent had been sought from the appropriate people for the installation of camera surveillance equipment in people’s bedrooms and the provider had not ensured that people would be safeguarded from misuse of the recordings obtained. You can see what action we told the provider to take at the back of the full version of the report.

When necessary, people were supported to eat and drink and access other health care professionals in order to maintain their health.

People had positive relationships with the staff that supported them and spoke about them with affection. The provider sought out and respected people’s views about the care they received. Staff knew how to maintain people’s privacy and dignity when delivering personal care.

The provider was responsive to people’s needs and changing views. People were supported by staff they said they liked and care was delivered in line with their wishes. People could raise concerns and complaints and they were managed appropriately.

People were confident in how the service was led and the abilities of the management team. The provider had established processes for monitoring and developing the quality of the care people received. The registered manager had not ensured that overt surveillance equipment that was being installed at the service was going to be used in line with all the relevant legislation.