This inspection was unannounced and took place on the 08, 09, 13 & 14 February 2017.

The home was previously inspected in July and August 2015 during which we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. We found that medicines had not been managed in a safe way. We also found a breach of the Care Quality Commission (Registration) Regulations 2009 as the register person had failed to notify CQC of incidents of abuse or allegations of abuse.

During this inspection we found that the provider had taken action to address the breaches identified at the last inspection.

Brampton Lodge is a residential care home providing accommodation and nursing, personal and intermediate care for up to 59 older people, some of whom are living with dementia. The service is provided by Care Concepts (Appleton) Limited. At the time of our inspection the service was providing accommodation to 56 people.

All bedrooms are single, wheel chair accessible and have en-suite facilities which include a shower. Two passenger lifts are installed to enable access between the ground and first floor areas. The home is divided into four units and has four lounges and dining areas, a smaller lounge and various seating areas. There are three assisted bathrooms and a multipurpose room with hair salon.

At the time of the inspection a registered manager was 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.

During our inspection of Brampton Lodge, we spent time talking with people using the service, their relatives and staff. We also undertook observations within the home. We saw that staff took take time to communicate and engage with people using the service and that people were treated with dignity and respect. Staff were also observed to be responsive and attentive to the needs of people using the service and people were empowered to follow their preferred routines.

The needs of people using the service had been assessed and planned for. Risk assessments had been completed alongside each care plan where appropriate, to help staff to identify and control potential and actual risks. Care and support plans viewed were person centred and included key information on what was important to people, their likes and dislikes, tips for promoting effective communication and key information on their support needs.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training and supervision to develop the necessary skills and competence for their roles.

People had access to health care professionals subject to their individual needs and medication was ordered, stored, administered and disposed of safely.

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff had received training in relation to this protective legislation.

People had access to a range of activities available in the home and local community.

People had access to a choice of menu which offered a varied, balanced and wholesome diet.

Audits had been established to monitor service operations and systems were in place to safeguard people from abuse and to respond to complaints.

During our visit we spoke to people living in the home and their relatives. Their comments were very positive about the care and treatment provided by the home. Comments included: "I wouldn’t want her to go anywhere else ." and “I really cannot fault it.”

Relatives told us they felt very welcome in the home and were included to whatever level they wished to be. They could make themselves a drink whenever they visited and get involved in the many entertainments provided.

Staff were observed to treat the people living there with sensitivity, patience and respect. The staff we talked to felt well supported by both the manager and the providers and described a wide programme of training and development. Staff were very aware of potential abuse and knew what steps to take if they suspected it. The relatives told us that they had no concerns. One commented, “I have no concerns, not a hint of it. ”

We observed a range of audits in use to monitor the quality of the service provided. Both relatives and the people living in the home had regular opportunities to comment on the service by completing feedback questionnaires and attending meetings.

We spoke to six people who were living at the service and two visitors during our visit. Their comments were overall very positive about the service and the care received. Comments included:

“It’s marvellous, the staff are lovely”; “We can’t ask for anything more, the home is so beautiful they have thought of everything” and “It’s excellent.”

People living at the service were able to tell us that they were happy with the service. visitors told us that the standard of care was always very good whenever they visited. Visitors also told us they were always made to feel welcome when they visited and they were sometimes offered a cup of tea. They made a suggestion that it would be good to be able to make a cup of tea whenever they visited or to always be offered one when they visited. The provider advised they would review people’s suggestions.

Staff were observed to treat the people living at the service in a dignified, friendly and respectful manner. We noted that everyone was well dressed and well groomed. We saw many examples of good communication and patience by care staff, who interacted with people in a positive manner.

We spoke to two people living in the home. One person said “I am quite comfortable. The nurses always give me pain relief medicine if I need it”. The other person told us “The staff are good and everything is fine”.

The people we spoke with were extremely complimentary about the staff, the accommodation and the food. They said that staff understood their needs and provided care and support in a kind and considerate way. They said the home was always clean and the standard of accommodation was very good. Everyone said the food was also very good. People said they could express their views and were involved in decisions about their care. The only criticism that people had was that there weren’t enough social activities for them to take part in.

This inspection was unannounced and took place on the 20 July 2015, 31 July 2015 and 17 August 2015.

The service was previously inspected in January 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Brampton Lodge is a residential care home providing accommodation and nursing, personal and intermediate care for up to 59 older people, some of whom are living with dementia. The service is provided by CareConcepts (Appleton) Limited.

All bedrooms are single, wheel chair accessible and have en-suite facilities which include a shower. Two passenger lifts are installed to enable access between the ground and first floor areas. The home is divided into four units and has four lounges and dining areas, a smaller lounge and various seating areas. There are three assisted bathrooms with modern electric rise and fall baths and a multipurpose room with hair salon.

On the three days of our inspection the service was accommodating 58 people with different levels of need.

At the time of the inspection there was no registered manager at Brampton Lodge. The provider had appointed a manager following the recent resignation of a registered manager who was in the process of applying for registration with the Care Quality Commission.

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 manager was present during the three days of our inspection and engaged positively in the inspection process. The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We found that medicines were not managed in a safe way.

We found that the provider had not consistently notified the Commission of incidents or allegations of abuse in relation to people using the service.

During the three days of our inspection, people living at Brampton Lodge were observed to be comfortable and relaxed in their home environment and in the presence of staff. People using the service and relatives spoken with were generally complimentary about the care provided at Brampton Lodge.

We observed that interactions between staff and people using the service were kind, caring and responsive to individual needs. We also observed people’s choices were respected and that staff communicated and engaged with people in a polite and courteous manner.

For example, comments received from people using the service included: “I can honestly say they are very good”; “All the staff are great. They are all cheerful and helpful”; “The care provided is great”; “I have a laugh with the staff. They are nice”; “It’s lovely here. They are nice staff both day and night”; “The staff make the place a pleasant home to live in” and “The standard of care provided is excellent. Nothing is too much trouble for the staff”.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to a range of health care professionals (subject to individual need).

Systems had been developed by the provider to assess the needs and dependency of people using the service; to obtain feedback on the standard of care provided and to respond to safeguarding concerns and complaints.

We have made a recommendation about accident and incident logs so that they include information on action taken and lessons learnt in response to incidents.