We inspected this service on 8 January 2019 to complete a comprehensive inspection.

Brandon House is operated by HC-One Limited; a large provider of care homes. Brandon House provides nursing care and accommodation for up to 35 people. The majority of people who live at the home are older people living with physical frailty due to complex health conditions and / or dementia. The home offers end of life care to people. At the time of our visit there were 30 people living in the home.

People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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.

At our last inspection in February 2018 we rated the service as Requires Improvement. This was because in two out of the five key areas we checked, we found improvements were required. At this inspection, we found improvements had been made and further improvements were planned for. The area of Safe continues to be rated Requires Improvement, however, the overall rating has changed to Good.

Overall, medicines were handled safely. However, during our inspection visit a staff member did not consistently follow the provider’s policy for safe administration of medicines.

Staff understood their responsibilities to protect people from the risks of abuse and told us they would share any concerns they had following the provider’s safeguarding policies. The registered manager understood and followed their legal responsibilities when safeguarding concerns were identified to them by staff or through checks made. The provider checked staff’s suitability to deliver care and support during the recruitment process.

People were protected from the risks of cross infection and the home was clean and tidy. Individual risk management plans were in place for staff to follow and staff knew what action to take in the event of an emergency.

People were supported by trained staff, who overall, followed the provider’s policies and training given to them. People felt staff had the appropriate levels of skill, experience and support to meet their care and support needs.

People were supported to eat a balanced diet and encouraged to eat and drink enough to maintain their wellbeing. Staff supported people to access support from external healthcare professionals to maintain and promote their health.

Staff had received training in the Mental Capacity Act 2005 and worked within the principles of the Act. Managers understood their responsibilities under the Act and when ‘best interests’ meetings should take place.

Staff supported people with kindness and in a caring way to meet their physical care and support needs. People’s privacy and dignity was respected.

People had individual plans of care which provided staff with the information they needed. There were numerous activities offered to people, however, these took place largely on the ground floor of the home. There was ‘work in progress’ by the provider to look at how communal space could be increased on the first-floor.

Staff were happy in their job role and felt supported by the registered manager through meetings.

People and their relatives had no current complaints about the service. Concerns and complaints raised were investigated by the provider.

The provider, the area director and registered manager checked the quality of the service to make sure people’s needs were met. There was recognition that some improvements, such as timely record keeping, needed to be embedded into the service. Audits had identified

This inspection took place on 14 February 2018 and was an unannounced visit.

At the last inspection on 31 May 2017, the service was rated as requires improvement. This was because we found there were not always enough staff to keep people safe and respond to their needs. Risk management plans and the actions taken to manage risks were not consistently recorded. We found the mealtime experience was not positive for everyone and improvements were needed in providing people with opportunities to go out into the local community. Staff did not always feel valued and sometimes lacked confidence in their role. Audit systems had not identified these concerns.

This inspection visit was a comprehensive inspection and during this inspection we checked to make sure improvements had been made. Improvements had been made to the effectiveness and responsiveness of the service and these are now rated ‘Good’. However, some improvements were still needed in their audit systems because they had not identified some of the improvements we found in the safety of the service.

Brandon House Nursing Home is a care home registered to provide nursing and personal care to a maximum of 35 people. People in care homes receive accommodation and nursing and/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. At the time of our inspection visit, 32 people lived at the home. Seven of those people were living in the home on a 'discharge to assess' basis. Those people would be in the home for a short period prior to discharge to a more suitable place of care.

The home has accommodation over two floors with communal lounges on both floors and a dining room on the ground floor.

A requirement of the service’s registration is that they have 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 and the associated Regulations about how the service is run. There was a registered manager in post.

People told us they felt safe at the home. Staff had received training so they understood what might constitute abuse and the action they should take to safeguard people if they had any concerns. Accidents and incidents that had impacted on people’s safety had been referred to the local authority safeguarding team and had been investigated. The provider’s recruitment policy ensured, as far as possible, that staff were safe to work in a care environment.

On the day of our visit there were enough staff to keep people safe and respond to their requests for assistance. However, staff told us they often worked without the full complement of staff which meant they could not always be so responsive. An identified staffing need between 8.00pm and 10.00pm was not being filled at the time of our visit.

The provider used a range of recognised risk assessment tools to identify potential risks to people’s health and wellbeing. Improvements were needed when staff recorded the actions they had taken to manage identified risks. Staff supported people to mobilise and transfer around the home safely and where people had fallen, appropriate action had been taken to minimise the risk of further falls.

Staff received training to meet people’s needs, and effectively used their skills and knowledge to support people and build relationships. Staff understood their roles and responsibilities in relation to infection control and hygiene.

Staff were responsive to changes in people’s health needs. They understood how to manage people’s specific healthcare needs and when to seek professional advice and support so people’s health was maintained. People received their medicines as prescribed.

Although staff found it difficult to articu

This inspection took place on 31 May 2017 and was unannounced.

Brandon House Nursing Home provides dementia nursing care for a maximum of 35 people. On the day of our visit there were 31 people living in the home. The home has two floors each with its own communal and dining area.

A registered manager was 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.

During our last inspection undertaken on 12 November 2014 we found inconsistencies in people’s records regarding their mental capacity. During this visit improvements had been made and this meant the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent to care was sought in line with legislation and guidance. Mental capacity assessments had been completed and where people had been assessed as not having capacity, best interest decision meetings had taken place and the outcomes were clearly recorded.

People toId us they felt safe living at Brandon House Nursing Home. However, people’s family members and the staff felt on occasions there were not enough staff available to keep people as safe as possible.

Procedures were in place to protect people from harm. Staff had a good understanding of what constituted abuse and staff refreshed their knowledge by completing safeguarding training. Risks associated with people’s care were identified. Detailed information for staff to follow to reduce risks and to keep people safe when delivering care was not always consistently recorded.

Some people were at risk of dehydration or malnutrition. However, we could not be sure those people had received sufficient nutritional intake as quantities being consumed were not being accurately recorded.

There were processes to keep people safe in the event of an emergency. Incident and accident forms were completed. Information was analysed and action was taken to reduce the likelihood of the incidents happening again.

People’s family members spoke positively about the way their relation’s medicines were administered by the trained staff.

The provider's recruitment procedures minimised, as far as possible, the risks to people’s safety. New staff members received effective support when they first started working at the home and staff received regular training which supported them in meeting the needs of people living in the home effectively.

Staff had their work performance monitored through one - one meetings with their manager. Staff had opportunities to attend and contribute to monthly team meetings. The provider had a process for recognising individual staff member's commitment and hard work.

We received mixed feedback from people regarding the food and drink that was available to them. The lunchtime experience upstairs was positive for people. However, downstairs people were not always supported effectively to eat or to enjoy their meal. However, staff demonstrated a good knowledge of people's nutritional needs and their dietary requirements. People received the appropriate health care to meet their needs.

The home had a contract for seven discharge to assess short term placements which were funded by the CCG (Clinical commissioning group). Staff knew the people they cared for well. Staff behaviours and attitude to their work showed they wanted to look after people who were in their care well. However, staff were busy and they did not have as much time as they would like to spend with people. Staff tried to be responsive to people's needs and tried to ensure people’s requests were met in a timely manner but sometimes people had to wait for assistance.

People were treated with kindness by individual s

This inspection took place on 12 November 2014 and was unannounced.

Brandon House Nursing Home provides dementia nursing care for a maximum of 35 people. The home is divided into two units, one on the ground floor and one on the second floor. Each unit has their own communal areas.

We last inspected the home in February 2014. After that inspection we asked the provider to take action to make improvements in how records were maintained in the home. The provider sent us an action plan to tell us the improvements they were going to make, which they would complete by March 2014. At this inspection we found improvements had been made in record keeping within the home. This meant the provider met their legal requirements.

A registered manager was 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.

Staff demonstrated a sound knowledge of what could potentially constitute abuse and the actions they needed to take to keep people living at Brandon House Nursing Home safe. Staff knew how to diffuse situations that could cause agitation resulting in an escalation of people’s behaviours.

There was detailed information to support staff in managing identified risks and appropriate equipment to reduce risk and promote independence.

The manager had recently reviewed and adjusted the staffing levels within the home. As a result there was an extra member of care staff on the first floor unit. Staff spoke positively of this change saying that it enabled them to spend more time with people when not responding to their care needs.

Medication was managed appropriately and records demonstrated people received their medication as prescribed.

Staff received support from the manager to undertake further qualifications in health and social care. Staff had access to a variety of training that supported them in meeting the needs of people living in the home effectively. Staff received regular supervision and appraisals to support their personal development.

The manager understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards. Some mental capacity assessments were not consistently completed so it was not always clear exactly whether capacity fluctuated or remained constant.

People were offered appropriate support to maintain their nutrition and hydration. Where people had lost weight they were referred to the dietician for advice and support.

Staff were caring and spoke reassuringly to people who showed signs of distress. They enabled people to make decisions about their everyday routines and relatives confirmed they were involved in making decisions about their family member’s care and support.

Care plans were detailed and provided staff with information about people’s preferences and likes and dislikes. This enabled staff to deliver care in a way people preferred. Care plans were reviewed regularly so changes in need could be identified and met.

Staff spoke positively about the changes in the home since the manager had taken up their post 12 months previously. The manager had introduced systems that ensured staff could raise issues and gave assurance that any issues would be dealt be. Staff told us the manager was approachable and carried out regular checks through the home.

The manager felt supported by a good management team and by the provider. They were aware of the challenges the service faced and had acted to respond to those challenges.

We visited Brandon House Nursing Home in August 2013 and identified a number of concerns with the care and welfare people living there received. In October 2013 we revisited the home. We found the service provided had improved, but further improvements were required in the planning and delivery of care. During this visit we spoke with the deputy manager, five members of staff and a visiting relative to the home. The majority of people had limited communication so we carried out periods of observation during which we saw staff interacting well with individuals in a friendly, relaxed but respectful manner.

Care records we looked at were detailed and gave a good picture of the individual and their individual needs. They were reviewed regularly to ensure they reflected any changes in people's care needs. Staff knew the people living at the home very well and were able to demonstrate how they cared for them and met their individual needs.

We found there was a much more proactive approach in managing mental and physical health care needs. We saw relationships with external healthcare professionals had improved and they were providing regular support when issues were identified.

We looked at a selection of people's daily records such as food charts and turn charts. We found record keeping needed to be more accurate to evidence staff were doing all that was required in care and support plans.

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

Three inspectors visited Brandon House Nursing Home to follow up on concerns raised during our last visit on 12 August 2013.

We reviewed the care of five people with varying levels of need. Some were unable to communicate with us so we spent a period of time observing how people were being cared for within the home. We also spoke with eight members of staff, the manager and the group's Quality Assurance Manager.

We found the service had made some improvements with pressure care management and the monitoring of people's weights. However, we identified there were still some areas of care and welfare where further improvements needed to be made.

Since our last visit the service had recruited more staff and there was less reliance on agency staff. Staff demonstrated a good understanding of people’s needs and people responded positively to them. One staff member told us, "Staff are more content. They are able to support people without being rushed." One person told us, "Staff do a great job. It’s a very demanding role and they are very caring.”

Staff told us that new staff were now receiving an induction to the service and spoke positively about the support from the new management team.

Two inspectors visited Brandon House Nursing Home on 12 August 2013. The inspection was part of our annual inspection programme as well as to check concerns we had received about the service. The manager and deputy manager had left their positions in the three weeks prior to our visit. A manager from another home in the provider group had taken up the role of manager until a new manager had been appointed. They were being supported by the group's Quality Assurance Manager.

People at the home had very complex needs and were unable to tell us about their experiences. We closely observed the care provided to people and looked at associated records. We found there were improvements needed in all five of the standards we reviewed.

Care records were not always accurate and did not demonstrate that people's care and treatment needs were being effectively and safely managed. Action was not taken when it had been identified people had lost significant amounts of weight.

The service had to use a high level of agency staff as they did not have sufficient numbers of staff to cover all the shifts on the rota. We were concerned there were insufficient nursing staff to meet the needs of people at night.

Arrangements to minimise the risk of infection in the home were not always being followed by staff.

This was the first inspection of this service since it was taken over by a new provider in October 2011.

We made an unannounced visit to this care home on 16 August 2012.

We spoke with ten of the 34 people using the service at the time of our inspection and one of their relatives. People spoken with told us they were satisfied with the care they received. Their comments included,

“They are friendly”

“There usually seems to be enough staff. Some staff are more caring than others.”

” I feel safe here.”

We spoke with the registered manager, the deputy manager, two nurses and three care staff. We looked at some records relating to the running of the home, such as the staff duty rota and training records.

Some people using the service had complex care needs, which meant they might have difficulty talking to us about their experiences. We spent time in one of the lounges closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

Overall we found that Brandon House was providing effective care and support to meet the needs of people using the service.