This inspection took place on 20 February 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Brandon Lodge Care Home provides care and accommodation for up to 38 people with nursing and residential care needs. On the day of our inspection there were 36 people using the service.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of our inspection, the registered manager for Brandon Lodge Care Home had recently left the service and the deputy manager was in charge. The deputy manager told us a new manager had been appointed but hadn’t started work at the home yet.

We last inspected the service in February 2015 and rated the service as ‘Good’, however the Safe domain was rated ‘Requires improvement’ due to insufficient numbers of staff on duty. At this inspection we found the service was ‘Good’ in all areas and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered provider had a safeguarding adults policy in place and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Brandon Lodge Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence. Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The registered provider had an effective complaints procedure in place and people who used the service, family members and staff were regularly consulted about the quality of the service.

This inspection took place on 2 February 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. The home was last inspected by CQC on 10 September 2013 and was compliant.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Brandon Lodge Care Home is located in a quiet residential area in the village of Brandon, County Durham. It is a two storey, purpose built home which provides accommodation, nursing care, palliative care and respite care for up to 38 older people. On the day of our inspection there were 37 people using the service.

People who used the service and their relatives had conflicting views about the standard of care at Brandon Lodge Care Home. They told us, “I am happy”, “I am happy here”, “Staff are not always helpful” and “I asked for assistance for my relative and I was told you will have to wait until a care worker has time to spare”.

There were insufficient numbers of staff on duty in order to meet the needs of people using the service.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Training records were up to date and staff received supervisions and appraisals.

There were appropriate security measures in place to ensure the safety of the people who used the service.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

The provider had procedures in place for managing the maintenance of the premises.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLs with the registered manager, who told us that there were DoLS in place and in the process of being applied for. We found the provider was following the requirements in the DoLS.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. We also saw staff had completed training in the Deprivation of Liberty Safeguards.

People were protected against the risks associated with the unsafe use and management of medicines.

We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at lunch time when required.

The home had a programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed before they moved into the home. Care plans and risk assessments were in place when required and daily records were up to date. Care plans were written in a person centred way and reviewed regularly.

We saw staff used a range of assessment tools and kept clear records about how care was to be delivered.

We saw people who used the service had access to healthcare services and received ongoing healthcare support. Care records contained evidence of visits from external specialists.

The provider consulted people who used the service, their relatives, visitors and stakeholders about the quality of the service provided.

We spoke with nine people who used the service and six relatives.

We asked people if they were asked for their consent to care and treatment. Comments included “They always ask before they do anything” and “They don’t just tell me what they’re going to do, they always ask first.”

People told us, without exception, they were happy with the care provided. Comments included “The care is gold standard, they go the extra mile for you”, “The staff are a great lot, it couldn’t be better”, “The staff are all lovely” and “I wanted my relative to come here as it is the best for care.”

Most people were satisfied with staffing levels. One person said “If I press the button they come straight away.” Another said “The staff are very good here, they are as quick as they can be.”

We found the provider requested feedback from people who used its services, relatives and staff, and took action to address any concerns.

We found records were up to date and securely held.

All the people we spoke with said they were happy at Brandon Lodge Care Home. One person said "I love it here." People said they had been given the opportunity to look around the home before deciding to live there.

People said they were happy with the staff and the care they provided. One person said "The staff look after me well" and another person said "It’s lovely here, the staff are really attentive."

We also spoke to some relatives, they said they were involved in care planning and reviews of care. One person said “they keep me up to date”, another said “I am very comfortable with how they make my relative feel, I know that if I can’t get in to visit they will be well looked after”.

People said they were aware of the complaints system.

People told us that they felt they were treated with dignity and respect. A relative told us, “All the ladies always look nice – well dressed and clean.”

Another visitor said, “If my (relative) spills any food they make sure she is changed so that she’s not sitting in stained clothes.”

People commented positively on the activities at the home, especially seasonal events. People told us that they had been enjoying making calendars and other arts and craft activities.

People told us that they felt “well cared for”. One person said, “The care is the important thing, and I think the care is very good here.”

One relative also told us, “The senior staff work with me to provide the right care for mum. They are so familiar with her needs that they can spot any changes and they don’t hesitate to get doctors or nurses to see her.”

Another relative said, “We have reviews about my (relative) so we can all agree how they should care for her.”

Some of the people we talked with had concerns about the cleanliness and infection control practices within the home. One visitor said, “There was an outbreak of norovirus (‘winter vomitting’ bug) but they still went ahead with a social fayre so there were loads of people coming into the home.”

Another relative said, “They’ve got hand gel at the front entrance but it’s not easy to see and staff don’t encourage people to use it.”

Another person commented, “It’s a nursing home but it’s not always clean.”