This inspection took place on 15 August 2017 and was unannounced.

Brantley Manor Care Home is situated on the outskirts of Lincoln. It is registered to provide accommodation and care for up to 33 older people, ranging from frail elderly to people living with dementia. On the day of our visit, there were 27 people using this service.

At the last inspection, the service was rated Requires Improvement. At this inspection we found the service was rated as Good.

The service had 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 associated Regulations about how the service is run.

During our previous inspection we found that the provider had not followed their policy to ensure that where people required their medicines to be given in their meals (covert medicines) this was done safely. In addition, medication information sheets did not include information about people's allergies to medicines.

At this inspection we found that improvements had been made. Medication records had been completed to include people’s allergies. We also saw that where people required their medicines to be given covertly, best interest discussions had taken place with people’s GP and written plans were in place to support people to take their medicines.

We also found at the previous inspection that some people were sharing bedrooms where inadequate screening was in place. There were six shared bedrooms and people’s privacy had not always been adequately protected.

At this inspection we found that the provider had made improvements. At the time of this inspection only three of the six double rooms were occupied by two people, with the remaining rooms being used for single occupancy or were vacant. There were screens available in the rooms occupied by two people to ensure their privacy was maintained during personal care. In addition the registered manager showed us proposed plans to convert the six double rooms into single rooms with en-suite wet rooms. The registered manager told us they hoped this work would commence in the new year.

People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Adequate staff with the appropriate skill mix were available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories. People’s views were listened to and they were actively encouraged to be involved in their care and support whenever possible. Any information about people was respected and treated confidentially.

People’s needs were assessed before they commenced living at the service and the care plans reflected how their needs were to be met. Records showed that people and their relatives were involved in the a

This inspection took place on 13 April 2016 and was unannounced. Brantley Manor provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 33 people who require personal and nursing care. At the time of our inspection there were 32 people living at the home.

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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe. Medicines were usually administered safely but the provider did not follow their policy for covert medicines, (these are medicines which are given in meals without people's knowledge). Medication administration sheets(MARS) were completed fully however information sheets did not include people’s allergies.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to.

Regular audits were carried out and action plans put in place to address any issues which were identified. Audits were in place for areas such as falls and infection control. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

The summary is based on our observations during the inspection, speaking with people who used the service, and the staff who supported them. We spoke with two staff members and two people who used the service. We also looked at four care records in detail and other documentation.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We observed care and saw how members of staff treated people. We saw care was delivered well and in a respectful way. We saw that staff were kind and attentive and encouraged people to be independent. We saw that staff showed patience and

gave encouragement when they supported people.

During our inspection we observed staff spoke with people on an individual basis and understood their particular needs. For example, we observed when staff provided care to people they chatted with them about things which were important to them such as their family.

We observed when staff supported people they did so at people's own pace and encouraged people to participate in their care. For example, when they supported people at meal times staff sat with people and asked them if they were ok. We saw when people were struggling to complete tasks staff were supportive and reassured people.

Is the service responsive?

We saw that people's individual physical, mental and social care and support needs were assessed and met. We saw evidence that care plans had been discussed with people. This also included people's individual choices and preferences as to how they liked to spend their day. For example, care plans detailed what time people liked to go to bed and what support they wanted during the night.

During our inspection we saw staff gave people choices and asked them what they would like to do before assisting them. For example, when offering drinks people were given choices about what drink they would like and if they would like a snack with their drink.

We observed staff obtained people's consent before they carried out any care. For example, staff asked people if they wanted support with a task.

Is the service safe?

Risk assessments regarding people's individual care needs, for example falls and mobility were carried out and measures were in place to minimise these risks. The service had risk assessments in place for areas such as the use of bed rails and refusal of care.

The home had policies and procedures in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves.

When we spoke with the registered manager they gave us an example of when they considered making a DoLS application on behalf of a person to ensure the care they received was appropriate.

The service was safe, clean and hygienic. We saw that regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members. Staff told us about situations when they required more support for people and they were able to obtain this, for example, a piece of equipment.

We observed care plans had been updated to reflect people's changing needs and where people had short term needs due to illness care plans were in place to ensure these were met.

We observed staff responded to people's needs and requests in a timely manner.

Is the service well led?

Staff said that they felt supported and trained to safely do their job. They told us they felt able to raise issues with the managers.

Quality assurance arrangements and checks were in place and people were listened to. We saw evidence learning took place following incidents and audits to ensure the continual improvement of the service were undertaken.

Records were accurate and reflected the care people required.

During our visit we spoke with two people, two members of staff and the registered manager. We observed the care people received and looked at four people's care records.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We observed care and saw staff were responsive to people and interacted with them positively.

We saw from the care plans and observations people received care which was appropriate to their needs.

People told us, “Very happy here” and “Food’s good.”

When we looked at the records we found they detailed the care people required and care was delivered to meet people's needs. We found gaps in the turn records we looked at and some inconsistencies in record keeping.

We knew the provider notified us of serious incidents appropriately.

We saw the provider had an up to date statement of purpose which detailed the service available to people.

As part of our inspection we spoke with a number of people who used the service. They told us they liked living there.

People said, “No complaints at all”, “It’s comfortable”, “They do their best”, “You have nice clean beds”.

We spoke to a relative. The person said their relative was very happy here.

People told us they could usually get help when they needed it.