The inspection of Brantwood Hall Care Home took place on 9 July 2018 and was unannounced. The home was previously inspected in April 2017 and was rated requires improvement with three breaches of the Health and Social Care Act 2008 regulations.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, responsive and well led, to at least good. During this inspection we found evidence of significant and sustained improvement resulting in better care for people living at Brantwood Hall.

Brantwood Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 29 people in one adapted building. On the day of the inspection 26 people were living at Brantwood Hall.

There was a registered manager in post at the time of the 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe and felt comfortable living at Brantwood Hall. Staff were confident in how to report any safeguarding concerns and were also keen to stress they had not had any such concerns recently.

Risks were managed in such a way as to be least restrictive and promote people’s independence. Each risk was subject to a thorough analysis of how it affected the individual and then tailored risk reduction measures were put in place. We saw evidence of how these risks had been effectively diminished through a reduction in falls to people. Analysis of any incidents or accidents was equally person-focused, ensuring all relevant parties’ views were considered.

Although we observed some pressure points in the day due to demands on staff, people’s needs were met in a timely manner. People’s level of dependency was accurately recorded and the registered manager assured us cover was available in the case of short notice absence.

Medication administration was safe although we recommended to the registered manager a review of the lunchtime medication as it was not appropriate for this to be given while people were eating. The home was clean and staff wore appropriate protective clothing when required.

The registered manager had a comprehensive knowledge of evidence-based guidance and showed this in practice as did the staff. They had a range of resources to use and ensured this was implemented in a number of ways in everyday care delivery such as the use of specific therapies to reduce the risk of falls. This was also mirrored in the many and varied range of activities on offer for people to partake in which catered for differing needs and abilities, always promoting people making their own choices.

Staff had received an induction and regular supervision which looked at all aspects of care practice, and this was supported by training. This training was reflected in interactions we observed between staff and people in the home where staff were very respectful and attentive to people. Staff worked well as a team, supporting each other and ensuring people’s needs were met effectively. People were treated with respect and their dignity was promoted.

There had been significant improvements to the environment since the last inspection and this reflected people’s choice, including the newly opened ‘Blue Rinse’ hairdressing salon.

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.

Care records were person-centred and ensured staff had clear direc

The inspection of Brantwood Hall Care Home took place on 25 April 2017 and was unannounced. This was the first inspection under the new provider for this home.

Brantwood Hall Care Home provides accommodation for up to 29 older people in one house over three floors. There are two lounges on the middle floor. People had their own rooms. There were 22 people living in the home on the day we inspected.

There was no registered manager in post on the day we inspected although the registered provider assured us a recent recruitment drive had been successful and checks were being undertaken. 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.

Risk management in the home was poor with little evidence of robust risk assessment in relation to moving and handling people, the use of specialist equipment, nutritional support needs, skin integrity and fire safety. Although it was clear staff knew people well we observed some poor practice in relation to moving and handling and found no guidance for staff in the care records. Attempts were made during the inspection to remedy some of these concerns but further work was needed to reflect people’s current level of need.

People and relatives were comfortable in Brantwood Hall and told us they felt safe as staff were always around and responded to their needs in a timely manner. We saw safeguarding concerns were reported appropriately and action taken swiftly where this was necessary to reduce the risk of further harm.

We were told staffing was a mixed picture with weekends being a particular concern. However, we saw staffing rotas reflected appropriate staffing arrangements and we observed people’s needs were met promptly.

Medication was administered safely with correct procedure being followed and appropriate preparation and checks being carried out.

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.

Staff were appropriately trained and had access to updates as they needed them. One to one meetings with managers were not always carried out although this had been identified and once the permanent home manager was in place this would be easier.

People had access to a plentiful supply of drinks and snacks, and meal times were a positive experience for all. People were also supported to access GPs and other health and social care professionals as needed to ensure their needs were met.

Staff displayed positive interaction with all people in the home, ensuring even the smallest needs were met. They paid attention to people’s comfort and wellbeing and clearly knew people well. They actively promoted people’s independence through encouraging them to walk wherever possible and only offered assistance where it was obvious the person required this.

Discretion was evident when supporting people with personal care and privacy was maintained for people.

Care records did not reflect people’s current needs and were difficult to navigate. We were aware a new system was in the process of being implemented but some of these records were also inaccurate and more work was required to ensure they were useful for staff.

People had an active role in planning and discussing the range of activities on offer, and we saw people engaged in trips out. We did not see evidence of any recent complaints but saw the procedure was easily accessible and previous complaints had been handled appropriately.

Quality assurance tools were limited although we did find the manager walk-arounds completed by the regional manager who visited the home on an almost daily basis provided a large amount of