We conducted an unannounced inspection at Braywood Gardens on 16, 19 and 26 October 2018. Braywood Gardens is a ‘care home’. People in care homes receive accommodation and nursing or 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.

Braywood Gardens is situated in Carlton, Nottinghamshire and is operated by Runwood Homes Limited. The service accommodates 99 people across eight units which are split across two floors. At the time of our inspection there were 95 people living at the home.

At our last inspection in December 2015 the service was rated good. At this inspection we found the quality of some aspects of the service had deteriorated. Consequently, we found concerns across a range of areas including safety, staffing, hydration and nutrition, consent and choice and leadership and governance. This resulted in several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. This was the first time the service had been rated as requires improvement.

There was a registered manager in place at the time of our 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.

During our inspection we found there were not always enough staff to meet people’s needs or ensure their safety. We saw staff were not always present to reduce risks such as falls. Risks in areas such as choking, skin integrity were not always identified or addressed and this placed people at risk of harm. Equipment used in people’s care and support was not always used safely. People were not always protected from the risk of abuse and improper treatment as staff were not always present, or did not always intervene in verbal and physical altercations between people. Improvements were required to ensure the home was clean in all areas. Overall, medicines were managed and administered safely, some improvements were needed to ensure staff had clear guidance about medicines. There were systems in place to learn from accident and incidents. Safe recruitment practices were followed.

There was a risk people may not be provided with enough to eat and drink. Mealtimes were not well organised; people were not always served with an appropriate diet and were not always offered timely or appropriate assistance at mealtimes. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Staff required more training to enable them to provide effective support to people with dementia. In other areas staff had training and support to enable them to do their job and told us they felt supported. People had access to a range of specialist health care professionals and feedback form these professionals was positive. The home was adapted to meet people’s needs.

Staff were not consistently kind and caring and did not always communicate clearly with people. People and their relatives told us that changes in the staff team meant they were not able to develop meaningful relationships. People’s rights to privacy and dignity were not always respected. People were not supported to be as independent as possible. People had access to advocacy services if they required this to enable them to express their views.

People did not consistently receive personalised care that met their needs and staff were not always responsive to people’s needs. People and their relatives were not always involved in

This inspection took place on 1 and 2 December 2015 and was unannounced. Braywood Gardens provides accommodation for up to 75 people with or without dementia and people with physical health needs. On the day of our inspection 71 people were using the service. The service is provided across two floors and people were able to access all communal areas of the building.

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 2008 and associated Regulations about how the service is run.

People felt safe living at the home and measures were in place to protect people from the risk of abuse. Relevant information about incidents which occurred in the home was shared with the local authority. Staff ensured that steps were taken to reduce risks to people’s safety, such as the risk of falling.

There were sufficient numbers of staff to care for people and support was provided in a timely manner. The provider ensured appropriate checks were carried out on staff before they started work. People received their medicines as prescribed and they were safely stored.

Staff were provided with the knowledge and skills to care for people effectively and felt well supported. People were given the opportunity to provide consent to their care. The Mental Capacity Act (2005) (MCA) was used correctly to protect people who were not able to make their own decisions about the care they received.

People were provided with sufficient quantities of food and drink that were appropriate to their needs and told us they liked the food. People received support from various healthcare professionals when required and staff followed the guidance provided by them.

There were positive relationships between people and staff and we saw kind and caring interactions. People were able to be involved in the planning and reviewing of their care and told us they were able to make day to day decisions. People’s privacy and dignity were respected and visitors were welcome at any time.

People received the care they needed and staff responded to any changes in their needs. There was a programme of activities available which were widely enjoyed. People knew how to complain and the complaints were appropriately investigated and responded to.

There was a positive, open and transparent culture in the home. People and staff felt able to speak up about any matters of importance to them. There were clear management structures in place and everybody felt the registered manager led by example. There were different ways people could provide feedback about the service and these were well utilised by people. The quality monitoring systems had identified areas where improvements were required and ensured action was taken.

We carried out this inspection to follow up on three warning notices we made after our inspection on 4 and 5 September 2013. We told the provider they must be compliant by 31 October 2013. We also used this inspection to follow up on the compliance actions we made after that inspection. The provider told us they would be compliant by 3 October 2013.

At this inspection we found that the provider had taken positive steps to meet the standards.

We found that care and treatment was being delivered in accordance with people’s care plans to ensure their individual needs were met.

Effective processes had been put in place for the secure handling of medicines.

There were enough qualified, skilled staff who were well supported to meet people’s needs.

The provider had put systems in place to assess and monitor the quality of services.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We spoke with seven people using the service and they told us they were able to make choices about what they did such as, “We get a choice of food and if we want to spend time in our bedroom we can do that.” Another person said, “I prefer to sit in my room and listen to music and that is up to me, I choose what I want to do.”

We found people's needs were planned for and delivered appropriately in three units of the home. However on one unit care was not always planned and delivered to people safely. Most people we spoke with were happy with the care they received.

People using the service felt safe from the risk of abuse and knew who to speak with if they had any concerns. However the failure to respond to information which might constitute abuse had put people at risk of potential abuse.

Staffing levels were not being increased to meet the changing needs of people and on one unit we had concerns there were not enough staff to meet the needs of people safely. People we spoke with spoke positively about the staff working in the home and felt they were caring and kind to them.

There were systems in place to ensure people knew how to make a complaint and complaints were recorded by the manager.

We carried out this inspection to follow up on the compliance actions we issued to the provider in respect of the care and welfare of people who use services. The provider told us they would be compliant by 30 April 2013.

People using the service told us that they were mostly happy with the care they received. They made decisions about their care and daily routines. Some people told us that their care was rushed at times and they had made compromises about their care preferences because staff were so busy. One person said, "I'm generally happy with the care." Another person said, "I'm very happy, and I love the attention I get."

We found that people did not always experience care, treatment and support that met their needs and protected their rights. We also found that there were not enough qualified, skilled and experienced staff to meet people’s needs at all times.

We found that staff had not received up to date training and the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

The provider had not achieved compliance with the standards within their stated timescales.