Bredon View is a ‘care home’. People in care homes receive accommodation and nursing 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. Bredon View can accommodate up to 26 older people. At the time of our inspection there were 18 older people living there of whom one had been diagnosed as having dementia. Bredon View provides family style accommodation in Cheltenham. People each have their own bedroom with en-suite facilities. They share bathrooms, a lounge, dining room and a cinema/activities room. The garden to the rear is accessible.

This inspection took place on 15 January 2019. At the last comprehensive inspection in July 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

At the time of the inspection there was no registered manager. A new manager had been appointed in October 2018 and they were submitting applications to the Care Quality Commission to become registered. 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’s care was individualised and person centred, reflecting their life histories, likes and dislikes and needs. Staff understood them well. People’s needs had been assessed and were monitored and reviewed each month or sooner if their needs had changed. Their relatives were involved in this process and kept informed about any changes. 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.

People were encouraged to be as independent as possible. Staff encouraged them to do as much as they could for themselves. Risks were assessed and strategies were in place to minimise any hazards. People’s safety was promoted. They were supported to stay healthy and well. Their nutritional needs were closely monitored. Special diets were provided if needed. People had access to snacks and hot and cold drinks. People had access to their GP, optician, dentist and chiropodist. Staff liaised closely with health care professionals. People’s medicines were managed safely.

People were being asked about which activities they would like to take part in. These included pet therapy, baking and cooking, trips out and gardening. People were supported individually to go out for walks, to do puzzles and to chat with staff. Musical movement and fitness classes were held in the home. People were supported to attend a place of worship. Friends and family were able to visit whenever they wished.

People were supported by enough staff to meet their needs. Checks were completed as part of the recruitment process. Staff felt supported in their roles and had access to refresher training to keep their knowledge and skills up to date. Staff were knowledgeable about people, their backgrounds and individual needs. People were treated with respect and sensitivity. They had positive relationships with staff and enjoyed spending time in their company. Staff understood how to keep people safe and were confident any concerns they raised would be listened to and the appropriate action taken in response.

People’s views and the opinions of their relatives and staff were being sought to make improvements to the

This was an unannounced inspection which took place over two days on the 7 and 8 July 2016. Bredon View provides nursing and personal care for up to 26 people. Accommodation can be provided for people who wish to live together. People have access to two lounges and a dining area, en-suite bedrooms, and assisted bathrooms. A rear garden provides an outdoor seating area and is accessible to all people. At the time of our inspection 19 people were living there. There were eight people who had been diagnosed as living with dementia.

At the last comprehensive inspection in November 2014 we rated this service as requires improvement in the key questions, effective and well-led. This related to the lack of effective quality assurance auditing, outstanding maintenance issues and not recognising the needs of people living with dementia. Action had been taken to address these.

The home 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. The registered manager was not present during this inspection. The deputy manager was present and two representatives of the provider attended in her absence.

People received individualised care which reflected their personal wishes, routines important to them and their likes and dislikes. People were supported to make choices about their day to day lifestyles. They had developed positive relationships with staff who understood their needs well. People’s care and support had been reviewed with named staff and their care records had been kept up to date with their changing needs. People had access to health care professionals when needed and were supported to maintain their health and well-being. People’s rights were upheld and staff had a good understanding of how to keep people safe. Any risks people faced were assessed and hazards minimised by providing the appropriate equipment or delivering the care and support they needed.

People had access to a range of activities which were meaningful and reflected their individual lifestyle choices. People’s individual dietary needs had been considered and meals provided which reflected these. People’s medicines were safely administered. Staff had access to a range of training and individual support to make sure they understood their roles and responsibilities. They said they communicated well as a team and health care professionals confirmed they worked well with them. There were enough staff to meet people’s needs.

People’s views were sought to monitor the standard of the service provided. Any issues or concerns were acted upon to make improvements to people’s experience of their care and support. The registered manager was open and accessible. People, visitors and staff were positive about their style of management. There were a range of quality assurance systems in place to monitor the service provided and action had been taken to address any shortfalls. External audits of the home confirmed the improvements which had been made.

Bredon View provides personal care and accommodation for 26 people. At the time of our visit there were 17 people living at the home five of whom were living with dementia or memory impairment. People's accommodation was spread over two floors with some ground floor rooms available. A lift was provided to access the first floor. All bedrooms had en-suite facilities. People had access to a lounge, dining room and garden.

This was an unannounced inspection which was carried out over two days on the 4 and 5 November 2014. 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 and associated Regulations about how the service is run.

We last inspected Bredon View in December 2013. At that inspection we found the service was meeting all the essential standards we assessed.

Although the needs of people living with dementia were recognised they were not provided with an environment which helped them to remain independent and stimulated them in their day to day lives. Consideration had been given to the needs of people with a sensory disability and information or books were available in formats which they could use.

Quality assurance processes highlighted areas for improvement and some small changes had been made as a result. Improvements to the environment had been identified but there were no plans in place to confirm when these would be carried out. People, their relatives, staff and health care professionals had the opportunity to give their views about the service in a variety of formal and informal ways. They were confident complaints or concerns would be listened to and acted upon to make things better. Health and social care professionals said the registered manager worked with them to implement their recommendations to improve the service.

People’s needs were assessed, monitored and reviewed. Any changes to their health or wellbeing or accidents and incidents were responded to quickly. Referrals were made to social and health care professionals to keep them safe and well. People had their medicines when they needed them and they were administered safely. People said they enjoyed a range of activities from musical movement, to bingo, games and day trips out. Staff spent time with people individually chatting and enjoying their company. The atmosphere was jovial and light hearted. People’s relatives and friends visited whenever they wished and were made to feel welcome.

Staff said they felt supported and had access to training to maintain or develop their skills and knowledge. They spoke positively about the registered manager and the team. People and their relatives were happy with the staff team and the care they provided. Staff were observed treating people sensitively and had a good understanding of people’s needs and preferences. There were sufficient staff working at the home to meet people’s needs.

We made a recommendation for the provider to consider how improvements can be made to the service people receive.

We spoke with six people who lived in the home. They told us "its fine here","staff treat us well and are on hand to help us with our care". Two people told us they had nothing to do and there were no activities provided. Most said they had been on day trips and could take part in music sessions or games if they wished.

One person told us, "staff are good, the staff team stay the same, they understand our needs". Another person said, "staff treat us well, they check on us, they are very good". Another person told us, "staff are all very good to us".

People and their visitors said they had no concerns. They told us that any issues they raised would be dealt with quickly and action taken to address them.

No-one living in the home at the present time is able to look after all their own medicines, so they are looked after and given by care staff.

People we spoke to were happy with the way they were given their medicines. One person was able to use their own inhaler and was satisfied with this arrangement. Another person carried a medicine for emergency use that they could use themselves, if needed.

One person told us that they had not been asked whether they wanted to look after their own medicines when they moved to the home. This person was clear about when they had their medicines and said that they did not want to look after them themselves.

Another person told us that they could not remember about the details of their medicines but said they were happy with how staff looked after them, adding that the staff were very kind.

One person told us they liked to go out each day walking to the local station. Other people told us "I am bored - there is not enough to do" and " no activities, I never do anything."

People told us "you couldn't ask for better. Everyone is really helpful" and "the girls are good. Couldn't fault them. They work very hard."

People said, "the food is ok, we have fresh fruit but the bowl is emptied quickly. They will be around to refill it soon," and " they have a lot of trouble with the food being cold."

People told us they had access to information about the service they received. They said they could go to house meetings to discuss such issues as what activities they would like or changes to the home. People talked to us about their key workers and how their wishes and choices were reflected in their care plans. They said, "there is a relaxing and friendly atmosphere", couldn't wish for anyone better (staff)" and "I am really well looked after". People said they liked to go out on trips in the better weather and enjoyed games and music. One person told us "I don't do a lot, sit and watch television". People knew how to make a complaint and said they would talk to the manager if they had any concerns. A person commented, "staff deal with issues and if they don't know the answer they ask seniors". People said they enjoy a choice of meals and have snacks and drinks throughout the day. People told us they see a range of health care professionals.

We spoke with twelve people who lived at the home, four visitors and seven members of staff. We observed people having lunch and tea. People told us they were "happy" and "looked after well".

The way in which people wished to be supported was reflected in their care records. Their preferences, likes and dislikes and routines were noted and respected. People said they could take part in activities such as zumba, music and movement or bingo.

People told us "the food is really good" and "the food is lovely". People had choices about their food and drink. People's individual dietary requirements were taken into consideration and respected.

Systems were in place to safeguard people from possible harm or abuse. One person told us "I feel as safe as houses here". We observed staff supporting people who were anxious or unhappy with patience and respect.

The administration and management of medicines promoted the safe handling and storage of medicines. Staff completed medicines training and their practice was monitored.

Effective recruitment and selection processes were in place to ensure staff had the skills, knowledge and experience to work with people. We were told, "the staff are all very nice" and "staff are lovely, very respectful". A visitor commented, "nothing is too much trouble for them, they go that extra mile".