Brendoncare Froxfield provides accommodation which includes nursing and personal care for up to 44 older people some of whom are living with dementia. At the time of our visit 35 people were living at the home. The bedrooms are arranged over two floors and each corridor was colour coded.

The bedrooms for people who were living with dementia were situated on the white corridor and were separate from the main building. People living on this corridor had access to the main communal areas within the home. The registered manager explained they were currently looking to move away from having areas of the home named by colour as they felt it was impersonal. They were consulting with people using the service to gather their suggestions for naming the different areas of the home. There were communal lounges with dining areas on the ground floor with a central kitchen and laundry.

This inspection took place on 15 and 16 November 2016 and was unannounced. At a previous inspection which took place in November 2015 we found the provider was not meeting all of the requirements of regulations relating to the recording of people’s care needs, the safe management of medicines and the recording of mental capacity assessments and best interest decisions. We made a recommendation in relation to the effectiveness of the systems in place to monitor and evaluate the quality of the service. They wrote to us with an action plan of improvements that would be made. We found on this inspection the provider had taken all the steps to make the necessary improvements.

A registered manager was employed by the service and was present throughout 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.

People and their relatives spoke positively about the care and support they received. People felt safe living at the home. People had the freedom to make daily choices regarding their day to day living. People spoke positively regarding the food choices and thought there was plenty to choose from.

We observed staff developed extremely positive caring and compassionate relationships with people. People were treated with dignity and respect and were encouraged to maintain their independence and make choices. Staff knew each person as an individual and were patient and caring in their approach when offering support. They were kind and made time for people, which included lots of laughter and where appropriate hugs.

People received personalised care and staff knew each person well, such as what made a good day for them. People were relaxed and comfortable with staff and did not hesitate to seek assistance or support when required. There was a relaxed, calm and happy atmosphere at the home with lots of smiles, fun and affectionate gestures. Care was focused on people’s wishes and preferences and people were supported to remain active.

Care plans confirmed people had access to health care professionals. Visits from health care professionals were recorded and any outcomes of these visits. Feedback from visiting healthcare professionals was extremely positive and complimentary regarding the care and support people received to meet their health needs.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

There was a strong emphasis on supporting people to eat and drink well. Staff encouraged those people who were reluctant to eat with their nutritional intake. People were supported to eat a well-balanced diet and those who were at risk of malnutrition and/or dehydration had their food and fluid intake monitored.

People were protected from the r

We found that the people who lived at Brendoncare Froxfield and their advocates were happy with the care they received and that, as far as possible, they were consulted and involved in how they wished to lead their lives. People's health and welfare needs were being met and the support they received was appropriate to their needs.

We found that people were being well treated and there were systems in place to protect them from possible abuse. Experienced staff were available in enough numbers to be able to provide the care and support that people required.

We found that the quality of the service was being monitored and systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

We met with twelve people living in the home and four of their relatives. People said they liked living at Brendoncare and their views were respected. One person told us “there’s no instructions here, I do what I like”, another said “yes I’m happy with the care” and a relative told us “I feel involved”.

We observed staff were respectful to people and met their needs, making sure they were involved in decisions about their care and treatment. The home had clear procedures about how to support people when they were unwell, including how to meet one person’s possible acute allergic reaction.

The home was hygienic throughout, including communally used areas, such as assisted bathrooms, and areas like the laundry.

We met with 13 members of staff, including ancillary workers, care workers, registered nurses and support staff. Staff told us they felt supported in their role. One member of staff described the provider’s training programme as “well planned”. Another member of staff told us they could talk to their line manager and “she listens”.

People said they felt they could bring issues up with staff in the home. One person told us “I’m sure they’d do something if we brought a problem up”. The provider had clear systems for reviewing the quality of service provided and where issues were identified, they put relevant action plans in place.

People appreciated the care and support that they received from staff. Staff were described as “very caring” and we saw that people’s privacy and dignity were being respected. One of the staff told us “choice is a priority” and we heard about the choices that people could make, for example about what time to get up and where to have their meals.

Relatives told us they were made to feel welcome in the home. A visitor said the staff were “very patient” and we saw staff going about their work in a friendly and approachable manner.

Staff were aware of the importance of providing people with the right support, for example with pressure area care and mobility. We found, however that risk assessments and care plans were not being consistently reviewed and updated. This meant that there was a risk that people would not receive the care they required in order to meet their needs.

People told us that they felt safe in the home. Staff said they felt confident about being able to recognise abuse and report any concerns.

Brendoncare Froxfield provides accommodation which includes nursing and personal care for up to 44 older people. At the time of our visit 43 people were using the service. The bedrooms are arranged over two floors. There are communal lounges with dining areas on the ground floor with a central kitchen and laundry.

A registered manager was employed by the service. 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.

We looked at seven care plans and found some guidance did not always identify how care and support should be provided. There were also some parts of the care plans where we could not read what was written in terms of care and support required. This meant that people were at risk of not receiving the care and support they needed.

We found the service was not meeting the requirements of the Mental Capacity Act (2005). Where people were deemed as lacking capacity assessments were not always completed correctly.

Whilst there were systems in place for monitoring the quality of the service to ensure people received a high standard of care and support they had not identified some of the areas requiring improvement.

Where one person received covert medicines these were not always managed in line with the provider’s policy.

People and their relatives spoke positively about the care and support they or their relative received. People and their relatives said they felt comfortable with raising concerns and had confidence that action would be taken where appropriate.

People were supported by staff that understood how to respect people’s privacy and dignity. Staff had the knowledge and skills to carry out their roles. Staff told us they had access to training that was appropriate to their role.

The service had a clear set of values which included treating people with dignity and respect and promoting independence.

Staff knew how to identify if people were at risk of abuse and what actions they needed to take should they suspect abuse was taking place. The registered manager and nurse managers dealt with and responded to all safeguarding concerns.

People were supported to eat a balanced diet. There were arrangements for people to access specialist diets where required. There were snacks and drinks available throughout the day during our inspection.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours.

There were plans in place to respond to emergencies such as fire. Personal fire evacuation plans had been completed for people using the service.

We found 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.