This unannounced inspection took place on the 26 January 2017. At the last inspection on 30 December 2014, no regulations had been breached and the provider achieved an overall good, but there was some improvement required in certain aspects of the service. At this inspection we found that improvements had been made.

Bretby House is a residential care home which provides accommodation with personal care for up to 24 older people. At the time of our inspection 21 people were living at the home.

A registered manager was in place. 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.

At the last inspection improvement was required in monitoring people at risk of losing weight, the choice of meals available to people and mealtime support for people that required assistance to eat their meals. There had been an improvement. People told us the quality and choice of food available had improved although there were some issues with the people telling us their dinner and puddings could have been served hotter. People were able to choose what they ate and drank and were supported to maintain a healthy diet with input from dietary specialists. People were supported to receive care and support from a variety of healthcare professionals and received appropriate treatment if they were unwell.

People and relatives told us they felt the home was a safe environment for people to live in. Staff spoken with could identify the different types of abuse and explained how they would report abuse. People were protected from the risk of harm and abuse because staff knew what to do and were effectively supported by the provider’s policies and processes. Risks to people were being monitored and staff identified risks to people and explained how those risks should be managed. Staff had a good understanding of the risks and the action that was required. The care plans and risk assessments were reviewed and updated regularly although on occasion, the information contained within the care plan did not always reflect that contained within the risk assessments.

We saw all staff were busy but were available to provide support to people when needed. This included support for people to eat, drink and move around the home safely. Requests for assistance from people were responded to promptly. The provider’s recruitment processes ensured suitable staff were recruited.

People received appropriate support to take their prescribed medicines and accurate records were kept of the medicine administered to people. Medicines were stored securely and consistently at the recommended temperature given by the manufacturer and were safely disposed of when no longer required.

People were assisted by suitably trained staff that told us they received training and support which provided them with the knowledge and skills they needed to do their job effectively. People and relatives felt staff were knowledgeable on how to support people effectively and that staff possessed the necessary skills.

We found mental capacity assessments had been completed for people who lacked the mental capacity to consent to their care and welfare. The provider had taken suitable action when they had identified people who did not have capacity to consent to their care or treatment. Applications had been made to authorise restrictions on people's liberty in their best interests.

People's care records contained information relating to their specific needs and there was evidence that the care plans were updated when people's needs. People and relatives told us they were involved in developing and reviewing their care plans. People were supported by caring and kind staff who demonstrated a positive r

This was an unannounced inspection that took place on 30 December 2014. The service was last inspected on 25 April 2013 and was found to be meeting the requirement of the regulations inspected.

Bretby House provides accommodation to up to 24 older people who are in need of personal care. Bedrooms and bathing facilities are provided over three floors which can be accessed via a passenger lift. There were 21 people in the home when we inspected.

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 about how the service is run.

People said they felt safe in the home. Staff had the skills and knowledge to recognise abuse and raise their concerns with the managers. The risk of harm to people receiving a service was assessed and managed appropriately. There were sufficient numbers of suitably recruited staff to meet people’s needs safely. People received their medicines safely and as prescribed but we saw one example where staff had not waited to ensure that the tablets given to and individual were taken as required.

People and relatives spoken with were clear that they felt that staff had the skills and knowledge to meet their needs. People told us they were encouraged to make decisions about their care where possible. The mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. All staff spoken with confirmed they had received training but we found that applications for DoLS that may have been needed had not been submitted at the time of our inspection.

Most people felt they were supported to have choices at mealtimes but some people felt choices could be improved. Food and drinks were prepared so people’s individual dietary needs were met. Support to encourage people to eat and offer alternatives was not offered consistently in the two dining areas.

People’s health care needs were met by visiting professionals to the home and by attending appointments at local hospitals so that their medical conditions were kept under review.

People, their relatives and a visiting professional to the home were all complementary about the staff and said they had a kind and caring attitude towards people. People were supported to make day to day choices and to maintain and improve their independence.

Staff supported people so that their individual needs were met according to their needs assessment. People were involved to determine how they wanted to be supported. We saw that changes in people’s needs were identified, monitored and plans put in place so that people’s needs continued to be met.

People were provided with opportunities to be involved in group activities if they wanted. People were supported to maintain relationships with people important to them.

The service consulted staff, people who lived there and their relatives to get their views about the service and improvements were made as a result of suggestions made. This showed there were systems in place to monitor the quality of the service provided and get people’s views.

There were 23 people living in the home on the day of our inspection. Some of the people who lived at the home had complex needs and health conditions that prevented them telling us their views about the care they had received. We spoke with two staff, a relative, observed how staff cared for people during our visit and spoke with five people who could speak to us.

One person told us, “The staff are like my friends.” A relative we spoke with was complementary about the service provided. We observed staff treating people with respect and dignity. This meant people were happy with the service provided.

People's needs had been assessed and care was provided in a personalised way. A range of healthcare professionals including doctors, district nurses and the optician ensured that people’s health needs were met. This meant that people's care and health care needs had been monitored and met.

Systems were in place to protect people from harm.

Staff were supported to be able to carry out their roles safely. Staff felt they were able to raise concerns and these were listened to. This meant that staff felt supported by the manager and provider.

People were consulted about the service they received. Systems were in place to identify any shortfalls in the quality of the service being provided and actions were taken to improve the service. This meant that the quality of the service was monitored on an ongoing basis.

This visit was part of our programme of scheduled visits. As part of this visit we looked at the actions taken by the provider to achieve compliance with the improvement and compliance actions made at our visit of May 2011. We found that the provider had taken all the actions needed to achieve compliance.

Some people living in the home were not able to tell us about the care they received. To get a view on the care they received we observed the way care workers responded to people in the home during our visit on 15 May 2012. We spoke with five people living in the home who were able to tell us about their care. We spoke with one visiting professional and one relative after our visit.

We saw care workers spending time with people and supporting them in the way they wanted to be supported. There was a good, happy atmosphere in the home.

Records showed that people had been asked how the service was to be provided.

All the people we spoke to told us that they were happy, were able to choose where to sit and what to eat. We saw care workers offering choices of drinks

Three care workers were able to tell us how they provided care to people. This reflected what was written in the care plans. Records showed that a variety of health care professionals were involved in ensuring that people’s on going and as and when required health needs were met. One person said: “They’re looking after me ok.”

We saw that people were given choices at mealtimes. There was a variety of meals identified on the menus. We saw records of meetings that showed people had been asked about what they would like to see on the menu during meetings. People told us:-

“Meat is nice.”

“Vegetables are cooked better now, they used to be hard.”

There were systems in place to ensure people were safeguarded from harm. Staff had received training about how to protect people and knew what their responsibilities were. We saw that people looked happy. A visiting professional told us the manager had taken the appropriate actions to safeguard people’s rights.

We found the home was clean and comfortable.

People’s bedrooms were comfortable and contained pictures and other items that made them homely. Equipment in the home was serviced regularly to ensure it was safe for use. People living in the home had access to equipment that maintained their mobility for as long as possible.

There were sufficient numbers of staff on duty with the skills and knowledge to care for people. One relative told us “The staff are lovely.”

There were systems in place to ensure records were maintained and stored safely.

There were systems in place to ensure that people’s views were known about the quality of the service being provided.

The people living in the home told us that they were happy with their bedroom accommodation. They told us that the staff were good and they came when help was needed. People told us that they did not know what they were going to eat before they got their meals.