This inspection was unannounced and took place on 25 September 2019.

Our last inspection took place on 10 and 23 May, 8 June, 10 and 11 July 2018 and was promoted by a statutory notification we received of an incident relating to medicines management. During our inspection we had ongoing concerns about medicines management particularly relating to the reconciliation of medicines when new people were admitted into the home or when discharged from hospital.

We found that Brinnington Hall was in breach of the Health and Social Care Act 2008 (Regulated Activities); Regulations 12 Safe Care and Treatment.

Following this inspection, we asked the registered provider to clarify their position in relation to future admissions to ensure that people's medicines could be received and booked in safely at Brinnington Hall. The registered provider made the decision to suspend admissions into the home until improvements were made. The home then started to admit one person a week between office hours on Monday to Thursday only to ensure sufficient time was available to book in medicines accurately.

We received an action plan from them and held a meeting with the registered manager, regional director and head of compliance to reassure ourselves that action was being taken.

At this inspection we looked at the safety of medicines management arrangements at the home and the action taken by the registered manager to address our previous concerns and prevent this type of incident happening again. We found improvements had been made.

Brinnington Hall 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. 61 people were receiving personal care only during 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. There was a registered manager in place and they were present during the inspection. The registered manager was supported by the regional director throughout this inspection.

We checked the admissions records relating to the reconciliation of medicines since our last inspection. We found that improvements had been made in the systems to ensure that people had the right medicines in place at the point of admission, returning to the home from hospital and when medicines records were transferred from one month’s cycle to the next. This had been achieved by improving the homes admission procedures for people moving in to the home, increasing the numbers of the management team on both days and nights and putting systems in place to make regular spot checks of medicines.

We were satisfied that the actions on the plan we received from the registered provider had been met or were in progress.

We saw that the supplying pharmacist had carried out a pharmacist advice visit. The report into this visit shows no major concerns. Following our inspection visit we contacted the local authority quality assurance office and the clinical commissioning group to check if they had any concerns about the safety of medicines management at the home. No concerns were raised with us.

We initially undertook an unannounced focused inspection of Brinnington Hall on 10 May 2018. The inspection was prompted by a statutory notification we received of an incident relating in part to medicines management following which a person using the service died. This incident was subject to a criminal investigation and as a result this inspection did not examine fully the circumstances of the incident.

At this inspection we looked at the safety of medicines management arrangements at the home and at what action had been taken by the registered provider to prevent this type of incident happening again. Due to further medicines management concerns raised with us pharmacy inspectors returned to the service on 23 May and 8 June 2018. Ongoing concerns remained and we returned to the service on 10 and 11 July 2018 to complete a responsive comprehensive inspection.

Brinnington Hall 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. Brinnington Hall provides accommodation and personal support for up to 67 people. Sixty two people were using the service at the time of our initial visit on 10 May 2018.

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. There was a registered manager in place and was present during the inspection. The registered manager was supported by either the regional director or the compliance manager during our inspection visits.

At our comprehensive inspection undertaken in October 2016, the home was in breach of safe medicines management. At our last comprehensive inspection in July 2017, we recommended that whilst some improvements had been made to the management of medicines, all the issues had yet to be resolved. Plans were in place to change the supplying pharmacist and the home were being supported by the local Clinical Commissioning Group to help make these changes.

At this inspection we found that although the pharmacy had recently changed there were continued shortfalls in the safety of medicines management, including the reconciliation of medicines for a person recently admitted into the home.

You can see what action we told the provider to take at the back of the full version of the report.

Staff had received training in safeguarding adults. They could tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns would be taken seriously by the registered manager. Systems were in place to ensure staff were safely recruited.

Care records we reviewed included information about the risks people might experience and what action needed to be taken by staff to reduce them.

The home had achieved 98% compliance with an assessment undertaken by the local authority infection control and prevention nurse.

Staff told us they received the training and supervision they needed to be able to carry out their roles effectively.

The registered manager had taken appropriate action to apply for restrictions to be put in place, in a person’s best interests, to be legally authorised by the local authority.

People told us they enjoyed the food. We found meal times were social occasions and saw the food provided was plentiful and very well presented.

People had access to the health care professionals they needed.

The registered provider had continued to make improvements to the home to help make it more dementia frien

This was an unannounced inspection, which took place on 24 and 25 July 2017. We last inspected the service in October 2016. At that time we identified ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to unlawful restrictions, care records, management of medication, dignity, management of risks, recruitment and quality monitoring systems. Following that inspection the provider sent up a plan detailing what action they intended to take to ensure the regulations were met.

Brinnington Hall is a care home providing personal care and accommodation for up to sixty seven older people, some of whom live with dementia. The home is located in the Brinnington area of Stockport and is a large purpose built building with secure gardens. All rooms are single with en suite facilities. At the time of the inspection there were 64 people living at the home.

The service has a manager who was registered with the CQC. They were present throughout 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.

Staff spoke positively about the registered manager who had just been appointed at the time of our last inspection in September 2016. They felt she was open and approachable and that necessary improvements were being made to enhance the service provided.

Issues and concerns had been identified with regards to the management and administration of people’s prescribed medicines. Whilst some improvements had been made, this had not yet been resolved. We have made a recommendation about the safe and effective management of people’s medicines.

All information and checks required when appointing new staff were in place ensuring their suitability for the position so that people were kept safe.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedures and confirmed they had completed relevant training.

Care plans were person centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans and monitoring charts had been put in place so that staff could quickly respond to people’s changing needs.

Suitable arrangements were in place in relation to fire safety and the servicing of equipment was undertaken so that people were kept safe.

All areas of the home were clean and well maintained and procedures were in place to prevent and control the spread of infection.

We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where able people were encouraged and supported to make decisions for themselves.

We found staff received on-going training and support essential to their role so they were able to do their job safely and effectively. Sufficient numbers of staff were available. Staffing levels were kept under review to ensure they were able to meet the current and changing needs of people.

People were offered a choice food and drink throughout the day. Where people’s health and well-being was at risk, relevant health care advice had been sought so that people received the treatment and support they needed. People told us and records showed that people had regular access to health care professionals so changes in their health care needs could be addressed.

People were provided with a good standard of accommodation that was well maintained. We saw people’s rooms were comfortable and had been personalised with their own photographs and belongings.

People were supported

This inspection took place on 24 and 25 October 2016 and was unannounced. This was the first time we have inspected Brinnington Hall when registered with the current provider. Our last inspection of Brinnington Hall when registered with the previous provider was June 2014, when we found the service was meeting all standards inspected.

Brinnington Hall is a residential care home providing care and support for up to 67 older people, some of whom have a diagnosis of dementia. The home is located in the Brinnington area of Stockport and is a large purpose built care home with secure gardens. All rooms are single and have en-suite facilities.

There was not a registered manager in post at the time of inspection. The former registered manager had worked at the home for around six months and had left in August 2016. The acting manager had been in post for three weeks and told us they intended to submit an application to register with CQC. 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.

Prior to our inspection we received concerns in relation to staffing levels, medicines management and respecting people’s dignity. The provider had also acknowledged some shortfalls in relation to staffing levels and governance at the home. We identified breaches of seven of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe management of medicines, risk management, recruitment processes, staff training and supervision, care planning and assessment, meeting the requirements of the deprivation of liberty safeguarding, dignity and respect, and good governance. We are currently considering our options in relation to enforcement and will update the section at the end of this report once any action has concluded.

We found there were sufficient numbers of staff to meet people’s needs in a timely way. The provider had recently recruited staff and staff told us staffing levels had improved. Rotas showed that shifts were covered and there was decreasing use of agency staff. The provider acknowledged there had been previous staffing issues and the acting manager accepted this might have contributed to the high number of minor injuries/accidents we saw recorded in September 2016.

Prior to our inspection we were made of a substantiated safeguarding concern relating to a person who sustained an injury having fallen from bed in February 2016. One of the recommendations made was that staff should receive falls training. This training had not been provided at the time of inspection. The acting manager told us they were aware this training was required and had submitted a request to the providers’ training department. We are continuing to carry out enquiries in relation to this concern.

Staff we spoke with knew how best to respond to the people they supported. People told us staff were kind and caring in their approach and that staff respected their privacy and dignity. We observed staff had time to spend talking with people and observed many positive interactions.

People told us staff respected their privacy and dignity. However on two occasions we heard staff speaking loudly across communal areas to other staff members discussing people’s personal care needs. This showed a lack of consideration for those people.

A range of activities were offered to people during our inspection. This included flower arranging, a visiting musician and an exercise group. Staff told us that since staffing levels had improved, they had found they had time to support activities and spend meaningful time with people. Trips out from the home were offered on a regular basis, and there were initiatives such as a ‘pop-up