This inspection was unannounced and took place on the 29 and 30 August 2018.

We last carried out a comprehensive inspection of this service on 8 and 9 January 2018. At that inspection we found 13 breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to the person-centred care, dignity and respect, need for consent, safe care and treatment in relation to risks within the environment, people’s health and well-being, management of medicines and infection control, safeguarding from abuse premises and staff training and development. We also issued a warning notice with regards to the lack of evidence to demonstrate Good Governance. Due to the breaches found the service was rated Inadequate in the Safe and Well-led domains and Requires Improvements in the Effective, Caring and Responsive domains. The service was given an overall rating of Inadequate and placed in Special Measures.

Following the inspection, we required the provider to complete an improvement action plan to show how they would improve all key questions; safe, effective, caring, responsive and well led to at least good.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Browfield is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Browfield provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Accommodation is provided on three floors. There is no passenger lift. On street parking is available to the side of the home. The home is situated approximately one mile from Bury town centre and is close to all local amenities and public transport. At the time of our inspection there were 12 people living at the home.

The service had a registered manager, who is also the owner of the home. A registered manager is a person who has registered with the CQC 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 the registered manager was approachable and they could talk with them.

Audits and checks were completed to monitor and review the service provided. We recommend information gathered as part of the quality monitoring is consolidated and used to inform the development of the homes improvement plan. This will help to demonstrate sustained and ongoing improvement so the people receive a quality service which meets their needs.

Action had been taken to ensure the safety of building. Up to date risk assessments, maintenance records and fire safety checks were in place to help keep people safe. On-going redecoration was to be completed to enhance the appearance of the home.

Suitable arrangements were in place to protect people from abuse. The provider had worked in partnership with the local authority to address recent issues. Staff were provided with procedures to guide them and recent training had been completed. Staff spoken with knew what action should be taken so that people were protected.

A safe system for the management and administration of people’s medicines was in place.

Sufficient numbers of staff were available to support people living at Browfield. Relevant recruitment checks were completed prior to new staff commencing work at the home.

Suitable arrangements

We carried out an unannounced inspection of Browfield Care Home on 8 and 9 January 2018.

At the last comprehensive inspection on 17, 24 and 26 May 2016 the service was rated good. However we identified the service had not complied with the regulation relating to updating people's care records. We asked the provider to complete an action plan telling us what they intended to do to make the improvements needed. This was provided. On the 9 December 2016 we carried out an announced focused inspection of Browfield Care Home to check that improvements relating to updating care record’s had been made. We found that appropriate action had been taken.

At this inspection we found a number of breaches of the HSCA regulations in relation to care plans and risk assessments, the management of medication, safeguarding people from abuse, lack of activities and opportunities, maintaining people’s privacy and dignity, unlawful restrictions, maintenance of the premises and equipment, fire safety, infection control, staff training and development and good governance.

We also recommend that the service consider current guidance on determining staffing levels based on dependency and take action accordingly.

Browfield Care Home 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.

Browfield provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Accommodation is provided on three floors. There is no passenger lift. The home is situated approximately one mile from Bury town centre and is close to all local amenities and public transport. At the time of our inspection there were 14 people living at the home.

The service had a registered manager who was present during the inspection. The registered manager is also the sole director of the company. 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.

Whilst staff had received training on identifying and responding to allegations of abuse, adequate systems to safeguard people and staff needed to be improved so that people were kept safe.

Suitable arrangements were not in placed to ensure the safety and protection of people and staff in the event of an emergency arising.

People were not provided with safe, well maintained accommodation in which to live. Suitable arrangements were not in place to ensure people were protected against the risks of cross or spread of infection.

Not all care records showed that risks to people's health and well-being had been assessed and planned for so that staff had the information needed about how best to support the person to help reduce or eliminate such risks.

Systems were not in place for the safe management and administration of people’s medicines.

The staff team were very stable with no new staff having been employed for a number of years. Previous inspections of recruitment records have been satisfactory.

Suitable arrangements were not in place to ensure staff were aware of their responsibilities in ensuring people were not being unlawfully restricted.

We found staff had not received all the necessary training and support essential to their role to help ensure the current and changing needs of people could be met in a safe and consistent way.

We received a mixed response from staff about the support they received. It was acknowledged by the registered manager that systems to support staff needed formalising.

People said they were happy with the quality and variety of meals offered.

Staff worked in co-operation

This was an announced focussed follow up inspection, which took place on 9 December 2016. We carried out our last inspection in May 2016 when we found the service had not complied with the regulation relating to updating people’s care records. At this inspection, we found that the regulation had been met.

Browfield provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Twelve people were living at Browfield at the time of our visit.

The service had a manager who was registered with us. 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. The registered manager is also the registered provider for the service.

Individual care records in an easy read format and risk assessments had been updated to reflect people’s current support needs and personal preferences. Where appropriate people had signed the person centred plans and risk assessments to confirm their agreement to them.

This was an unannounced inspection, which took place on 17, 24 and 26 May 2016. We had previously carried out an inspection in May 2015 when we found the service had not complied with all the regulations we reviewed in relation to levels of cleanliness, the maintenance of the premises and staff training. At this inspection we found that these regulations had been met.

Browfield provides accommodation for up to fourteen people with enduring mental health needs who require support with personal care. Fourteen people were living at Browfield at the time of our visit.

The service had a manager who was registered with us. 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 found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to care plans and risk assessments needing to be updated so that they reflected people’s current support needs in a person centred way.

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

People who we spoke with confirmed that they felt safe at the home. One person said, “Violence and trouble are not tolerated here so I feel safe” and another person said, “I do not feel unsafe.”

We saw that there were recruitment and selection procedures in place to protect people who used the service from coming into contact with potential staff who were unsuitable to work with vulnerable people. There were enough staff on duty to meet the needs of people who used the service.

People’s medicines were managed well and the home was seen to be clean and tidy throughout.

With the exception of one person, people who used the service had the capacity to make decisions about their day to day lives and what they did with their time.

People told us they were happy with the food provided. We saw that they were offered food and drink frequently throughout the day.

Arrangements were in place to request health and social care services to help people keep well and advice was sought when needed.

The relationships we saw between people who used the service and the staff supporting them were warm and friendly. The atmosphere was calm and relaxed. The service made every effort to keep people at the home for as long as possible so that they could stay with residents and staff that knew them well.

People had a diverse range of needs. Some people went out and about on a regular basis to day centres or to meet relatives and friends whilst others chose to stay in.

We found people who used the service were encouraged to maintain their independence, wherever possible. Some people took responsibility for household tasks such as keeping their bedroom tidy, going shopping with staff and drying up after meals.

People who used the service and staff reported that the provider who was also the registered manager and the assistant manager were approachable and supportive. Feedback received from a quality assurance review was generally positive about the home.

Before our inspection, we contacted the local authority commissioning and safeguarding teams. They informed us they had no concerns about the service provided.

People we spoke with told us that they liked the food provided at the home. One person told us “I like it, pudding, chips and peas is my favourite.” Another said, “I cannot grumble about the food.”

The provider had introduced a new medication system since our last inspection visit. We saw that all staff members who were authorised to administer medication had received training from the supplying pharmacy about how to use the system safely.

Some people showed us their room. One person had recently had their room decorated, refurbished and had a new carpet fitted. They told us they had chosen the colour the room had been painted and the bedding lampshades and curtains. They said they were very pleased with the room.

Appropriate checks were undertaken before staff began working for the provider.

We saw that there were frequent and friendly interactions between members of the staff team and people living at Browfield throughout our visit. The atmosphere was calm and relaxed. People we spoke to said, “The staff are very good” “they are kind and helpful” and “I can talk to the manager and deputy manager about anything”.

Before our visit we spoke with the local commissioning and safeguarding teams. They told us that they had no concerns about the service provided at this time.

Not everyone was able to or wanted to talk with us. Some people said that they that they were “happy, “alright” and “I am fine.”

We talked to one person at length about the changes in their physical health. They told us that they had received a lot of support from the staff. They said that the provider had fitted a chair lift to the stairs so that they could continue to get to their room and staff took them out occasionally to the local park in a wheelchair.

People who were able told us that they felt safe and secure at the home. They said that if they had any worries or concerns they could speak to the provider. They were confident that the provider would try to resolve the matter. A relative commented in a quality assurance document “I am very grateful not to have to worry and that my relative is safe in your hands.”

Feedback from relatives on the quality assurance document stated that the staff “were very friendly” and “staff at the home are excellent and caring and show empathy to the residents.” People said that the provider was very approachable and supportive and they would feel comfortable speaking to them should they have any concerns.

This was an unannounced inspection which took place on 26 May and 3 June 2015. We had previously carried out an inspection on 4 September 2013 when we found the service had complied with all the regulations we reviewed.

Browfield provides accommodation for up to fourteen people with mental health needs who require support with personal care. Fourteen people were living at Browfield time of our visit.

The service had a manager who was registered with us. 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 found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to infection control and improvements needed to the premises and staff training.

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

People we spoke with either told us they felt safe or indicated they did so. They said “It’s alright” and “It’s not bad here. I feel safe. I get on with all the staff.” A person who had recently moved into the home indicated that they had been made to feel welcome.

There were enough staff on duty to meet the needs of people who used the service. One person said “They all do their best.” We saw that staff always responded quickly to requests of support from people who used the service.

Recruitment processes in the service were sufficiently robust to help ensure the protection of people from the risks of unsuitable staff being recruited. We found staffing levels were appropriate to meet the needs of people who used the service.

There were appropriate systems in place for the administration of medicines.

People who used the service told us they enjoyed the food that was available and we saw that they were offered food and drink frequently throughout the day.

All the people we spoke with gave positive feedback about the staff in Browfield. During the inspection we observed frequent and friendly interactions between staff and people who used the service. The atmosphere at the home was calm and relaxed.

The service made every effort to keep people at the home for as long as possible so that they could stay with residents and staff that knew them well.

People were supported to maintain their independence and most people were involved in activities that met with their personal preferences.

All the people we spoke with told us the registered manager and the assistant manager of the service were very approachable and would always listen and respond if any concerns were raised.

Feedback from a quality assurance review was positive with comments that included “Friendly and homely atmosphere, caring and pleasant staff” “Excellent care, they contact me promptly if any concerns” and “Always well aware of patients conditions and management.”

Prior to our visit we contacted the local authority safeguarding and commissioning teams and no concerns were raised by them about the care and support people received from Browfield Residential Care Home.