This inspection took place on 1 August 2018 and was unannounced which meant the home did not know we were visiting. This was a comprehensive inspection. At the last inspection the service was rated Requires Improvement overall and we asked the registered provider to demonstrate sustained improvements. This included ensuring all staff received regular supervision and were trained to develop into their roles. At this inspection we checked these improvements had been made and sustained at the home.

Bryan Wood is registered to provide accommodation and personal care for up to 45 people. There were 36 people living at the home on the day of our inspection. Bryan Wood is a large three-storey building offering accommodation across three floors accessed by a passenger lift. One floor is designated for people living with dementia. Each floor has a communal lounge and bathrooms. Outside there is a courtyard with seating.

Bryan Wood is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home had a registered manager who was available 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 told us they felt very safe living at Bryan Wood and their relatives also felt assured their family member was safe. All staff had received safeguarding training and knew how to identify and report suspected abuse and knew the procedure to report any incidents.

Standardised risk assessments were used in care plans so risks to people’s health and safety could be effectively tracked and monitored.

People’s dependency was monitored regularly and staffing levels supported people’s needs. Recruitment processes were thorough ensuring staff were employed who were suitable to work in a care home setting.

Medicines were administered safely and with due consideration to national guidance.

Staff were appropriately trained and knowledgeable about infection control procedures.

The registered manager had robust systems in place for monitoring accidents and incidents and ensuring learning from these was implemented and understood through regular staff meetings and supervisions.

Care plans contained detailed personal histories, and people’s preferences in relation to their physical needs, and social and leisure activities. Appropriate consideration had been given to people’s consent and their capacity to do so for a range of care and support needs. The registered provider was operating within the principles of the Mental Capacity Act 2005 and applications to lawfully deprive people of their liberty (DoLS) had been appropriately submitted to the local authority.

Training completion levels were high. Staff supervisions were planned and taking place regularly. Annual appraisals were up to date. Communication between the registered provider, the registered manager and staff was good.

People were provided with a good choice of freshly prepared food and ‘hydration stations’ and ‘snack stations’ throughout the home were well-used.

People were supported to receive access to healthcare which was demonstrated and recorded in care plans.

People were consulted and involved in refurbishment plans. Dementia-friendly signage was in evidence throughout the home as well as pictorial noticeboards. People’s bedrooms were highly personalised.

Staff were aware of the need to ensure people’s dignity and respect their privacy. Staff were aware to support people’s independence wherever possible.

The registered provider’s monthly quality reports showed effective oversig

This inspection took place on 8 and 28 February 2017 and was unannounced. At the last inspection on 28 September 2015 we asked the provider to take action to make improvements in relation to people at risks of malnutrition, record keeping and compliance with the Mental Capacity Act (2005). At this inspection we checked improvements had made and sustained at Bryan Wood.

Bryan Wood is registered to provide accommodation and personal care for maximum of 45 people. There were 34 people living at the home on the day of our inspection. Accommodation is provided in an extension to the main Victorian house over two floors, with one floor designated for people living with dementia. There are also a small number of bedrooms in the Victorian part of the building accessed by a passenger lift.

There was no registered manager in place but the registered provider had appointed a new manager who was in the process of registering with the Care Quality Commission. 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 provider had put in systems to support the new manager to develop into their role.

Since our last inspection there had been instability in the management at the home, as the previous registered manager had left the service and a new manager appointed but left after being in post for a short time. This meant that although significant improvements were found at this inspection, the home had not yet demonstrated improvements had been sustained. This included ensuring all staff received regular supervision and were trained to develop into their roles. This had been planned but had not yet been completed and there had been a gap where staff had not received supervision.

All the staff we spoke with demonstrated a good understanding of how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

Standardised risk assessments had been undertaken for those people at risk of malnutrition and pressure sores. Other risk assessments such as choking risk assessments were in place and we observed practice which confirmed risks were reduced. There had been an improvement in moving and handling risk assessment and care planning since our last inspection and the number of falls at the home had significantly reduced over the past two months.

We found the necessary recruitment checks had been made to ensure staff suitability to work in the home and staff received an induction to ensure they developed into their role and were able to shadow shifts with more experienced staff to ensure they felt confident to take on the caring role.

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.

Food was freshly prepared and choice was offered at mealtimes. We observed staff supporting people with their meals and senior staff monitored people at risk of malnutrition to ensure they had adequate nutrition and hydration.

We found staff to be compassionate and caring when dealing with the people who lived at Bryan Wood. We observed staff protecting people’s privacy and dignity and ensuring their needs in relation to equality and diversity were appropriately met.

People were provided with care which met their choices and preferences such as what time they got up, went to bed, what they ate and they were encouraged to share their views on how they wanted the service to be run. Staff we spoke with demonstrated they were aware of the needs of the people they were supporting and their individual personalities and preferences.

The activities coordinator engaged wi

This inspection took place on 28 September 2015 and was unannounced. The service was last inspected on 24 July 2014 and at that inspection we found the service was meeting all the legal requirements.

Bryan Wood provides accommodation and personal care for up to 38 people. There were 34 people living at the home on the day of our inspection. Accommodation is provided in an extension to the main Victorian house over two floors, with one floor designated for people living with dementia. There are also a small number of bedrooms in the Victorian part of the building accessed by a passenger lift.

There was a registered manager who had been registered since August 2015. 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.

All the staff we spoke with demonstrated a good understanding of how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

We saw some risks assessments had been completed well such as the risk around a person self-administering medication. But other risk assessments had not been completed fully such as around moving and handling.

We found all necessary recruitment checks had been made to ensure staff suitability to work in the home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act (MCA) 2005. We found that there were people who may be deprived of their liberty at the home, but no applications for authorisations had been submitted to the local authority. In addition capacity assessments had not been completed for all the people at the home who lacked capacity which meant the home was not complying with the Mental Capacity Act 2005.

Staff had received an induction, training, supervision and appraisal to ensure they had the skills to perform in their roles.

Food was all freshly prepared and choice was offered at mealtimes. However, we observed one person who required support at meal times was not supported and staff had recorded the person had eaten their pudding when we had observed they had not done so.

We found staff to be compassionate and caring when dealing with the people who lived at Bryan Wood.

Staff we spoke with demonstrated they were aware of the needs of the people they were supporting and their individual personalities and preferences.

The activities coordinator engaged with people to ensure activities were meaningful to the people who lived there and they were innovative in their approach to planning activities.

We found an inconsistent standard and quality of recording which meant that in some cases people’s needs and preferences were well recorded and in others information about the needs of the person was missing.

Staff spoke highly of the new registered manager and told us they were approachable and listened to them.

We found the registered provider completed detailed audits of the home and identified actions to be completed to raise the quality of the service. However, the manager audits missed the quality information which would enable the registered manager to identify and resolve issues in between the registered provider’s audits.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

The inspection visit was carried out by one inspector. During the inspection, we spoke with the home manager, a senior care assistant, two care assistants, three people who lived at the home and one visitor who was the relative of one person who lived at the home. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records. During this inspection we also followed up on a compliance action for outcome 21 (records) which was given at our last inspection in December 2013.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. However, we found parts of the premises were in need of updating. We were told the person employed for the purpose of maintaining the home had recently had their working hours reduced. The manager told us this had impacted on the maintenance of the home.

There were enough staff on duty to meet the needs of the people who lived at the home.

One visitor, who was a relative told us; “They seem to have plenty of staff around and they’re always friendly.”

Is the service effective?

We looked at three people’s care records we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs.

People were provided with a healthy, nutritionally balanced diet to support their health. This protected people from the risks of inadequate nutrition and dehydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that care assistants were patient and encouraging when supporting people.

The three people we spoke with all told us they were very happy with the care they received at the home. One person told us, “The staff are so good to me. Nothing is too much trouble for them. I feel very well cared for. The food is lovely too, and there are always snacks available. I’ve put two stone on since I came here.”

The care assistants we spoke with told us they felt confident the service provided to people who lived at the home was good and they had a good staff team.

When we looked around the home we saw people’s bedrooms had been personalised and contained personal items such as family photographs.

Is the service responsive?

We saw from the care records that people’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and life histories had been recorded. The care, treatment and support provided at the home met people's individual needs.

People were supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff we spoke with told us they felt well-supported by the manager. One of them said, “The manager is really nice; very approachable and encouraging.”

At the time of our inspection 33 people were living at the home and we saw that care was being provided over three floors. The downstairs floor provided accommodation for people living with dementia, and the middle floor and upper floors provided accommodation for people who required residential care. During our inspection we spoke with the registered manager, four members of care staff, two kitchen staff, six people who lived at the home and one visitor.

(During our inspection) we reviewed how peoples' care and treatment needs were assessed, planned, and delivered in order to ensure their safety and welfare. We also spent time talking with people who lived at the home. All of the people we spoke with told us they were, 'Comfortable’ living at the home and the majority also told us, "The staff are very nice and look after us well." One visitor told us their relative was "Really well looked after."

In the main reception area there was a range of information on display for people who lived at the home, their relatives and visitors. This included previous CQC inspections, the homes brochure of services, healthy eating information, planned activities, photos, posters and items of memorabilia which related to the past and present day.

The main entrance and internal doors were all secured and controlled by electronic key codes to keep people safe. We saw staff answering the main entrance door. If staff were not able to recognise people they enquired as to whom they were and asked them to sign the visitor’s book in the main entrance.

We were able to speak with four people living at the home during our visit. They told us they were comfortable and felt safe in their surroundings. They all told us that the staff cared for them well, they were kind and they were able to talk to staff about any concerns or worries. One person told us it was their first experience of living in a home and they felt well looked after by the staff.