This inspection was carried out over two days on the 6 and 15 March. Our visit on the 6 March unannounced. At the last inspection on 25 and 26 January 2016 we rated the service as requires improvement overall. We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to risk assessments, infection control, medications, Notification of authorised DoLS applications, the need for consent, ongoing supervision and appraisals for staff and effective governance systems.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service and no further breaches to the regulations.

Bryn Haven is a residential care home located on the outskirts of a large housing estate in Brinnington, Stockport. It is located near local facilities, a main road and a bus route that provide direct access into Stockport town centre. The home is one of a group of eleven homes managed by a 'not for profit' organisation; Borough Care Limited. Bryn Haven is registered to provide personal care and accommodation for up to 42 older people

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 2008 and associated Regulations about how the service is run.

People living at the service, told us they felt comfortable and happy living at the service. The atmosphere was relaxed and welcoming with lots of information available to people about the service.

We saw the food was attractively presented with good size portions. People told us they enjoyed the meals. The dining areas were relaxing and well maintained and enhanced the dining experience.

Activities were provided by the Activities and Lifestyle Facilitator (ALF) and visiting entertainers. The service provided games and activities to help provide access to regular events throughout the week. We saw that meaningful activities were provided by a full time activity co coordinator based on people's personal preferences. They have a dementia group that they attend in the community and participate in the arranged outings.

There was a long-standing staff team in place, with low levels of turnover. This meant that staff knew the people they provided care and support to very well. Staffing levels had been recently revised by the registered provider to provide senior staff and deputies on duty each day. This initiative provided access for everyone to senior leadership and consistent management of the service over a seven day period.

We recommended the registered provider reviews published guidance to help them to demonstrate how staffing levels are calculated to meet people’s needs. Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

Procedures were in place to minimise the risk of harm to people using the service. People received their medicines safely and as prescribed by their doctor. The service had regular auditing of medications to make sure they were being appropriately managed at all times.

Staff understood how to recognise and report abuse which helped make sure people were protected by well trained and informed staff.

Risk screening tools had been developed to reflect any identified risks and these were recorded in people’s support plans. The risk screening tools gave staff clear instructions about what action to take in order to minimise risks e.g. for falls.

Staff understood the need to obtain verbal consent from people using the service before a care task was undertaken. Staff were seen to obtain consent prior to providi

During our inspection we used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs. We also spoke to three people who told us that they liked living at the home.

We looked at three care records and saw that these were person centred and contained information that was reviewed regularly.

Staff we spoke with told us and we saw that there were processes in place to ensure that people were protected from the risk of harm and abuse, and that there were sufficient members of staff to support people.

We saw that there was a system in place to ensure that the quality of the service was monitored and that a complaints process was in place to enable people to raise any concerns that they had.

We spoke to four people who live in the home but because of their care needs only one person was able to speak to us. The person we spoke to told us they liked living in the home and loved their food. They said “I like it here”.

We spoke to the family of one person who lives in the home and they told us their relatives care was second to none.

They told us they felt comfortable talking with the staff and they were consulted regarding any changes to their relatives care.

They said staff involved them in any decisions made in respect of their relatives care and treatment. They also told us they were happy their relative was living at the home and said “I know they are safe”.

We observed staff throughout our visit and saw they treated people with dignity and respect. We observed people during meal time and saw that staff consulted with people on how they liked their food.

We spoke with a family member, people using the service, staff and one of the GP’s during our visit on the 31st October 2011. We also spoke with family members and representatives by telephone on the 15 November 2011. They all told us that they were satisfied with the care provided.

Comments made to us included:- “Been fantastic, amazing, feel reassured”; “Was asked for information about X to include in the care plan”; “Always involved with the care – very informative”; “Home always clean and tidy”; “Very welcoming”; “Definitely respect privacy and dignity and feel X is safe.”

People had been seen by a manager before they were offered a place at the home. At this time an assessment of the person’s needs, which formed the basis of the care plan, was completed. The care plan had information about what the person liked, disliked and their particular care needs. The care file was kept in the person’s bedroom, which meant that relatives could see any changes in the person’s general health and well being.

We received no complaints about the food however these were comments from family members and friends rather than the people who lived at Bryn Haven. We did ask the people who lived at the home but they were unable to provide a meaningful response to our questions due to their mental health. However we did during our visit observe that the food looked appetising and that people were eating what they were given. One family member did tell us that their relative had "Put on weight;" and added "So presume they are eating well and like the food."

No one we spoke with had any complaints or concerns. Everyone said that if they did, in the future, they would have no hesitation in talking to the manager.

There were areas that could be improved and these were discussed with the manager. We talked about the information in the care plans which could be more personal; the updating of the home as it was looking ‘worn’; and the provision of training by professionals who were experts in dementia care.

We did however make a judgment that the home was compliant with all the essential standards as we found that the people who lived at Bryn Haven were safe and had their needs met.

During our review of the service we were also given information by the District Nurse, Stockport MBC contracts and compliance team, Stockport NHS pharmacist all of whom had no concerns about Bryn Haven.

This inspection was carried out over two days on the 25 and 26 January 2016. Our visit on 25 January was unannounced.

We last inspected Bryn Haven in September 2013. At that inspection we found that the service was meeting all the regulations we assessed.

Bryn Haven is a residential care home located on the outskirts of a large housing estate, in Brinnington, Stockport. It looks out onto a main road and bus route; provide direct access into Stockport town centre. The home is one of a group of eleven homes managed by a 'not for profit' organisation; Borough Care Limited.

Bryn Haven is registered to provide care and accommodation for up to 42 older people although currently they are providing care for up to 41 people.

The home has 41 single bedrooms, including 18 with en-suite facilities. Accommodation is provided over two floors. There is a small garden to the front of the property and a reasonably sized, enclosed garden to the rear which has a summerhouse.

At the time of this inspection the manager was not registered with the Care Quality Commission (CQC). The acting deputy manager was due to take up permeant post on 1 February 2016. The home had been without a registered manager since September 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.

During this inspection we identified seven 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 this report.

Medicines were not managed safely. We found there was no accurate, documented evidence that a drink thickener required by a person who uses the service with swallowing difficulties, to prevent the risk of choking had been used, which could put the person at risk of choking. We saw there were gaps in the recording of prescribed creams which meant there was a risk that creams had not been applied when required, which could have resulted in unnecessary discomfort to the person.

We saw some sterile dressings and an eye pad in two first aid boxes were out of date. If dressings are used beyond the expiry date it cannot be guaranteed that the dressing inside remains sterile and therefore should not be used.

We saw that some areas of the home were not visibly clean and there were no detailed cleaning schedules in place to indicate exactly what cleaning had been undertaken.

Building work was being undertaken on the first floor of the home and risk assessments had not been undertaken by the home to ensure people were kept safe.

Not all staff had received regular formal one to one supervision and none of the care staff had received an annual appraisal which meant that some staff were not being appropriately guided and supported to fulfil their job role effectively.

Consent to care had not in all cases been appropriately obtained from people using the service. This meant that some care plans did not demonstrate that decisions had been made in the person’s best interest.

The Care Quality Commission had not been sent all the required statutory notifications relating to the outcome of some the Deprivation of Liberty Safeguards (DoLS) that had been made to the authorising authority. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Systems were in place to monitor the quality of service people received. However due to the shortfalls we found during our inspection they require improvements.

Visitors we spoke to whose relatives used the service told us they thought Bryn Haven was a safe and caring place to live and they thought people were happy and well looked after.

Relatives spoken with told us they had never made a complaint but told us that any issues they had raised had been dealt with to their satisfaction.

Staff we spoke with had a clear understanding of their role in protecting people and making sure people remained safe.

Staff working in the home understood the individual needs of the people who lived there and we saw that care was provided with kindness and dignity. We saw that people who used the service looked clean, well dressed, relaxed and comfortable.

Staff completed induction training when they commenced working at the home, including familiarisation with the policies and procedures for the service.

We saw that activities were provided by staff on duty and outside entertainers.

Members of staff we spoke with told us that the management team were very approachable and supportive.

We saw that there were sufficient numbers of suitably qualified staff on duty at any one time to provide safe care.

We saw people could make choices about their food and drink and were supported by staff where needed to ensure adequate diet and fluids were taken.

We saw staff had good relationships with people and had a understanding of the individual needs and personal preferences of the people they were caring for.

We saw that staff asked people’s permission before any care was undertaken.

A GP we spoke told us that Bryn Haven gave people a high standard of care.