The inspection visit took place on 03 December 2018 and was unannounced. At our last inspection we rated the service Good. At this inspection we found that the rating had changed and was now Requires Improvement overall.

Bryony House is a ‘care home’. People in care homes receive accommodation and nursing or 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. Bryony House is a care home without nursing, which can accommodate up to 35 people. At the time of our inspection 30 people were using the service and included older people.

The acting manager had been in place for the last six months and was looking to make an application to become registered manager. 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 were not assisted to mobilise safely through the consistent use of safe moving and handling practices by staff.

Staff were not always available to support people and there were concerns around the number of staff on each shift. Hazards were found around the home which could impact on people’s wellbeing. Risk assessments were in place and safeguarding processes were followed.

Safe recruitment of staff was carried out and people received medicines as required.

People felt that staff treated them with kindness and compassion. People were supported to be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible.

People told us that they did not always have the opportunity to be stimulated by activities and we did not see any take place, with many people spending the day sleeping. The audit trail for complaints was completed retrospectively. Care plans contained information about the person, their needs and choices. People were able to speak openly with staff and understood how to make a complaint. End of life wishes were considered.

Audits did not provide enough information to be effective in identifying ongoing patterns and trends. Inappropriate practice had not been identified through any audits or checks. Staff did not always acknowledge confidentiality in the way in which they spoke of people and their needs within the home. People and staff were positive about the leadership skills of the registered manager. We were provided with information we expected to receive.

Staff were knowledgeable on people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

We found a breach of regulation 17. You can see what action we told the provider to take at the back of the report.

This inspection took place on 18 November 2015 and was unannounced. We last inspected this service in October 2013 and found it compliant with all the regulations we looked at.

Bryony House is a residential home which provides personal care and accommodation to older people some of whom live with dementia. Although most people used the service permanently, a few people were receiving temporary respite care. The service is registered with the Commission to provide personal care for up to 35 people. At the time of our inspection there were 28 people using the service including one person who was in hospital. There was a registered manager at this location. 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.

People were kept safe because staff knew how to recognise the signs of potential abuse and what action to take. Staff supported people in line with their care plans in order to keep them safe from the risk of falling and provided reassurance when necessary.

All the people and staff we spoke with told us that there were enough staff to meet people’s care needs. The registered manager regularly reviewed staffing levels to ensure there were enough staff when people’s conditions changed.

Staff knew how to manage medicines safely and administer medication as prescribed. Some people had been assessed as competent to manage their own medicines and regular reviews were undertaken to identify that they remained safe to do so.

People were supported by staff who knew how to support their specific conditions. People received the care they required to keep them well because staff had received regular training and supervisions to maintain their skills and knowledge.

Staff sought consent form people and asked their opinion of how they wanted to be supported. When people were thought to lack mental capacity the provider had taken the appropriate action to ensure their care did not restrict their movement and rights. This ensured people were supported in line with the principles of the Mental Capacity Act 2005 (MCA).

People could choose what they wanted to eat and told us they enjoyed it. There was a wide choice of food available and people could choose where they wanted to eat. When necessary the provider would monitor people’s weights and seek expert guidance to ensure people ate enough to remain well.

Staff had developed caring relationships with people and took pleasure in supporting them to engage in things they knew they liked.

People felt that concerns would be sorted out quickly without the need to resort to the formal complaints process. Records showed that any issues were dealt with appropriately.

The service encouraged people and staff to comment on how the service operated and to be involved in directing how their care was provided and developed.

The service had taken part in an NHS initiative to improve the quality of care people received in care homes. This had resulted in several health benefits to the people who lived there.

The service had a clear leadership structure which staff understood. However the provider had not taken prompt and effective action when staff had made them aware of concerns about staff development. A system of having designated key workers was not wholly effective as some care staff were not aware of the people they were key worker to.

There were processes for monitoring and improving the quality of the care people received. The provider conducted regular audits and we saw that action plans had been put in place when it was identified that improvements were needed.

We used a number of different methods to help understand the experiences of people using the service. Some people had complex needs which meant they were not able to tell us their experiences. We spoke to three people who used the service, the registered manager and three members of staff.

Everybody we spoke with told us that they were happy living at the home and felt that the provider understood their specific care needs. People spoken with told us, “I like living here, I have no complaints” and “Its fine here, just as good as it always was.”

At our last visit we were concerned that people’s care plans did not contain enough information to support people’s individual care and welfare needs. At this inspection we saw that things had improved. The provider had reviewed the care records of each person who used the service. They had developed individual risk assessments to manage any risks associated with each person’s specific conditions. All the staff we spoke to could explain people’s care plans to us and therefore knew how to deliver care which met people’s needs and could keep them safe from the risk of harm.

The provider had a system in place to deal with comments and complaints. People who used the service could be confident that their comments and complaints were listened to.

Some people who used the service were unable to tell us their experiences because of their complex needs. We spoke to seven of the people who use the service, the manager and five staff. We looked at care records and other documents relating to the management of the service provided. All the people we spoke with said they liked living at the home. One person who used the service told us, “It’s great here, they look after me very well”.

People who used the service were involved in planning their care. They were supported to make choices about the care they received.

People received care which met their needs but the provider did not always have care plans in place to manage the individual health and support needs of some of the people who used the service.

People had a choice of food and drinks which met their nutritional needs. There was a choice of drinks, snacks and fresh fruit available all day.

Staff felt supported to meet the care and welfare needs of the people who used the service. One member of staff told us, “I like working here, it feels like a team”.

The provider was able to protect people against the risk of unsafe care and treatment by regularly assessing and monitoring the quality of the service provided and introducing changes when required.

When we visited the service on 02 November 2012 some people who lived at the home were not able to give us their views because of their complex needs. We observed people, looked at care records, spoke with care workers, the deputy manager and relatives. The registered manager was on sick leave when we visited. We spoke with four staff, three relatives and five people who used the service.

We saw that all of the staff treated people with warmth and kindness and people who used the service told us that the staff caring for them had a good manner and respected their dignity.

We saw that the provider carried out assessments of their individual needs so the care was planned and delivered appropriately. A relative told us they were confident their spouse's care was planned and delivered in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that service users were safeguarded against the risk of abuse.

We found that care workers were skilled, qualified and competent to provide people with the care required to meet their needs. A district nurse told us,” I trust the staff to carry out my instructions". One person told us that staff responded promptly to requests for assistance,” Staff will always answer the bell, even if they are busy they will still come".

We found that the provider protected people who use the service from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.

People who use the service told us that they were happy with the service provided at Bryony House. They told us that they were involved in making decisions about their daily lives and that they received the care and support in the way they preferred and in a respectful manner.

People told us that they felt confident to raise any concerns that they may have about the service and that actions are taken in response to them.