This inspection took place on 13 and 14 March 2018 and was unannounced on the first day. We last inspected the service 06 and 07 June 2017 when we rated the service as good.

This inspection was prompted by information we received from Greater Manchester Police regarding a serious incident; we are making further enquiries in relation to this incident. The provider had notified us of the incident and during the inspection we saw invites to disciplinary meetings and records of discussions about recent issues linked to this incident which had led to formal disciplinary action. This demonstrated the provider addressed any staffing issues raised in a prompt manner.

Sunrise of Bramhall provides personal and nursing care and accommodation for up to 98 older people. Sunrise of Bramhall 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. Two providers, Sunrise Senior Living Limited and Sunrise Operations Bramhall II Limited have dual registration for Sunrise of Bramhall. This means both providers have joint and equal responsibility for the care and support provided at this home.

The service, which is known as a 'community', is divided into two separate neighbourhoods, the 'assisted living' neighbourhood and the 'reminiscence' neighbourhood. The assisted living neighbourhood provides nursing and residential care for up to 72 older people. The reminiscence neighbourhood provides residential care and support for up to 26 older people living with dementia.

The purpose built community is located in Bramhall Stockport. Accommodation is provided over three floors and some accommodation provides single studio suites that can be shared by up to two people.

Reminiscence rooms have a similar layout to those in assisted living and are situated on the ground floor. All bedrooms are single rooms with en-suite facilities and extensive car parking adjoins the building. At the time of this inspection 69 people were living in the assisted living community, 24 people in the reminiscence community.

At the time of inspection there was a manager in post, however they had not yet formally registered 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.

Regular audits were carried out in a number of areas.

People living at Sunrise of Bramhall told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

We saw there were individualised risk assessments in place to identify specific areas of concern. The care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from people before providing support. People’s health needs were managed effectively and there was evidence of professional’s involvement.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs.

There was evidence of robust and safe recru

This inspection took place on the 6 and 7 June 2017 and was unannounced on the first day.

We last inspected the service 9 January 2017 when we rated the service as requires improvement. At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to person centred care, medicines management, governance and staffing. This inspection was to check improvements had been made following the last inspection and to review the ratings.

Sunrise Operations Bramhall ll Limited is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 98 older people. The community is owned and managed by Sunrise Senior Living, an American based operator which provides independent living, assisted living, nursing and dementia care services for older people. The service, which is known as a ‘community’, is divided into two separate neighbourhoods, the ‘assisted living’ neighbourhood and the ‘reminiscence’ neighbourhood. The assisted living neighbourhood provides nursing and residential care for up to 72 older people. The reminiscence neighbourhood provides residential care and support for up to 26 older people living with dementia.

The purpose built community is located in Bramhall Stockport. Accommodation is provided over three floors and some accommodation provides single studio suites that can be shared by up to two people. Reminiscence rooms have a similar layout to those in assisted living and are situated on the ground floor. All bedrooms are single with en-suite facilities. Car parking is at the front of the building. At the time of this inspection 80 people were living in the Sunrise Bramhall community.

Systems to make sure the safekeeping and administration of medicines were followed and monitored were in place and reviewed regularly. Medicines were stored safely and administered by designated trained care workers and nurses. Any specific requirements or risks in relation to people taking particular medicines were clearly documented in their care records. At Sunrise of Bramhall a care record is known as an individual service plan (ISP).

Care workers we spoke with confirmed they had received safeguarding and whistleblowing training (raising a concern about a wrong doing in the workplace) and knew who to report concerns to if they suspected or witnessed abuse or poor practice. We saw records to show care workers received regular supervision to help make sure they were carrying out their duties safely and effectively.

During both days of the inspection we saw people were supported by sufficient numbers of care workers. Care workers we spoke with told us they had undergone a thorough recruitment process and had undertaken employee induction and training appropriate to their job role. This helped to make sure the care provided was safe and responsive to meet people’s identified needs.

People lived in a clean and well maintained environment. We saw that the community was decorated to a high standard; there was a warm and relaxed atmosphere. Appropriate equipment and health and safety checks were carried out to help maintain a safe environment for people to live in.

People who used the service and their relatives were complimentary and positive about the care and support provided and the attitude of the care team and management. They felt that the overall care provided was very good and the environment was furnished and maintained to a high standard.

We saw positive and caring interactions between care workers, nurses and people who used the service, which helped to make sure their dignity was respected and their wellbeing was promoted.

Complaints were addressed and recorded appropriately by the management team. People who used the service and their relatives told us they knew how to make a complaint and felt confident to approach any member of the staff team if they had any concerns.

This inspection took place on the 19, 20, 21 December 2016 and the 9 January 2017 and was unannounced.

We last inspected the service 26 and 27 January 2015 when we rated the service as requires improvement. At that time we found the service was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to the supervision and appraisal of staff, delivery of person centred care, meeting people’s nutritional and hydration needs and records being stored confidentially. We found that the provider was now meeting some of the requirements of these regulations. However we identified other areas where the provider was not meeting the legal requirements. We identified breaches of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to the delivery of person centred care, safe management of medicines, doing all that is practicable to mitigate risk, the effectiveness of governance systems in place, maintaining accurate, complete and contemporaneous records, supervising and ensuring the competency of agency staff. You can see what action we have told the provider to take at the back of this report.

Sunrise Operations Bramhall ll is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 99 older. 73 people receive care in the main part of the home, an ‘assisted living’ neighbourhood. The home also provides residential care and support to 26 older people living with dementia within a separate ‘reminiscence' neighbourhood.

The purpose built home is owned and managed by Sunrise Operations Bramhall II Limited. The home is located in Bramhall Stockport. Accommodation is on two floors and is divided into ‘community’ areas. Assisted living accommodation provided some single studio suites that could be shared by up to two people such as a married couple. Reminiscence rooms had a similar layout to those in assisted living and were situated on the ground floor. All bedrooms were single and had en-suite facilities available. Car parking is at the front of the building. At the time of this inspection 97 people were living at the home.

A registered manager was not in place however a interim manager and ‘pipeline’ (temporary) general manager were in place at the time of 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. The location has a condition of registration that it must have a registered manager. However steps were being taken by the provider to recruit one within a reasonable timescale.

Prior to our inspection we had received information of concern in relation to the management of medicines, a lack of sufficient numbers of staff, activities for people who use the reminiscence service, call buzzer response times and the general management of the home. The provider was addressing these issues prior to and during the inspection.

Medicines were not always managed safely and we did raise a number of safeguarding alerts with the local authority. These were progressed formally under safeguarding procedures and passed to the local authority’s quality assurance team to follow –up. The registered provider had taken action prior to and during the inspection to address concerns identified.

We saw that people were supported by sufficient numbers of staff, although a high number of them were agency staff. Care staff and registered nurses we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was always available to them. Recruitment procedure

We found that the care records identified the needs of people in relation to the care and support they required to maintain their health and wellbeing. Two people spoken with indicated that the staff provided sensitive and flexible care and support and they were well cared for.

People spoken with told us they had no concerns about the care being provided and they felt safe and protected by the staff from potential harm.

We observed staff administering medicines and saw that these were handled safely, securely and appropriately.

We saw there were sufficient numbers of skilled and qualified staff to meet people’s needs.

We saw there were procedures that were being followed to ensure people’s records remained confidential.

When we carried out our unannounced inspection visit we spoke in detail to four people who lived in the home. All were complementary about the home and the way staff looked after them. One person told us that they “liked it very much” and staff “have enough time for you”. Another said people were “treated properly” and were “well looked after”.

We looked at the assessments and care plans for some people and they were appropriate and up to date. Staff were knowledgeable about the people they were looking after and we saw they treated people properly.

We looked at the home’s arrangements for protecting people against the risk of infection and we saw that they had proper policies and procedures and that staff were trained. The home was kept clean and hygienic.

The premises were suitable for the service provided and kept in a good state of repair. Vital equipment such as lifts and fire systems were properly looked after by outside contractors.

The home had procedures to ensure that people they recruited were suitable and these were adhered to. Checks were made into people’s backgrounds as required by the regulations. Staff received induction training when they first started work and were kept updated through a yearly training program.

Visiting professionals told us:

“Can’t praise them highly enough”

“Respected opinions and well thought of”

“Call in weekly”

“Any advice followed”

“Via hospital or GP”

“Home can refer”

“Always someone around”

“Staff support and make sure person is ready for visit”

“Enjoy visiting here”

“Always a quiet room to write up my notes”

“Consultations in private”

“If person needs x 2 people staff will help with transfers”

“I am very happy with the home”

“Staff are fantastic”

People living at the home told us:

“You get used to a certain standard of living and want to maintain that standard and they do that very well, the environment is perfect”

“The people here are lovely”

“I enjoy my own company but there are plenty of activities for people to choose from”

“My room is perfect it overlooks the gardens and I love the views”

“I don’t need a lot of care”

“I get my medication at specified times”

“Everybody has been very kind, very nice”

“I would speak to the manager if I had any concerns and I am sure she would deal with them appropriately”

“I am very happy they are so helpful”

“I visited a number of homes in the area but when I came here it cinched it for me”

“The team are absolutely fantastic we could not get better”

“I have just been to the council meeting it gives me the opportunity to have a say or discuss any issues we may have” and “if we ask for change they usually record how they intend to make the changes”.

“It is a beautiful place and they look after us very well”

“We have the same people looking after us”

“If we needed the GP they would make the arrangements for us”

“I would speak to the manager if I was not happy about the care or the way we were being treated”

“We can go anywhere and do anything, there are always activities going on”

“We are very comfortable here”

“Can’t praise them highly enough”

“The staff are nice very respectful”.

“Staff are lovely”

“Very professional”

“It is very nice here and I have all I need”

“They are all very helpful”

“I can speak to the manager if I am unhappy”

“They keep a record of my care needs; this was all discussed before I came here”.

“I get my tablets when I expect to get them”.

“It is very pleasant”

“We have everything we need and the staff are very helpful”

“We have had reason to speak to the manager with a concern but this was dealt with well and we were very happy with the response”

“There is always something going on just been to the residents council meeting and am going downstairs for a coffee now”

“We have a beautiful room we are very pleased with it”

“There are some people who complain but we find it very nice”

“The food is lovely I enjoy my breakfast, of course lunch is nice but I prefer breakfast time”

This was an unannounced inspection.

The service does not have a registered manager. A home manager was in place and an application to become registered had been submitted to CQC in January 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.

Sunrise Operations Bramhall II (Stockport) is owned and managed by Sunrise Operations Bramhall II Limited and is part of the Sunrise Senior Living Group. The home is purpose built and is registered to provide residential and nursing care for up to 99 people. Accommodation is on three floors which can be accessed via stairs or a passenger lift. There were a number of communal areas of varying size that supported people spending time together in larger areas but also privately in smaller lounges. A separate ‘reminiscence neighbourhood’ providing specialised dementia care, was devoted entirely to people who were living with Alzheimer’s or other forms of dementia. At the time of our visit 74 people were living at Sunrise Bramhall ll (Stockport).

Staff training was available to help make sure that the care provided to people was safe to meet their needs. However a structured system of staff appraisal and supervision was not being followed to promote staff’s professional development and assist staff to talk through any issues about their role, or about the people they provide care, treatment and support to with their line manager or supervisor.

Written information in some care records was not consistent and lacked information for staff to provide effective care.

Some people were not fully supported to maintain good health by receiving appropriate ongoing, nutritional healthcare and support.

Appropriate intervention was not put in place to promote and maintain people’s skin integrity.

People’s privacy and dignity was not always respected because their personal information was not kept confidential at all times.

The provider assessed and monitored the quality of care using an in house auditing system that was being completed regularly. The provider encouraged feedback from people using the service and their families.

Relevant training such as Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) training was ongoing. The MCA and DoLS apply in England and Wales only. The Mental Capacity Act allows restraint and restrictions to be used only if they are in a person’s best interests. These safeguards protect the interests of vulnerable people and help to make sure people are given the care they need in the least restrictive way. Before a person receives any type of examination, treatment or therapy they must give their permission (consent). The manager demonstrated they had a clear understanding about this legislation. At the time of our visit two people were subject to DoLS.

The manager was proactively trying to recruit to vacant staffing positions to make sure consistent levels of appropriate staff was maintained at all times.

Medicines were stored, administered and returned safely and records were kept for medicines received and disposed of this included controlled drugs (CD’s).

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.