Bramley House provides accommodation and personal care for up to 37 older people, some of whom may have dementia. At the time of our inspection, 33 people were living at Bramley House. The home was last inspected in March 2016 and was found to be meeting all the standards required.

This inspection took place on 4 and 8 April 2018 and was unannounced on the first day.

We found a breach of Regulation 11 Need for Consent. The process of gaining consent for people who lacked capacity was not followed. There were no mental capacity assessments or best interest decision making documentation to accompany applications to authorise a Deprivation of Liberty Safeguard.

We have made a recommendation about the management and storage of some medicines.

We have made a recommendation for the provider to seek guidance on care planning for people whose needs are changing.

Risk assessments were not reviewed regularly and there were sometimes not enough staff.

The staff required more regular and up to date training to equip them with the appropriate skills to care for people with particular needs. Staff did not receive regular one to one supervision to identify training needs and to support their well-being.

There was a registered manager in post at the home. ‘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 said they felt safe living at Bramley House and safeguarding procedures were in place. Staff were knowledgeable about safeguarding and their responsibility to whistle-blow if required.

People were supported to have control of their daily lives and we observed staff giving people choice. Staff knew people’s preferences and people told us staff were kind and caring.

The home environment was pleasant and decorated tastefully. It had recently undergone some refurbishment and improvements had been made. This included a large, light communal area known as the orangery, a large safe and level access garden and extra en-suite rooms. There were plans in place for a hairdressing salon and new baths and lighting in the downstairs bathrooms.

There was a range of activities available for people. The home had pets, which people and their relatives enjoyed and plans in place for specific events, to include people and their visitors.

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

Bramley House provides accommodation and personal care for up to 37 older people. At the time of our inspection, 36 people were living at Bramley House. The home was last inspected in May 2013 and was found to be meeting all of the standards assessed.

This inspection took place on 11 February 2016 and was unannounced. We returned on 1 March 2016 to complete the inspection.

There was a registered manager in post at the service. 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 who use the service and their relatives were positive about the care they received and praised the quality of the staff and management. Comments from people included, “staff are respectful and kind” and “I am very happy with the care”. People told us they felt safe living in Bramley House and were involved in planning and reviewing their care. Systems were in place to protect people from abuse and harm and staff knew how to use them.

Staff understood the needs of the people they were providing care for. People’s needs were set out in care plans they had been involved in developing. Staff followed these plans, which helped to ensure people received care in the way they preferred. The registered manager was in the process of changing to an electronic care recording system.

Staff were appropriately trained and had the right skills to provide the care people needed. Staff had a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People’s views about their care and support was listened to and acted upon. There was an effective complaints procedure in place.

The provider regularly assessed and monitored the quality of care provided at Bramley House. Feedback from people and their relatives was encouraged and was used to make improvements to the service.

This inspection was to follow up on shortfalls we identified in our previous inspection in medicines management and record keeping. Whilst we were there we looked at other outcomes as part of our routine inspection work.

We spoke with four people who used the service and three staff. People told us they thought the care was good. One person said “it’s very good here. They help you to be independent.” Another person told us “I have no complaints. I can go out when I want. That’s important to me.”

We observed staff were patient and kind. All staff interacted spontaneously with people to share a joke or offer a compliment. People seemed relaxed. They moved around the home freely and used all communal areas.

We observed people were involved in decisions about their care. The manager had made appropriate referrals to the relevant authorities when they had concerns about a person’s mental capacity.

People told us they enjoyed the food. The menu was varied, offered choice and included meat, fish, vegetables and salad.

People’s records were regularly updated and overall included enough information for staff to assist people with their care needs.

We found people’s medicines records were accurately completed. Medicines were stored safely. Staff had received appropriate training to administer medicines.

We observed on the day of the inspection medicines were administered safely and in line with the home's policy. We saw from people's medicines records there had been recording errors.

People were satisfied with their care. One person said "It's tops! Although the mattress is uncomfortable." We noted people's risk assessments and care records had been updated and were reviewed regularly. Overall there was sufficient detail in the care plans to provide appropriate care. However some people who were assessed as being at risk of developing pressure ulcers did not have support plans to manage the risk.

People told us they were very happy at the service. They made positive comments about the members of staff. People were offered a range of activities, both in groups and one to one.

A district nurse made positive comments about the staff’s knowledge of people’s needs and told us they were quick to alert them to any health concerns.

People’s care and support needs were being met, but this was not always evident from the care plans. The care plans had not been fully reviewed or revised since the previous registered manager had left in March 2012.

People’s morning medicines were not being given to them directly from the original sealed pack from the pharmacy. Members of staff did not sign the medicine administration records after each administration of medicines. This meant people were at risk of receiving the wrong medicine.

A new manager was in post and had worked at the service since December 2012. They told us they worked alongside the previous registered manager as part of their induction until April 2012 when they formally took up the post of manager. They told us they were in the process of applying to become registered with us. They had received their Criminal Records Bureau certificate and were in the process of filling out the registration application forms.

Members of staff said they felt well supported by the new manager. Staff had regular ongoing training.

Records were not regularly reviewed or kept up to date with detailed information about people’s care and support needs.

Action plans were in progress to improve the quality of the service.