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Inspection carried out on 14 March 2017

During a routine inspection

Bricklehampton Hall is registered to provide accommodation and nursing care for up to 55 older people who may have a physical disability. There were 49 people living at the home at the time of our inspection.

This inspection took place on 14 March 2017 and was unannounced.

There was a registered manager (who was also referred to as matron) was in post at the time of 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 told us they felt safe because of the way staff cared for them. Staff took action to care for people in ways which promoted their safety and people's care plans gave clear guidance for staff to follow in order to promote people’s well-being. Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People told us they were supported in a safe way and had their medicines as prescribed.

There were enough staff employed to care for people. Staff were recruited based upon their suitability to work with people who lived at the home. People benefited from receiving support from staff with the knowledge and skills to care for them. Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

People were assisted in having enough to eat and drink to stay healthy. People were given choice of meals. Where necessary they were given extra help to eat and drink to stay well. People said they had access to health professionals, and there was a twice weekly visit from a local doctor. Relatives had been informed if appropriate and were confident their family member had the support they needed.

Staff knew how to support people when specific decisions needed to be made to meet their needs in their best interests. We saw people were given choices about their care and support. This enabled people to be involved in the decisions about how they would like their care and support delivered. People’s right to privacy was taken into account in the way staff cared for them.

People told us they were happy living at the home, supported by caring staff. People’s independence was promoted. Visitors were welcome to see their family members or friends when they wanted.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. People’s care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

Quality audits were undertook by the registered manager and the provider to develop people’s care further. The provider and registered manager took account of people’s views and suggestions to make sure planned improvements focused on people’s experiences.

Inspection carried out on 17 August 2015

During a routine inspection

This inspection took place on 17 August 2015 and was unannounced.

The provider is registered to provide accommodation, nursing and personal care for 55 older people.

There was a registered manager in post at the time of 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 were kept safe from potential abuse and harm by staff who understood how to identify and report any concerns. Staff were trained and supported to meet the needs of people which included supporting people safely to take their medicines. People’s medicines were managed safely, medicines were stored correctly in locked trolleys and there were clear processes for recording and auditing, so medicines could be accounted for.

Staff were encouraged to become specialist leads for the benefit of the whole staff team and the people they supported, to develop best practice. This practice supported people to continually receive quality care. Checks had been completed on new staff to make sure they were suitable to work at the home.

People were asked for their consent for care and had their rights and freedom protected. Staff asked their permission before providing care and delivered it in a way they preferred.

People were given choices of food and drink suitable for their dietary requirements in order to keep them healthy. People had access to a range of health professionals to promote their health and well-being.

People were treated by staff as individuals; they knew and understood people’s individual preferences. They responded to people’s support needs and requirements in a timely manner which included helping people with their personal care and supporting people with following their interests.

People knew how to complain and felt the registered manager was approachable to share their concerns and felt confident they would be dealt with.

People benefited from living at a home where quality checks were completed on different aspects of the service to drive through improvements.

Inspection carried out on 23 April 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Systems had been in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People were protected against the risks associated with medicines because the provider had made improvements following out last inspection in December 2013. There were now appropriate arrangements in place to manage medicines.

Staff employed by the home had been recruited effectively. The provider demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no current applications were in place. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans due to their conditions. The provider had also considered information and involvement from relatives, other health professionals and staff. People told us: “They really care for me here” and: “I am comfortable and looked after here”.

Visitors confirmed that they were able to see people in private and that visiting times were flexible and the home were accommodating and welcoming.

The provider had been able to demonstrate that they had cooperated with other providers to ensure people received the care and treatment that met their needs. For example, we saw that people were supported with having eye and hearing tests.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us: “They (staff) are helpful when I need them” and: “They take things at my pace, I am not rushed”. A relative told us: “I am here every afternoon, it’s like I am part of a larger family now”.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions. One person told us: “I have a sense of humour that the staff here now know”.

Is the service responsive?

People completed a range of activities in and outside the service regularly and the provider had staff dedicated to arranging and supporting people to attend these activities.

We saw the home had been responsive to people’s changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested one person to be reassessed due to their changing needs. Appropriate equipment to meet the person’s needs had then been sought.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions. We saw that responses to the comments left had been made available for people to see.

Staff told us they were clear about their roles and responsibilities. Staff told us that they felt the home provided a good quality of service and people were well cared for. They told us that the system in place meant they felt supported in their role and where to find information when needed. For example, there was information in each person’s room for the staff to follow and record the care provided.

Inspection carried out on 6, 9 December 2013

During a routine inspection

When we carried out our inspection care and support was provided to 54 people.

We spoke with the registered manager, the deputy manager, three nurses, two care workers, the activities coordinator and a housekeeper. We were also able to spend some time with office and administration staff. We spoke with two people who visited people who used the service. We spoke with some people who used the service. Due to the health needs of some people who used the service we also observed the care and support provided to people.

People we spoke with were complimentary about the care provided. One person who used the service told us: “I can’t fault the place. It’s my home now”. Another person commented on the staff: “They are all wonderful.”

One visitor described the home as: “Warm, well cared for and safe. It’s all those things”. They also told us that they did not worry about their relative due to the care and support provided at the home.

We found that improvements were needed to ensure that people always received their medication as prescribed.

The registered manager told us that some improvement had been needed to ensure equipment provided within the home was checked and maintained. These improvements had already commenced to ensure equipment was safe for its intended purpose.

The provider had systems in place to enable them to monitor the quality of the service provided. These systems were in place to ensure that people received appropriate care and support. Improvements were needed to identify concerns we found regarding the management of medicines.

Inspection carried out on 11 March 2013

During a routine inspection

52 people were living at the home when we inspected. We spoke with four people who used the service. We also spoke with the registered manager, two care workers, a diversional therapist and a patient services manager. We found people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the home and the care and support they received. One person told us: “I love the place”. Another person said: “This is a happy place”. Another person told us: “Matron is a lovely person”.

We found care workers respected people's privacy and dignity when providing personal care. People were involved in decisions about their care and their day to day experiences at the home.

Staff knew about the needs of the people they were caring for. We looked at care plans for three people and found that these contained varying levels of guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

People told us that they felt safe living at the home and knew who to speak to if they had any concerns. Staff had received training on how to recognise signs of abuse and knew how to report concerns.

Staff told us they were supported and we saw they were trained to an appropriate standard and participated in regular supervisions and team meetings.

We looked at complaints that had been received. Those received had been dealt with to people’s satisfaction.

Reports under our old system of regulation (including those from before CQC was created)