We inspected Bange Nursing Homes Limited t/a Bradley House Nursing Home (known as 'Bradley House' by the people who live there) on 18 and 26 February 2019. The inspection was unannounced, so this meant they did not know we were coming.

Bradley House 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. Bradley House can provide accommodation and nursing care for up to 34 older people living with dementia. At the time of the inspection there were 29 people living at the care home.

We last inspected Bradley House on the 5 and 6 February 2018, we rated the service Requires Improvement. We found two breaches of regulations relating to the provision of safe care and treatment and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. The provider sent us their action plan detailing their planned actions to improve the service. At this inspection we found improvements had not been made in relation to the provision of safe care and treatment and good governance. This is the fifth time the service has been rated Requires Improvement.

The service had a registered manager in place as required by their Care Quality Commission (CQC) registration. 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 registered manager was also part owner of the home and was supported by a clinical nurse.

Medicines were not always managed safely. Guidance for medicines when people needed them did not contain sufficient detail to ensure they were administered consistently. The records about the stock and administration of medicines were not accurate. When audits were done they did not evidence that medicines were always administered as prescribed or could be properly accounted for.

Risks associated with the premises, such as the regulation of water temperatures to reduce the risks associated with scalding were not effectively managed. The providers approach to undertaking fire drills was inconsistent, which meant staff may not know how to use evacuation equipment in an emergency.

Staff received induction and on-going training. However, we found a number of key courses were overdue for a small number of the staff team. A detailed training plan was in place, this had been developed by the new training co-ordinator and we were provided with assurances from the registered manager staff access to supervision and annual appraisals would be improved.

Quality assurance systems were not effective as we identified issues with the management of people’s medicines and the safety of the home, which the some processes failed to recognise.

Staff were kind and caring and treated people with respect. We observed many positive and caring interactions throughout the inspection. Staff knew people's likes and dislikes, which helped them provide individualised care for people.

There were sufficient staff on duty to support people safely. One staff member had not been recruited safely in line with the requirements of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Schedule 3.

People's rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

Risk assessments were in place for people who lived at Bradley House. Risk assessments were tailored around the needs of the pers

We inspected Bange Nursing Homes Limited t/a Bradley House Nursing Home (known as ‘Bradley House Nursing Home’ by the people who live there) on 5 and 6 February 2018. The inspection was unannounced, so this meant they did not know we were coming.

At the last inspection on 12 and 13 December 2016, the service was rated as requires improvement. We found one breach of the regulations, as improvements were needed in the recruitment of new staff. We also found improvements were needed in respect of fire safety, as we found fire drills had not been undertaken in the last 12 months to check that staff understand and are familiar with the operation of the emergency fire action plan. Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe.

Bradley House Nursing Home is registered to provide nursing and residential care for up to 34 people. People in care homes receive accommodation and nursing and/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. At the time of our inspection there were 28 people living in the home.

People were supported in one building over three floors. Nine people could be accommodated on the ground floor; bedrooms are all single, there is a shared bathroom, a combined lounge and dining area and a quiet lounge. There are rooms for 13 people on the first floor; these are a mixture of single and twin bedrooms with a shared bathroom and a communal lounge and dining area. There are five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager's office, the staff room, some storage areas and the laundry facilities.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The systems in place to monitor and improve the quality and safety of the service were not effective. Potential safety hazards were identified by the inspection team as we walked around the building. We brought these concerns to the management team's attention and found these had been resolved during the inspection. The safety of the premises and the quality of care provided was ineffective, as they had failed to identify a number of issues that we saw on our inspection. Failure to identify and act upon these risks to people's health and safety meant that the environment at the home was not always safe.

People were supported to access healthcare professionals when needed. Staff respected people's privacy and promoted their dignity by supporting people to be independent. People and relatives spoke highly of staff who they felt were caring and friendly.

Medication was correctly administered, stored and recorded. We looked at six people's medication administration records (MARs) and medication stocks and found that the MARs had been appropriately completed and medication stocks were accurately accounted for. The nurse we spoke with told us that they were confident managing people's medication and people received the right medication at the right times. We saw that relevant staff had received training on medication administration and there were policies and procedures in place to support staff.

Staff were safely recruited and were supported with an induction process. Criminal records checks, known as Disclosure and Barring Service (DBS) records, were carried out. We also saw that official identification,

We inspected Bradley House Nursing Home by the people who live there on 12 and 13 December 2016. The first day of the inspection was unannounced.

Bradley House Nursing Home provides nursing care for up to 34 older people. At the time of our inspection there were 29 people living in the home.

People were supported in one building over four floors. In the basement area there was room for seven people to receive nursing care; all the rooms were single bedrooms, there was a shared bathroom and a communal lounge and dining area in a large conservatory that had recently been modernised. Nine people could be accommodated on the ground floor; bedrooms were all singles, there was a shared bathroom, a combined lounge and dining area and a quiet lounge. There were rooms for 13 people on the first floor; these were a mixture of single and twin bedrooms and they shared a bathroom and a communal lounge and dining area. There were five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager's office, the staff room, some storage areas and the laundry.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection took place on 15 and 16 December 2015. At that time the service was not meeting all the legal requirements. During this inspection we checked to see if improvements had been made.

The provider did not have an effective recruitment and selection procedure in place and did not carry out relevant checks when they employed staff.

Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. However, we found the home had not undertaken any fire drills for the last 12 months. We have made a recommendation that the registered provider reviews the latest fire safety guidance for nursing homes.

The home was generally clean and tidy, although we found a similar malodour at the reception area of the home; this was also noted at the previous inspection. The registered manager provided evidence that this area was regularly cleaned and the manager was looking at alternative ideas to eradicate this malodour from the home.

Staff knew how to keep people safe and how to raise any concerns if they suspected someone was at risk of harm or abuse. Staff understood the risks people could face through everyday living and how they needed to ensure their safety.

We observed staff interacting with people in a positive, respectful and friendly manner. People told us staff were kind and caring. Staff were able to describe how they would support people to retain their independence and we observed aspects of this during the first day of inspection, particularly during the lunch time meal.

Medicines were managed safely and people had their medicines when they needed them. Regular checks on the management of medicines were carried out and action taken where shortfalls were identified. Staff administering medicines had been trained to do this safely.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

Staff were provided with regular supervision and training to support people with their care needs. People were supported to have a healthy diet and to maintain good health. The service was working within the principles of the MCA. We saw evidence of completed mental capacity assessments, best interests meetings care records. Staff had comp

We inspected Bradley House Nursing Home on 15 and 16 December 2015. The first day of the inspection was unannounced.

Bradley House Nursing Home provides nursing care for up to 34 older people. At the time of our inspection there were 32 people living in the home. People were supported in one building over four floors. In the basement area there was room for seven people to receive nursing care; all the rooms were single bedrooms, there was a shared bathroom and a communal lounge and dining area in a large conservatory. Nine people could be accommodated on the ground floor; bedrooms were all singles, there was a shared bathroom, a combined lounge and dining area and a quiet lounge. There were rooms for 13 people on the first floor; these were a mixture of single and twin bedrooms and they shared a bathroom and a communal lounge and dining area. There were five bedrooms on the attic floor; people there shared a toilet and used the communal bathrooms and lounge/dining rooms on the other floors during the day. All floors could be accessed by a lift. A separate part of the basement also contained the registered manager’s office, the staff room, some storage areas and the laundry.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our last inspection took place on 14 April 2015. At that time the service was not meeting all the legal requirements. During this inspection we checked to see if improvements had been made.

Some corridors and communal areas were cluttered. There were no risk assessments in place for various aspects of the care home premises; for example, stair gates, steep steps, the kitchen or laundry room.

Not all of the people living at the home had a personal emergency evacuation plan in place. They might therefore be at risk in the event of a fire or other emergency situation.

We found that the registered manager had not reported all safeguarding incidents to CQC as is required by the regulations and staff had not received regular safeguarding training.

Staff training and development was not up to date and the induction process for new staff was not documented.

There was a lack of consistent and effective audit at the service. This was noted at the last inspection and constituted an ongoing breach of the regulation relating to good governance.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Most aspects of medicines management were done well at the home; however, we found that not all ‘as required’ medications had instructions for staff. We recommended that the registered manager reviews and improves current practice in line with nationally available good practice.

There were enough staff on duty to meet people’s needs and the home employed a flexible system to minimise the use of agency care staff. Care workers had time to assist the activities coordinator to provide activities for the people who used the service. There was a full time activities coordinator at the home who kept records of the activities people had taken part in as well as those that people had refused, so that care workers knew which activities individuals preferred.

The registered manager ensured all the necessary checks were done on new staff before they were employed at the home. Appropriate checks were done in relation to existing nursing staff on an annual basis.

At our last inspection there was a breach in regulation as we noted there were issues with cleanliness and some décor was seen to be in need of improvement. During the inspection, apart from

We carried out a comprehensive unannounced inspection of this service on 14 April 2015. The service was previously inspected on 21 January 2014. There were no outstanding breaches of legal requirements from the last inspection that we needed to follow up.

Bradley House is a nursing home providing personal care and accommodation for up to 34 people, the majority of whom live with dementia. On the day of our inspection there were 31 people residing at Bradley House.

One of the providers is also the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage a 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 (Regulated Activities) Regulations 2014 about how the service is run.

The manager understood their role and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the importance of maintaining peoples’ rights. There was no evidence in people’s care plans that capacity assessments had been undertaken. We saw best interest documents in some people’s care plans but these were not complete.

The recruitment records showed that staff were not employed within the home until essential safety checks such as a Disclosure and Barring Service check (DBS) had been satisfactorily completed. This was to ensure they were safe to work in the home and were not barred from working with vulnerable people.

A range of training was provided to staff to ensure they were able to safely carry out their roles. We found staff had completed training in relation to safeguarding people from abuse. This provided staff with the skills and knowledge to recognise and respond to safeguarding concerns. There were no records to show staff supervision was taking place. We have made a recommendation about formalising and recording staff supervision.

On the day of the inspection there were enough staff on duty to meet people’s needs safely. We observed that support was provided in a sensitive way and people were not rushed. We saw staff contacted GPs when they had concerns about peoples’ health and a record was made of any advice given.

People’s medicines were securely stored and there were systems in place to ensure medicines were administered safely.

People and their relatives told us they were happy with the care provided at Bradley House and that staff were attentive, kind and respectful. Comments included: “I would thoroughly recommend it to anyone. [My relative] has really settled here it has been the best thing for him.” “I can’t praise them enough it has made such a difference to him.” “They [staff] are really good with [my relative].” “Staff are well trained.” “Very caring and very friendly.” One relative told us they thought that staff were “Sufficient in number”.

The provider worked with other professionals to make sure people received the support they required to meet their changing needs. Records showed that people had access to health and social care professionals such as social workers, GP, chiropodists, dieticians and speech and language therapists to meet their specific needs.

We found that care plans did not always show that people and/or their relatives had been involved in developing the care plans.

The people we spoke with told us that they would “tell the staff” if they had any concerns and that they would feel confident staff would act on their concerns.

We found there were some audits taking place to assess the quality of the service that was provided. However, areas such as accidents and incidents and the environment were not being audited to identify areas of concern or improvement.

We found breaches of the regulations relating to systems to monitor the quality of the service, cleanliness and records. You can see what action we told the provider to take at the back of the full version of the report.

We carried out a follow up inspection after having concerns in relation to medication during our last inspection. The provider sent us an action plan outlining how they would make improvements to become compliant with this outcome.

We looked at the medication records for all 30 people currently living at Bradley House

We found that improvements had been made since the last inspection.

Appropriate arrangements were in place in relation to the recording, handling, storage, disposal and safe administration of medicines. We looked at records for January 2014, the medication administration records (MAR) were in place detailing the medication, dosage and times that medication needed to be administered.

Staff were able to demonstrate a clear understanding of their roles and responsibility with regard to safeguarding people living at Bradley House. Appropriate adult safeguarding policies and procedures were in place to support staff.

During our inspection we reviewed five care records for people living in the home and saw evidence in four records that consent had been sought from relatives. All five care records we looked at were clearly set out in chronological order with assessments clearly linked to care plans.

We observed how people were supported and how staff interacted with people. We saw that the relationships between people living in the home and staff were warm and friendly.

The expert by experience spoke to two relatives and they told us: “X has been here for a good few years. I find the staff very good. They treat them very, very nice.” “They’ve only been here six weeks and they’ve settled very well.” “I think they are all lovely staff actually”.

Medicines were not always given to people appropriately. One person was prescribed two creams only available on prescription: We found that they were being applied by members of staff who were not qualified to handle medicines.

The manager provided us with an up to date copy of a training matrix highlighting training staff had received, and where up date’s were required.

Staff members the expert by experience spoke with said they enjoyed working at the nursing home. They also said they appreciated the encouragement of management and the support they received to obtain external qualifications.

We saw the manager had a matrix to monitor reviews of care had taken place and they had created a new audit system of care plans.

This review of record keeping follows the issuing of a Warning Notice for non compliance with this regulation in December 2012.

The warning notice was issued following major concerns identified during our inspection on 8th November 2012, when we found a lack of recording in assessments of care or nursing needs, assessments of capacity, risk assessments, medication administration and care plans. Additionally we found no evidence of care records being systematically reviewed or audited.

When we carried out the review we found there was significant improvement in record keeping, and a concerted effort by the manager to review and audit records. We found that people’s personal records including medical records were accurate and fit for purpose.

People living in the home had complex needs which meant they were unable to tell us their experiences. To form our judgements we observed care, spoke with the registered manager, staff and relatives, alongside analysing records.

We saw staff interacting with people living in the home, we observed staff chatting with people while they were having drinks in the afternoon and generally throughout the day in social areas. We saw staff talking with relatives when they visited.

We did observe one person whose needs were not being met in a timely manner

Records we looked at were not up to date to support peoples care needs or evidence consent or capacity to care or treatment. The registered manager was unable to provide evidence of suitable arrangements to monitor or assess quality of the records or care people received.

Staff we spoke to said they understood the steps they would need to take to ensure that people are safeguarded against the risk of abuse. Records provided evidence that people living in the home were being protected from harm.

One relative we spoke to told us “My X receives excellent care and the staff are always friendly and you can tell they care for the residents.”

During our visit we spoke with a local GP who told us they “Never any problems with following up on treatment we prescribe, we have a good relationship with seniors. The staff are very cautious about residents and will involve us with care and treatment early on.”

People who use the services at Bradley House Nursing Home all have a diagnosis of Dementia, which means people were not able to reliably give their verbal opinions on the service they received. Due to this our evidence was based on how people interacted with the staff, general observations throughout the visit and discussion with staff and visiting relatives.