This inspection took place on 4 and 5 July 2018 and was unannounced.

Brabourne Care Centre 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. Brabourne Care Centre is registered to provide accommodation, nursing and personal care for up to 82 older people. There were 72 people using the service during our inspection, 15 people were using the service for a short stay.

The service has three units over three floors: Edinburgh and Maxwell on the ground floor has capacity for 30 people; Eastwell and Ramsey, on the first floor has capacity for 29 people; and Mountbatten on the second floor has capacity for 23 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 (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in April 2017, the service was rated 'Requires Improvement', with three breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices relating to safe care and treatment, person centred care and good governance. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found improvements had been made, and the previous breaches had been met.

At our previous inspection we found that there was not sufficient, clear guidance for staff to follow when supporting people with catheter care, health conditions such as epilepsy and people's personal emergency evacuation plans (PEEPs) did not contain the necessary level of detail to ensure staff were able to assist people to leave the service safely in the event of a fire. At this inspection we found that overall these issues had been addressed and improvements had been made. PEEPs for most people had been reviewed and contained clear guidance on how staff should support people to leave in an emergency. We found that PEEP’s for some people who were staying for a short period of time did not always contain sufficient clear guidance. We discussed this with the registered manager, who told us they would ensure these were all reviewed. This is an area for ongoing improvement.

At our last inspection people’s care records did not consistently reflect the care they were receiving. At this inspection, improvements had been made. People’s care plans had been reviewed and now contained clear, specific guidance for staff. They also contained more person-centred detail. They contained clear information regarding how to support people with specific tasks, such as washing or showering and how they liked to be supported to go to bed.

At the previous inspection audits designed to measure the quality and safety of the service were not sufficiently robust. At this inspection we found improvements had been made. The registered manager told us they had begun to document the audits they completed. We reviewed audits of medication, PEEPs, and moving and handling assessments.

Medicines were managed safely and there were enough nurses and care staff on duty. Suitable provision had been made to prevent and control infection. Lessons had been learned when things had gone wrong. Equipment and the premises received regular checks and servicing to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the

The inspection visit was carried out on 27 and 28 April 2017 and was unannounced. The previous inspection was carried out in January 2015 where no breaches of the regulations were identified.

Brabourne Care Centre provides accommodation and nursing care for up to 82 older people. The premises are a purpose-built detached building, which is situated in a residential area of Ashford, near to the town and associated amenities. The service has three units on three floors: Edinburgh Maxwell on the ground floor has capacity for 30 people; Eastwell Ramsey, on the first floor has capacity for 28 people; and Mount Batton on the second floor has capacity for 23 people. There were 69 people living at the service at the time of the inspection.

The service is run by a registered manager, who was present on the days of the inspection visit. 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.

Risk to people had generally been assessed but not all risks had been managed with sufficient, individual guidelines in place for staff to follow. Care plans, risk assessments and guidance were in place but did not always provide staff with detailed and up to date guidance, so that they could support people in an individual way. Assessed risks to people's health, such as monitoring food and fluid intake or pressure reliving equipment were not consistently managed effectively.

There were enough staff on duty and they had received relevant training and supervision to help them carry out their roles effectively. Staff were observed putting their training into practice in a safe way. There was no use of a formal dependency tool to enable to registered manager to assure themselves that staffing levels remained adequate. Most recruitment files contained all the required information about staff, but the minority needed further detail about past employment.

A number of audits and checks were carried out each month by the registered manager or a nominated person, but they had not always been effective in identifying the shortfalls highlighted during our inspection.

Staff knew how to keep people safe from abuse and neglect and the manager referred any incidents to the local safeguarding authority as appropriate. Incidents and accidents had been properly recorded and preventative actions taken. Fire safety had been addressed through training, drills and alarm testing. Maintenance had been carried out promptly when repairs were needed.

Medicines were managed safely. People received their medicines safely and when they needed them. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

Staff encouraged people to be involved and feel included in their environment. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People's privacy and dignity was respected.

Staff treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

The registered manager completed a detailed assessment of people’s needs prior to moving into the service. This gave them an opportunity to know people and their support needs and to answer any questions or queries people of their relatives had.

Activities staff offered people a range of one to one and group activities that met their needs and preferences.

Complaints had been properly documented, and recorded whether

The inspection visit was carried out on 20 January 2015 and was unannounced.

The previous inspections were carried out in February 2014 and April 2014. In February 2014 the inspection had found a breach in regulations in relation to medicines management. At a follow-up inspection in April 2014, we found that the issues had been addressed and there were no breaches in the regulations.

Brabourne Care Centre provides accommodation and nursing care for up to 82 older people. The premises are a purpose-built detached building, which is situated in a residential area of Ashford, near to the town and associated amenities. The service has three units on three floors: Edinburgh Maxwell on the ground floor has capacity for 30 people; Eastwell Ramsey, on the first floor has capacity for 28 people; and Mount Batton on the second floor has capacity for 23 people. There were 80 people living at the service on the day of the inspection.

The service is run by a registered manager, who was present on the day of the inspection visit. 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.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and DoLS. Whilst no-one living at the home was currently subject to a DoLS authorisation, the registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

The service had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the local authority’s whistleblowing policy. They were confident that they could raise any matters of concern with their line managers, the registered manager or with the local authority safeguarding team.

The service had arrangements in place to protect people from assessed risks to their safety. These included building and environmental risk assessments, maintenance checks, regular servicing and checks for equipment, and risk assessments for each individual person receiving care and treatment.

The service provided sufficient numbers of nursing and care staff for people to ensure they were well cared for. They were supported by suitable numbers of ancillary staff, including administration, catering, domestic and maintenance staff.

Recruitment procedures were managed appropriately, and applicants were assessed as suitable for their job roles. Staff were provided with a detailed induction programme, which included training in essential subjects. Refresher training was provided at regular intervals. Staff were enabled to develop their knowledge and skills with further training courses, and formal qualifications. The service had a low staff turnover, and staff said they enjoyed working at the home and worked well together as teams. Staff were supported through individual supervision sessions, daily handovers between shifts, staff meetings, and yearly appraisals.

Nursing staff administered medicines, and carried out safe storage and management of medicines. People said they received their medicines on time.

The service provided a range of different foods to give people a varied and nutritious diet. People said that they had plenty of choice and the food was good. Food was mostly home-cooked and was attractively presented.

People said that the staff were caring, kind, polite and respectful. Staff interacted with people in a friendly manner, and responded quickly to them when they called for help. People and their relatives said that the staff kept them informed about any changes to their health needs, and any changes to the service. They were confident that staff listened to their views, and that any concerns would be taken seriously and dealt with appropriately.

The service encouraged people to retain their independence, and to follow their own lifestyles. Some people liked to socialise in the lounges and dining areas, and some preferred to stay in their own rooms. A variety of individual and group activities were provided, and some people said they enjoyed being able to go out of the home with staff or relatives. Activities staff spent time with people who stayed in their own rooms, so as to prevent social isolation.

People and their relatives were involved in their care planning and reviews. Care plans reflected people’s individual needs and choices, and showed on-going assessments for their health needs. A local GP visited the service routinely twice per week, and for urgent visits if required. Most people chose to be registered with this GP practice. Arrangements were made for other health and social professionals to provide advice and treatment as needed; and people’s relatives were able to speak with doctors or other health professionals if people wanted their relatives’ support. Staff were trained in end of life care, and showed kindness and compassion to people at the end of their lives.

The registered manager had a visible presence in the service and was available for people to talk with her on a daily basis. She worked alongside the nurses and care staff at times during the week, so that she kept up to date with people’s individual care needs and their levels of staff support. Each unit was overseen by a unit manager, and they were available to help staff with any advice or support needed. Staff said that their views were taken into account, and they felt involved in the general running of the service.

People and their relatives knew that the registered manager had an open door policy, and that they could talk with her, the unit managers and nursing staff whenever they wished to. Their feedback was obtained through ‘residents and relatives’ meetings, via e-mails, and through the use of yearly surveys carried out by the provider. People’s comments were used to bring about change and on-going improvements to the service. There were reliable processes in place, such as quality audits, to monitor the effectiveness of the service. These included infection control, hand hygiene, medicines, cleaning, and kitchen audits.

Records were quickly made available to the inspection team. They were accurately completed, up to date, and were appropriately signed and dated. They were stored in a way which protected people’s confidentiality.

The inspection was carried out to follow up a compliance action given in regards to medication management at the previous inspection in February 2014.

The visit lasted over two hours, during which time we inspected medication storage on each floor; talked with nursing staff; and examined medication administration records and policies and procedures.

We found that the manager had implemented new medication policies and procedures which reflected local practice. Action had been taken to meet the regulation, and we found that the service was compliant with the management of medicines.

At the time of our inspection, there were 71 people who lived in the home. We spoke with 14 people who lived there, 6 visitors, 8 members of staff and the manager.

People we spoke with who lived in the home told us that they were happy with the care and support they received. Comments included “the carer’s are good; they’re always helpful” and “the staff are very good” and “the staff are lovely; nothing seems too much trouble”. A visitor told us that they had looked at several homes for their relative and said “I have made a good choice; it’s very homely”.

People told us that they were supported to make their own day-to-day decisions and were involved in how their care and support was provided.

We found that care plans contained details about people's daily routines, their care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who lived in the home.

We found that the home had arrangements in place to protect people from the risk of abuse and people said that they felt safe. One person told us “I feel safe here and that’s important to me”.

We found that the home did not always have appropriate arrangements in place to manage medicines safely to help ensure that people were protected from the risks associated with medicines.

We found that there were enough suitably trained and qualified staff to support people’s needs. One member of staff told us “it’s a good team here; a lot of us have been here a long time and get on well”.

When we visited we spoke with eight people who lived in the home, three relatives and members of staff including the registered manager, the coordinating manager, nursing and care staff.

People told us that they were treated with dignity and respect and felt they were well cared for. Comments included, “Everyone seems to know what they are doing”, “When I came in I was very poorly but I can feel that I have improved” and “I have no complaints”.

We observed that staff respected people’s dignity by ensuring that they closed doors when they delivered personal care. We found that staff knew about people's individual likes, dislikes and preferences and we observed positive interactions between staff and the people who lived in the home.

We saw that staff were trained and supervised appropriately to enable them to deliver safe and effective care.

Staff knew who to report to if they had any concerns about the safety of the people who used the service.

There were systems in place to monitor and assess the quality of the service provided.

People told us that they were happy with the care and support they received. They appeared comfortable and well looked after. People told us that staff knew them well and were able to support them with their needs.

Relatives of people that used the service told us that they were happy with how the service kept them informed and involved them in their relatives care. They said that the staff were always polite and made time to get to know people.

People said that they were given choices around their food and support to maintain a balanced diet. We were told that their likes and dislikes were taken into account and that they could have a snack whenever they wanted one.

People said equipment was maintained and staff used it properly and safely.