This inspection took place on 18 and 20 April 2018. The first day was unannounced, however we informed staff we would be returning for a second day to complete the inspection and announced this in advance.

Brabyns House is located within walking distance of Marple village which has shops, pubs and restaurants. Public transport is also easily accessible. Brabyns House offers accommodation for up to 39 people who require assistance with personal care and support. At the time of inspection there were 36 people living in the home.

Brabyns House is a ‘care home’. People in care homes receive accommodation and nursing 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 our last inspection of Brabyns House in September 2016, the home was rated as ‘Requires Improvement’ with one breach of the Health and Social Care Act 2008 Regulation 19, relating to safe recruitment and one breach of the Care Quality Commissions (Registration) Regulations 2009 relating to submitting notifications to CQC. A requirement notice was issued in relation to the Regulation 19 breach. At this inspection we found the home had addressed this and the home were meeting the regulations appropriately.

There was a registered manager in post. 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 living at Brabyns House and their relatives told us they felt safe. Staff working at the home had received training on safeguarding which relates to protecting people from the risk of harm and abuse. The home had clear policies and procedures to ensure people were safeguarded.

The home used a system to calculate how many staff were needed to ensure people were supported safely. We saw this was regularly reviewed in response to changes in people’s needs. The staff we spoke with said they felt they always had enough time and staff to support people safely.

Staff had been recruited safely and all necessary checks had been completed prior to new members of staff starting work. Staff were skilled and received a broad range of training necessary for their roles. Staff received regular supervision and feedback to support them with their on going development.

The home were working within the requirements of the mental capacity act (MCA), applications for deprivation of liberty safeguards (DOLS) had been made where people had been assessed as lacking the capacity to make some of their own choices and decisions.

People we spoke with said the food in the home was very good. The registered manager said she wanted people to have a restaurant style experience. We saw the dining room was set with linen and flowers and looked welcoming. Meals were varied and people living in the home were able to have a choice of menu or an alternative if they wished. Snacks and drinks were available at all times. People's dietary needs were met and people who needed support to maintain their nutrition had clear plans and appropriate support provided.

People living in the home praised the caring attitude of the staff and management. During the inspection we observed staff interacted kindly and with patience at all times. Staff were seen to ask people before providing support and to behave discreetly in communal areas. Staff we spoke described how they supported people to uphold their dignity.

People’s care needs, their preferences and wishes had been fully considered and recorded in their care plans. We saw people had been involved in assessments and reviews. Care plans had been updated regularly to reflect any changes. People’s interests and previous experiences had been recorded and activi

This inspection took place on 27 September 2016 and was unannounced. The home was last inspected on 2 April 2014 and the registered provider was compliant with the regulations in force at that time.

The home is registered to provide accommodation and care for up to 39 older people, including people who are living with dementia. On the day of the inspection, there were 35 people living at the home. The home is situated in Marple, close to Stockport, in Greater Manchester. The premises had two floors and the first floor was accessed by a passenger lift. There were attractive gardens and car parking spaces to the front of the premises.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. However, we found the home’s recruitment and selection policies and procedures had not been operated effectively. This meant there was a lack of evidence that only people considered suitable to work with vulnerable people were employed at Brabyns House.

This was a breach of Regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Some notifications had not been submitted to CQC as required by regulation. This meant that we were not able to determine whether appropriate action had been taken following any accidents or incidents.

This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notifications of other incidents.

Staff told us they were well supported by the registered manager and senior staff group. They confirmed that they received induction training when they were new in post and told us they were happy with the training provided for them.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We checked medication systems and saw that medicines were stored, recorded and administered safely, although minor improvements were needed. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home and relatives told us that staff were very caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

People’s family and friends were made welcome at the home. A variety of activities were provided to meet people’s individual needs, and people were encouraged to take part.

People told us they were very happy with the food provided. We saw that people's nutritional needs had been assessed and their individual food and drink requirements were met.

There were systems in place to seek feedback from people who lived at the home, relatives and staff. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appr

During our inspection we spoke with two people who lived at Brabyns House and a visiting relative. We also spoke with the Deputy Manager, two members of staff and a visiting health care professional. We looked at people’s care records and the homes policies. We also spent time observing how people were cared for. Following our inspection we spoke with a local Fire Safety Officer and the Local Authority contracts monitoring team, who had recently inspected Brabyns House. We also spoke with the Registered Manager.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

People were cared for in an environment that was well-maintained and where needed, improvements were being made.

People were treated with dignity and respect by staff. People told us they had no concerns about the care they received.

The home had policies in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and it was acknowledged by the Registered Manager that management and care staff would benefit from additional training in these areas.

There were systems in place to effectively manage people’s medication and medication was stored appropriately and securely.

Is the service effective?

People’s care needs were assessed with their involvement, and where appropriate their families were also involved. People’s care plans provided person centred guidance for staff in how to deliver their care. Staff understood the importance of working with people and their relatives to provide good care and showed an understanding of people’s support and emotional needs.

People were provided with balanced, nutritious meals, which the people we spoke with told us they enjoyed. People were supported with their nutritional needs by appropriately trained staff.

Is the service caring?

People were encouraged to spend time visiting the home before moving in. This provided opportunities to build relationships with staff and the people they would be living with. We saw that people were spoken to with warmth and respect. Staff explained to people what they were assisting them with and why. The support they received was calm and unhurried. A relative we spoke with told us they were made to feel welcome by staff, who provided them with reassurance about their relative’s stay. They also told us they were regularly invited to eat a meal with their relative, which was an important social activity to them.

Is the service responsive?

A visiting health care professional told us in their experience people received good care, staff were keen to learn and discuss people’s care needs and that staff had a good relationship with local medical professionals.

There was a complaints procedure in place and the people we spoke with felt able to express their concerns, although they had not felt the need to. The views of people who used the service and their relatives were sought and responded to.

Is the service well led?

There was an effective management team in place and the staff we spoke with felt supported in their role. There were quality assurance systems in place to identify and address shortfalls in the service, although it was acknowledged by the Registered Manager that these could be developed further.

We spoke with a number of people who lived at Brabyns House, two visitors, the Deputy Manager and a member of the staff team. We also talked with Stockport Social Services Quality Assurance team and the District Nurse as part of our inspection process.

People told us “The manager is good and fair and listens to what you have to say;” “We are always made to feel welcome and the door is always answered promptly:” “We are very pleased with the care given to the residents;” “We have seen an improvement since the Deputy Manager came;” “I am very happy with my own little room it is home to me;” “I go out in garden every day when the weather is ok and speak to the gardeners;” “I have own way of doing things.”

We found during our inspection of the building that there was some risk to the safety of the people who lived at Brabyns House. We found that radiators in some bedrooms were very hot and were not protected and also the variety of windows throughout the home meant that not all met with health and safety requirements. We discussed our concerns with the Deputy Manager.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We asked commissioners of the service for their views; they did not have any relevant or concerning information regarding this provider.

We spoke to some people who use the service and a relative when we visited on 3 July 2012. People we spoke to told us that generally they were satisfied with the care and support given to them at the home. They said “Exceedingly good here”, “I cannot fault the care” “Excellent, I feel it’s like my home”. Some people we spoke to said they did not feel well involved with their care and were not familiar with their care plans. However a relative of someone who uses the service told us they were fully involved with their relatives care and were familiar with the care plan. People who use the service told us they felt staff listened to them and would respect their wishes where possible when being cared for. We were told by a relative staff were approachable and felt one would be able to contribute views and suggestions regarding care and that this would be listened to. People told us the food was very good. There was one choice on the menu at mealtimes however we were told that they could request an alternative if they wanted to and this was respected.

All the people we spoke to told us they were treated well and with dignity and respect. People said “They look after me well”, “They treat me with respect” “It’s like being at home”.

One relative we spoke with told us how their father’s condition had greatly improved since living here. They were pleased with the overall care which addressed all needs including physical, emotional, psychological, and dietary. They felt staff were approachable and respectful. We were also told there was a good regime of activities to stimulate people.

We received information via the CQC website about poor staffing levels from an anonymous source. We spoke with people living at the home, they told us: “there is not much to do really, the staff are so busy they just rush past”, “once they get me dressed they disappear and I never see them again”: “enough staff during the day but not at night, people wander around and come into my room”; “staff can be brusque – not enough time”; “turnover of staff has been tremendous, I don’t know who they all are”; “place has gone downhill since this manager started 2-3 years ago staff have left, the atmosphere is not good”.