This unannounced inspection took place on the 21 May 2018.

Brackley Fields Country House Retirement Home 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. Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 35 people in one adapted building. At the time of the inspection there were 27 people living in the home.

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.

At the first unannounced comprehensive inspection on 1 and 2 June 2016, we found the service to be rated ‘Requires Improvement’.

Staffing levels were not always sufficient and had not been calculated to meet the dependency levels of people living in the home. Individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people's needs. The quality monitoring in place had not highlighted the inconsistencies in individual care plans and risk assessments. Not all staff received regular one to one supervision and staff meetings were not being held on a regular basis.

The provider was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the staffing of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At the second unannounced comprehensive inspection on 15 and 16 December 2016, we found the service continued to be rated ‘Requires Improvement’.

Sufficient numbers of staff were not consistently deployed to provide people’s care. Following our inspection in June 2016, staffing levels had been increased but the number of staff deployed did not always reflect the number of staff that the provider had determined were necessary. Systems in place to monitor the quality and safety of the service were not sufficient. Planned audits had not always taken place and failed to identify risks associated with inconsistent staffing levels, management of medicines, record keeping and accidents and incidents.

The provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements in relation to the staffing and governance of the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations.

At the third unannounced comprehensive inspection on 31 July and 1 August 2017, we found that the service continued to be rated ‘Requires Improvement’.

Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not been identified, and there had been on-going shortfalls as a result. Improvements that were required to fire safety procedures had not been acted upon in a timely manner and environmental audits had not identified on-going deficiencies in fire safety measures. Adequate monitoring of people's falls had not been carried out; insufficient action had been taken to support people who were at high risk of falls. Improvements were required to ensure people received their medicines. People could not be assured that they would receive their prescribed medicines safely. Arrangements in place to ensure that staff had sufficient skills and knowled

This unannounced inspection took place over two days on 31 July and 1 August 2017.

Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 34 people. At the time of this inspection there were 31 people living in the home.

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.

At the last inspection on 15 and 16 December 2016 we found that the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have sufficient arrangements in place to monitor the quality and safety of the care and support provided in the home. We asked the provider to make improvements to the governance of the service. During this inspection we found that actions required to improve the governance of the service had not been completed. At the last inspection we also found that sufficient numbers of staff were not consistently deployed to provide people with their care. We asked the provider to take action to make improvements to staffing levels. During this inspection we found that the required improvements had been made.

Ineffective quality assurance systems were in place to monitor the care and support people received. The improvements that were required to the service had not been identified, and there had been on-going shortfalls as a result.

Improvements that were required to fire safety procedures had not been acted upon in a timely manner and environmental audits had not identified on-going deficiencies in fire safety measures.

Adequate monitoring of people’s falls had not been carried out; insufficient action had been taken to support people who were at high risk of falls. Improvements were required to ensure people received their medicines. People could not be assured that they would receive their prescribed medicines safely.

Staff did not always have the skills that they needed to provide people’s care safely. Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support were not sufficient. Staff had not been provided with sufficient training in key areas such as manual handing and first aid. There was a lack of oversight of staff training.

Improvements were required to ensure the staff adequately monitored people's nutritional needs. Some people had been identified as being at high risk of malnutrition. Staff did not follow the guidance to access appropriate medical advice. People were supported and encouraged to eat well and maintain a balanced diet. People were in the main supported to maintain good health, as staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed.

Staff were unclear of the lines of leadership and management of the service. There was a lack of confidence regarding how their concerns would be dealt with; staff were not always assured their concerns had been addressed. Staff were aware of the importance of managing complaints promptly in line with the provider’s policy. People living in the home were confident that any issues would be addressed and that if they had concerns they would be listened to.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that had a good understanding of their role in safeguarding people. Staffing levels ensured that people received the support they required at the times they needed it. People or their representative were inv

This unannounced inspection took place over two days on 15 and 16 December 2016.

Brackley Fields Country House Retirement Home is registered to provide accommodation and support with personal care for up to 34 people. At the time of this inspection there were 32 people living in the home.

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 could not be assured that sufficient numbers of staff to provide their care and support in the way in which they wished to receive it. Following our inspection in June 2016, staffing levels had been increased but the number of staff deployed did not always reflect the number of staff that the provider had determined were necessary. There were insufficient contingency plans in place to manage staff shortfalls.

Systems in place to monitor the quality and safety of the service were not sufficient. Planned audits had not always taken place and failed to identify risks associated with inconsistent staffing levels, management of medicines, record keeping and accidents and incidents.

People were not always protected from the risks associated with accidents; staff did not monitor people sufficiently after an accident to detect injuries that may not be apparent at the time of the accident.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service; however there was no process in place to review criminal records checks. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Although care plans were written in a person centred approach and detailed how people wished to be supported, the provider was unable to consistently demonstrate that people had been involved in planning their care.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

People felt safe in the home and relatives said they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people. People participated in a range of activities and received the support they needed to help them do this. In the main people were able to choose where they spent their time and what they did.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

At this inspection we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

This unannounced inspection took place on 1 June 2016.

Brackley Fields Country House Retirement Home is registered to provide accommodation for persons who require personal care support for up to 34 people. On the day of the inspection 32 people were living in the home.

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.

Staffing levels had not been calculated to reflect the dependency levels of people living in the home and were not always sufficient to ensure that the needs and choices of people living in the home were always met. Although this was applicable to all shifts in the home the impact was greater during the night.

This was a breach of one regulation 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 report.

Staff had an in-depth understanding of peoples care and support needs and understood how to care for them safely. However individual care plans and risk assessments were not personalised or accurate and provided conflicting information regarding people’s needs. This was discussed with the provider and they began an immediate review of all care plans and risk assessments in place.

Regular quality monitoring was on-going in the home; however this had not highlighted the inconsistencies in individual care plans and risk assessments. Systems were in place to gather feedback from people and their relatives and the provider had acted in response to suggestions for improvements.

Although staff felt supported by management not all staff received regular one to one supervision and staff meetings were not being held on a regular basis. This meant that staff did not have a forum to raise any concerns or ideas for improvement they may have; they had shared their concerns about staffing levels with the deputy manager bit not with the registered manager

People felt safe in the home and relatives said they had no concerns. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand the care needs of each person.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely; however some aspects of medicines administration practice needed improvement.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who lived in the home; they worked hard and did their best to provide care in a way that met people’s needs and choices.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

This is a summary of what we found-

Is the service safe?

People told us that they felt safe living at Brackley Fields Country House Retirement Home. Bedrooms were fitted with appropriate safety devices such as radiator guards and window restrictors and no slip or trip hazards were identified within the environment. Appropriate risk assessments were in place to ensure people’s health and safety. However staff had not had all of the required training provided within the appropriate timescales. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff training and quality assurance.

Is the service effective?

People were happy with the care that had been delivered, one person said “I am well looked after here, the staff are lovely and are very friendly; I am very happy here”.

Staff related well to people and knew how they liked to be supported. All of the people living at Brackley Fields had an individual plan of care; these contained the right information. People looked comfortable and relaxed within their environment and looked well cared for.

Is the service caring?

People told us the staff were nice to them and that there were enough staff to meet their needs. We also found that staff ensured people had access to appropriate health care professionals and services. We spoke with a relative who said “The staff couldn’t do enough for our relative, all of the family agreed the care could not have been better, we couldn’t have asked for more, the staff were wonderful”.

Is the service responsive to people’s needs?

We saw that staff were mindful of people’s privacy and that they treated them with respect; for example we saw that staff referred to people by their preferred name and obtained people’s consent before providing any support. Records showed that people had access to health professionals such as general practitioners, district nursing services, specialist nurses, dental services, podiatrists, opticians and other NHS services when required.

Is the service well lead?

The registered manager had identified areas for improvement through the quality assurance process; including the need to increase staffing levels and equipment to meet people’s needs and reduce the risks of falls. We found the registered manager had responded to the outcome of satisfaction surveys and meetings with people who used the service to improve the quality of the service. The people we spoke with confirmed that staff and management responded to their views.

However quality assurance systems had failed to identify that the required training in fire safety had not been renewed for existing staff, in addition although safety checks on the hot water dispensed in bathrooms had been checked on a weekly basis we found that the thermometer in use for routine hot water checks was not working properly.

This meant that some of the quality assurance checks designed to ensure the health and safety of the people who used the service were not always effective. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staff training and quality assurance.

We spoke with four people that used the service. They all told us that they were happy with the service. One person told us “We get well looked after and all of the people are kind”. Another person told us “The carers are absolutely marvellous, they really do care”.

We spoke with two staff members that worked at the service. They told us that they enjoyed their roles and that they felt like part of one big family.

We spoke with two family members of people that used the service. They both spoke very positively about the service. One of them told us “I am very happy with the level of service, the staff are very attentive and the service very responsive”.

We spoke with a professional who was visiting the service. They told us that they had no concerns about the service and that the staff listened and took advice and recommendations on board.

We saw that people’s likes, dislikes and preferences were taken into consideration. We found that people’s needs and risks had been identified, however, we were concerned as we could not always evidence that people’s needs were being met and the risks managed appropriately.

We saw that there was a safeguarding policy in place, there were adequate staffing levels at the service and that the provider conducted an annual feedback survey.