This inspection took place on 14 and 15 November 2018 and was unannounced.

Bradbury Grange 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. Bradbury Grange can accommodate 50 people. At the time of our inspection there were 50 people living at the service.

Accommodation is spread over two floors in a large detached property. On each floor there was a large communal lounge and dining room where people could choose to spend their time.

There was no 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. Like registered providers, they are ‘registered persons’. 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. A new manager had been appointed in September 2018, they told us they planned to submit an application to register with CQC.

We last inspected the service in March 2017 and the service was rated Good overall. During this inspection we found two breaches of Regulation and the service is no longer rated Good.

Recruitment processes were not sufficiently robust to ensure that people were supported by staff that were recruited safely. The area manager and manager had identified this prior to our inspection and were taking steps to make sure that recruitment processes were robust before any further recruitment took place.

Potential risks to people’s health and welfare had been assessed, however there was not consistent, clear guidance for staff to follow to mitigate the risk and keep people safe. The manager had identified this and was undertaking a review of each person’s care files.

Accidents and incidents had been recorded and analysed to identify patterns and trends, action had been taken to reduce the risk of them happening again. Checks had been completed on the environment and equipment to make sure it was safe.

People’s medicines were managed safely. Systems were in place to make sure people received their medicines and these were effective. Medicine records were accurate.

Care plans contained guidance about people’s choices and preferences. Care plans were reviewed regularly and with people where they were able or their representative. People were supported to remain comfortable at the end of their lives.

Staff met with people before they moved to the service to make sure that staff could meet their needs. Staff monitored people’s health and referred them to healthcare professionals when their needs changed. Staff followed the guidance given by health professionals to keep people as healthy as possible. People had access to professionals such as a dentist and optician. People were encouraged to lead as healthy lifestyle as possible, for example moving in their chair or bed. People had a choice of meals and were supported to eat a balanced diet.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible, the policies and systems in place supported this practice.

People were supported to be as independent as possible and where possible were involved in developing their care and support. People had access to activities they enjoyed and these reflected their interests. People were treated with kindness, staff respected people’s dignity and privacy. People were relaxed in the company of staff and staff understood how to support people when they were anxious.

People were protected from harm and abuse. Staff knew how to recognise signs of abuse and how to report any concerns. Staff were confident that the manager would deal with their concerns appropriately. The manager would deal with concerns to the local saf

This inspection was carried out on 9 June 2017 and was unannounced. Bradbury Grange is a residential care home in Whitstable, Kent, purpose built in 2010. It provides accommodation and personal care for up to 50 people. The service supports older people and those who are living with dementia.

There were 39 people using the service at the time of the inspection, six of whom lived with dementia. People were able to converse with us.

At our last inspection on 6 April 2016 we issued four warning notices in relation to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in regard to person centred care; consent; safe care and treatment; and governance, The registered provider sent us an action plan detailing the improvements they would make and confirmed they would be meeting the requirements of the regulations by June 2016. This inspection was carried out to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the warning and requirement notices and had made improvements to the culture of the service and the care people received.

There was a new manager in post since February 2017, who had registered with the Care Quality Commission (CQC) in May 2017. A registered manager is a person who has registered with the 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were appropriately recorded and monitored to identify how the risks of recurrence could be reduced.

People, relatives and staff told us there was a sufficient number of staff deployed to consistently meet people’s needs. Staffing levels had been calculated taking into account people’s specific needs and dependency levels. There were thorough recruitment procedures in place which included the checking of references and full employment history.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. Following an audit in medicines, the need for an improvement in the recording of PRN medicines had been identified a week prior to our inspection, and this was being addressed.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Staff had received mandatory training and were scheduled for refresher courses. All members of staff received regular one to one supervision sessions. Staff reported feeling well supported in their roles.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about particular decisions; meetings with appropriate parties were held and recorded to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food provided and their meal times. Staff knew about and provided for people’s dietary preferences and restrictions.

People’s individual assessments and care plans were

This inspection took place on 6 and 7 April 2016 and was unannounced.

Bradbury Grange is a care home which provides care and support for up to 50 older people. There were 36 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes and Parkinson’s. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.

Bradbury Grange is a large domestic-style house. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting/dining rooms on the ground and first floors. There was a large enclosed garden and adjacent garden room to the rear.

The service did not have a registered manager in post at the time of our visit and had not had one since December 2015.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.

Bradbury Grange was last inspected on 30 September and 1 October 2015.They were rated as inadequate overall at that inspection and placed into Special Measures. The provider sent us regular information and records about actions taken to make improvements following our inspection.

At this inspection we found that significant improvements had been made in some areas. In others, however, the changes made had not completely addressed the issues.

Assessments about individual risks had not always been followed through into practice; leaving people exposed to continued risk of harm. Some people’s needs had not been consistently met in relation to their healthcare or well-being.

The principles of the Mental Capacity Act (MCA) 2005 had not been applied in some cases; which led to people’s consent not being appropriately obtained.

Auditing carried out for the purpose of identifying shortfalls in the quality and safety of the service had not been wholly effective.

People’s safety had been protected through cleanliness and robust maintenance of the premises. Fire safety checks had been routinely undertaken and equipment had been serviced regularly.

There were enough staff deployed to meet people’s needs and they had received appropriate training and supervision to help them carry out their roles effectively. Staff were caring and responsive to people’s needs and interactions between staff and people were warm and respectful. Recruitment processes had been followed to ensure staff were suitable for their jobs.

People reported enjoying their meals, and any risks of malnutrition or dehydration had been adequately addressed. There were a wide range of meaningful activities on offer and a proactive volunteer group provided extra support and funding for outings and special occasions.

The interim manager was widely praised by people, relatives and staff for his commitment to improving the service. We found a more open, transparent culture amongst staff and management and the provider had displayed their improvement plans prominently. People knew how to complain but said they felt no need to as, “Things have been turned around here”.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people’s health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor Bradbury Grange to check that improvements continue and are sustained.

There were 44 people using the service and we spent time with or spoke with some of them. We spoke with people as a group and on an individual basis. We also spoke with some visitors and relatives. Everyone we spoke with said that they were happy with the service.

One person said “This is a very, very good home. I visited many homes and this is the best one.” Another person said “We are very well looked after.”

A visitor said “It’s lovely here; I have no complaints at all.” Another visitor said “It is an excellent home. The staff are kind and caring, I cannot think of anything that could be better.”

The home was clean, well maintained and felt very homely. People said that they were very happy with their bedrooms and with the facilities. One person said “The rooms are lovely, the bedrooms and bathrooms are very good, very clean.” The home was well maintained and suited people’s needs.

People told us that the food was very good and that they always had a choice of meals. One person said “If you want anything, you just have to ask and they get it. There are always drinks and snacks available too.”

People’s health and personal care needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well-being. People were treated with dignity and respect and the service responded to people’s changing needs. People told us that they felt safe.

The home was well managed and there was always a senior member of staff on duty. The manager and deputy manager were on call for out of hour’s advice and support.

There were enough staff on duty to meet people’s needs safely. One person said “I am never rushed. The staff are there when you need them.” Another person said “It doesn’t matter when you call them, day or night; there is always someone around, even if you just want a cup of tea!”

People who use the service told us what it was like to live at this service and described how they were treated by staff and their involvement in making choices about their care.

People said that they were very happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One lady said “It’s lovely here” another said “I’m quite happy here. Staff treat me well”. Other people were complimentary of the food and had no concerns with regard to the quality of care.

People said that they had an active say on ways to improve their care. The manager said they were receptive to comments and concerns and strived to resolve any issues as soon as possible. People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. Staff told us if a person using the service complained to them they “would report it to the manager”. Staff were confident that people were able to express concerns if necessary.

People told us that care staff were respectful when attending to their care needs.

One person told us," I like living at Bradbury Grange". Another person told us, "I am very content living here".

People told us that they had their own 'residents meetings' where people who lived in the home could talk about all aspects of home life. They said that these meetings were chaired and that the minutes were taken by people who lived in the home. We were told that the home manager attended these meetings at the invitation of the people who lived in the home.

This inspection took place on 30 September and 1 October 2015 and was unannounced.

Bradbury Grange is a care home which provides care and support for up to 50 older people. There were 49 people living at the service at the time of our inspection. People cared for were all older people; some of whom were living with dementia and some who could show behaviours which may challenge others. People were living with a range of care needs, including diabetes and Parkinson’s. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more independent and needed less support from staff.

Bradbury Grange is a large domestic-style house. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were sitting/dining rooms on the ground and first floors. There is a large enclosed garden and adjacent garden room to the rear.

The service had a registered manager in post at the time of our 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.

Bradbury Grange was last inspected on 16 and 17 March 2015. They were rated as requires improvement at that inspection. The Care Quality Commission (CQC) issued three Warning Notices after the inspection in respect of people’s safe care and treatment and the staffing and good governance of the service. The provider was required to meet the Warning Notices by 16 June 2015. In addition we made Requirement Actions about the need for consent, recruitment processes and assessing and fulfilling people’s individual care needs; and asked the provider to submit an action plan to us to show how and when they intended to address them.

We found that while improvements had been made in some areas, the provider had not fully met the Warning Notices or Requirement Actions during this inspection.

Medicines had not been consistently managed appropriately. Medicines rounds continued to take too long to complete in the mornings and records of medicine and creams administration had not been fully completed. This meant that it was not always possible to tell if people had received their medicines and creams as prescribed to them.

Some areas of the home remained unhygienic; including toilets, commodes and toilet seat risers. Toilet brushes were heavily soiled in some instances, but had not been included on cleaning schedules to ensure they were kept clean. There was no record or schedule of when people’s bed linen was changed and some people remarked that they felt changes were infrequent. People’s living conditions were not consistently hygienic.

Some equipment such as armchairs, side tables and toilet seat risers was either unsuitable or had not been properly maintained; creating risks to people using it.

Risk assessments had been put in place following the last inspection but were not always effective in providing guidance to staff about how to minimise risks to people’s health and safety. Some recorded actions to minimise risks were not followed through in practice by staff; so people remained at risk of harm despite the assessments.

Although staffing numbers had increased; people’s needs were still not being consistently met. Staff did not fully understand the ways in which people can experience abuse; and we observed occasions when people did not receive the care or attention they had requested.

People’s consent to their care and treatment had not always been appropriately recorded; so the service could not evidence that it was acting in accordance with people’s wishes. Assessments had been made of people’s capacity to make their own decisions, but these were generalised and did not focus on specific decisions. These assessments did not conform to the principles of the Mental Capacity Act 2005.

The registered manager had received authorisation to restrict the liberty of one person in line with the Deprivation of Liberty Safeguards (DoLS); which are monitored by the Care Quality Commission (CQC). He had also made several applications for other people. However, some further people were having their liberty restricted but the registered manager had not applied for DoLS authorisations as he had not understood that this was necessary. The registered manager had not made statutory notifications to the CQC when DoLS applications and authorisations were made. This meant that the CQC had not been made aware when people’s liberty was restricted in the service.

Guidance to staff about managing people’s health needs had not always been followed; which meant people were sometimes exposed to increased risk. Staff had not received supervision in line with the provider’s policy, to ensure they received support in their roles.

The quality of food on offer was largely criticised by people and relatives. During the inspection one person had sent out for food because their lunch had been “Inedible”. When people had been seen by the dietician, guidance had been followed by staff to assist with people’s nutrition needs but people had not always been referred to the dietician appropriately following weight loss.

The service was not always caring. People were not consistently treated thoughtfully by staff and some people and relatives told us how this affected their quality of life.

There had been some improvement in care planning since the last inspection but there was still a lack of information about promoting people’s independence. There was insufficient detail in care plans about how people liked to receive support from staff and some plans had not been reviewed regularly. Some staff could not accurately describe people’s preferences so there was a risk that people’s choices might not be observed.

Systems to assess the safety and quality of the service had been ineffective in picking up the shortfalls that were found during this inspection. Audits and ‘standards and values’ checks made by the provider had not identified the on-going concerns around medicines management and infection control.

Although people, relatives and staff felt that the registered manager was likeable, many of them reported that management was ineffective within the service. The action plan submitted to the CQC had not been completed to target timescales set by the provider and Warning Notices about some areas of the service had not been fully met at the time of our inspection. The registered manager told us “It’s my objective to make things right” but there had been insufficient improvement in the service since our last inspection.

New processes had been put in place around medicines to be taken as and when needed (PRN) and over-the-counter remedies. Staff had received up-to-date training in infection prevention and control and a designated staff member had been appointed as a lead to provide staff with guidance in this area. However, this had not sufficiently improved standards of hygiene in the service.

Staff had received fire safety training and could describe evacuation routes. Equipment such as hoists and the passenger lift had been routinely safety-tested.

There was a range of different activities available to people to help prevent social isolation. These included a chaplaincy service and in-house church services for those who wished to attend. Volunteers raised funds to provide people with special treats on their birthdays and at Christmas and Easter.

We found a number of breaches 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.