We inspected Bradbury Home on the 8 April 2019.

About the service: - Bradbury Home caters for up to 36 older people. At the time of our inspection 23 people were using the service. The service was set in a residential area with easy access to the local community and a large garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection the service was rated as requires improvement. At this inspection we saw improvements had been made and the service was now rated as good.

People’s experience of using this service: People and relatives were very complimentary of the service and staff. One person said, “The staff look after me very well, they are all very friendly.” Another person said, “The staff listen and are very helpful, they understand me.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were cared for and supported by staff who had received the appropriate training. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for the needs of people.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed choices.

People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis. People were supported to follow their interests and participate in social activities. The manager responded to complaints received in a timely manner. Support was given to people at the end of their life.

The manager had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Rating at last inspection: Requires Improvement (report published 17 July 2018)

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection of this service on 23, 24 and 31 January 2018. Breaches of legal requirements were found in relation to Regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). Because of our concerns the Care Quality Commission acted in response to our findings by rating the service as ‘Requires Improvement’ and serving two Warning Notices in February 2018, relating to breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The warning notices referred to inadequate medicines management and quality assurance arrangements at the service not being robust. The dates for compliance to be achieved were 9 April 2018 and 1 May 2018.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements. They told us they would be compliant by 9 April 2018.

We undertook this focused inspection on 14 May 2018 to check that the registered provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Bradbury Home on our website at www.cqc.org.uk

Bradbury Home 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. The care home accommodates up to 36 older people and people living with dementia in one adapted building.

Bradbury Home is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on three floors with each person having their own individual bedroom and adequate communal facilities are available on each floor within the service.

A registered manager was in post at the time of this inspection. The registered manager had returned in February 2018 following a period of absence, to manage the service on a day-to-day basis. A permanent head of care had now been appointed and the ‘relief home manager’ who had overseen the service during the registered manager’s period of absence continued to provide support three days a week. 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 provider and registered manager could demonstrate a better understanding and awareness of the importance of having robust recruitment procedures in place to safeguard people using the service. Recruitment practices were much improved and records as required by regulation had been sought. Risks to people were clearly identified and managed to prevent people from receiving unsafe care and support. The deployment of staff was better and there were sufficient staff available to meet people’s needs to an appropriate standard throughout the day. Call alarm facilities were answered promptly by staff on duty to ensure people’s care and support needs were met in a timely manner. Arrangements were now in place to review and investigate events and incidents and to learn from these.

Though the above was positive, whilst it was recognised that significant attempts had been made to ensure the proper and safe use of medicines, further improvements were still required. This referred specifically to making sure people received their prescribed medicines as they should and ensuring the administration of medication was recorded correctly. Additionally, improvements were required to ensure a

The inspection was completed on 23, 24 and 31 January 2018 and was unannounced. At the time of this inspection there were 26 people living at Bradbury Home.

Bradbury Home 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. The care home accommodates up to 36 older people and people living with dementia in one adapted building.

Bradbury Home is a large detached building situated in a quiet residential area in Southend on Sea and close to all amenities. The premises is set out on three floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service on each floor.

At the last inspection on the 12 December 2016 and 3 January 2017, the service was rated ‘Requires Improvement ’. A breach of regulatory requirements was evident for Regulation 12 [Safe care and treatment] and this related specifically to medicines management. 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 key question of ‘Safe’ and ‘Well-Led’ to at least good. The action plan was received on 15 February 2017. At this inspection, we found the service remained rated ‘Requires Improvement’. This is the second time the service has been rated ‘Requires Improvement’.

Prior to our inspection we received a statutory notification advising us of the registered manager’s absence from the service. At the time of the inspection the service was being managed on a day-to-day basis by a ‘relief’ home manager and acting head of care.

An effective robust system was not in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements. Statutory notifications as required by regulation were not always forwarded to the Care Quality Commission.

Some essential aspects of medicines management required further development. Not all risks to people were identified and improvements were required to record how these were to be mitigated so as to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plan documentation was accessible at all times, reflected all of their care and support needs and how the care was to be delivered by staff.

Training for staff was not as up-to-date as it should be. Specifically improvements were needed to ensure staff received appropriate training relating to medication, safeguarding, moving and handling, and to ensure this was embedded in their everyday practice. Staff recruitment practices required strengthening as these were not robust or in line with regulatory requirements. Not all staff had received a robust induction, formal supervision or an appraisal of their overall performance.

Although people told us that staff cared for them in a kind and caring manner and whilst some aspects of care by staff was seen to be good, other arrangements were not as effective as they should be and could potentially impact on the delivery of care people received. The deployment of staff was not always appropriate to meet people’s care and support needs and this required review.

People’s capacity to make day-to-day decisions had been considered and assessed; and people were supported to make choices and decisions. Staff member’s understanding and knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act (MCA) 2005 were good.

People received sufficient food and drink throughout the day and their healthcare needs were supported, having access to a range of healthcare services and professionals as required. Staff had a good relationship with the people t

The Inspection took place on 12 December 2016 and 3 January 2017 and was unannounced.

Bradbury Home is registered to provide accommodation and personal care without nursing for up to 36 people who may be living with dementia. There were 22 people living in the service at the time of our inspection.

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.

Improvements were needed to ensure that people receive their medication safely and as prescribed. Although there were systems in place for receiving, administering and disposing of medicines there were medication errors that had not been identified by the service’s own auditing system. Improvements were needed in the timeliness of responding to all issues raised. Although most people were confident that their concerns or complaints would be listened to and acted upon, some issues had not been resolved in a timely manner.

Risks to people’s health and welfare had been assessed and there were care plans and risk assessments in place to ensure people were cared for safely. The recent increase in night time staffing levels and the recruitment of more permanent staff had improved staffing in general. The recruitment process had also been improved recently to ensure that all staff working in the service had the appropriate pre-employment checks.

The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed. There was guidance and information available and some staff had been trained. More training was scheduled to take place to ensure that all staff had up to date knowledge.

People received sufficient amounts of food and drink to meet their individual needs and preferences. Healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

You can see what action we told the provider to take at the back of the full version of the report.

Staff knew the people they cared for well and were kind and caring towards them. They ensured that people’s privacy and dignity was always maintained. People expressed their views and opinions and they participated in activities of their choosing. People received their visitors at any time and their families and friends were made to feel welcome. Advocacy services were available should people need them. People’s care needs had been assessed and their care plans provided sufficient information for staff to meet their needs and to care for them safely.

The quality monitoring system was generally effective in monitoring the service. However the medication audits had not identified the issues raised in this report. The registered manager has been, and continues to implement changes to drive improvements to the service.

We found that staff had good understanding of people's individual needs. We saw that people were treated respectfully and their individuality and diversity understood. The interaction we saw between staff and people was friendly and relaxed.

Staff we spoke with said they had been properly recruited and trained. Staff told us that they received good support in their roles.

People had the opportunity to enjoy a range of activities and, with staff support, were able to get out and about in the community.

We saw that people’s care and support was planned and reviewed regularly. Risks to the health, welfare and safety of the person were identified and managed.

Some of the people we met at our inspection could not, because of their complex needs, tell us verbally about their experiences and so we used observation to help us understand their experience of the service. We also looked at care records and gained feedback from staff about people's care and support needs. People we were able to speak with told us that they were satisfied with how they were treated, with the level of support provided and with the facilities and activities available. One person told us, "The staff are all pretty good and I think this is a nice home.” Another person told us that, “The food is quite good, I get plenty to eat and I don’t have any complaints.” One person said, “I like it here, the staff are very good to me.”

People living in Bradbury Home and their families were happy with the level of care and support offered. People told us, "I am quite happy and comfortable here," "All the staff are nice," and, "We are treated very well." People's care needs were assessed and planned for with any risks associated with their care being minimised as far as possible. We saw that people were involved in this process and encouraged to identify their needs and preferences. People told us that they felt comfortable living in Bradbury Home and were aware of how to raise any concerns.

Staff said that they were well supported and had opportunities for training. We saw that care workers were generally kept up to date with training in essential areas such as moving and handling, but attention was needed to ensure that staff working at night were also kept up to date and well trained. Staff felt that communication and teamwork in the service had improved. This would help to ensure that people receive a good and consistent service.

People were happy with the quality of the service. There were good systems in place to ensure that the quality and safety of the service was maintained. However this needed continued monitoring to ensure that expected processes were carried out and maintained.

People living at Bradbury home are happy with the care and support they receive there. Everyone told us that the staff were good, friendly and approachable. We saw that there was a good rapport between staff and people using the service.

People told us that the accommodation was very good and that they found the home clean and comfortable.

People enjoy the food provided and told us that they are offered choices about what they would like.

There are good opportunities for people to be occupied and take part in different activities.

People who could not give us their views about Bradbury Home looked well cared for and appeared relaxed and happy.