This inspection took place on 8 and 9 January 2018. The first day of the inspection was unannounced. The service was last inspected in October 2016 when it was rated Requires improvement. This was because six breaches of regulations were identified. These were in relation to the management of medicines, safeguarding people from harm, staffing, records, good governance and notifications.

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 questions of safe, effective, responsive and well-led to at least good. This inspection was carried out to check the required improvements had been made.

Braeside Home for the Elderly (HFE) 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. The care home is a detached property and accommodates up to 24 older people on two floors. At the time of the inspection there were 13 people accommodated in the home.

The home had a registered manager in place. 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 manager had been in post since January 2017.

We found that since the last inspection, the new registered manager had made significant improvements to the way the home was run; this meant all the regulations we reviewed were now met.

People told us they felt safe in Braeside HFE and that staff treated them well. Our observations showed they were cared for by staff that were kind, caring and respectful of their dignity and privacy.

Staff had completed training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff told us they would be confident to use the whistleblowing policy that was in place should they witness poor practice in the service.

People told us there were enough staff on duty to meet their needs in a timely manner. During the first day of the inspection we noted staff did not regularly check on people who were sitting in one of the lounges. However, this improved on the second day of the inspection.

Records we reviewed showed all staff had been safely recruited. Improvements had been made to the training, supervision and support provided to staff by the registered manager. Staff spoken with highlighted training as one of the areas which had been vastly improved by the new registered manager.

We found there were appropriate policies and procedures in place for the safe management of people’s medicines and that people received their medicines as prescribed by health care professionals. Improvements had been made to the way medicines were stored to help ensure they were not accessible to people other than trained staff.

Care records we reviewed were personalised and provided a good level of detail for staff to follow. The initial assessment, completed before people were admitted to Braeside HFE, was used to formulate care plans and risk assessments; these records had been regularly reviewed and updated when people’s needs changed. We noted that people who lived in the home and, where appropriate their relatives, had been involved in these care plan reviews.

People’s communication needs were clearly documented within care plans as well as how staff should support them to express their views and wishes. Staff spoken with demonstrated a good understanding of people’s diverse needs and preferences.

Although all areas of the home were clean, we noted some improvements needed to be made so that people were properly protected from the risk of cross infection. A down

Braeside Home for the Elderly Ltd is registered to provide accommodation, care and support for up to 24 older people. At the time of our inspection there were 19 people in receipt of care. Bedrooms are located over two floors and people who used the service have access to three lounges a dining room and bathrooms. The home is located in the town of Oswaldtwistle, Lancashire.

An unannounced inspection took place on 13 October 2016.

The home had a registered manager in post on the day 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 20 January 2014, we found the service was meeting the regulations that were applicable at the time.

During this inspection we identified six breaches in the regulations relating to the management of medicines, safeguarding people from harm, staffing, records, good governance and notifications.

You can see the action we asked the provider to take at the end of the full version of the report.

Medicines were not always managed safely. Whilst people’s current medicines were stored safely in the home, the medicines that were waiting to be returned to the pharmacy had been left in a room which was unlocked. Some medication administration records had gaps in their recordings.

Records confirmed and staff told us they had undertaken recent training in the protection of vulnerable adults. People who used the service told us they felt safe living at the home. However we saw records relating to a concern that had not been referred to the Local Authority safeguarding team.

The home had recruitment procedures in place. Evidence of appropriate checks for new staff had been completed. These included references, identity and disclosure barring service checks.

Staff told us they had received training relevant to their role and we saw evidence of training recorded in three of the staff files we looked at. However, staff were unable to demonstrate an understanding of the Mental Capacity Act 2005 and staff had not received training in this area.

Records showed that staff were not in receipt of regular structured supervision from the registered manager. The registered manager told us team meetings were not taking place.

People who used the service were happy with the choices of meals on offer in the home. Meals looked appetising and support was offered in a timely and unrushed manner.

People told us they were happy with the care people received in the home. Staff and the registered manager demonstrated an understanding of people’s individual care needs. We observed positive meaningful relationships had been developed between staff and people who used the service.

Staff treated people with dignity and respect. Care was delivered in the privacy of people’s bedrooms and staff were seen knocking on peoples’ bedrooms doors and waiting to be invited in before entering.

People’s care records had information relating to their needs; however we saw gaps in relation to reviews and risk assessments in them.

The registered manager told us they had received no complaints in the home. People who used the service, visitors and staff had access to guidance about the procedure to follow if a complaint was needed to be made.

The registered manager and the registered provider had failed to monitor the service to ensure people were receiving safe, effective care.

We received positive feedback about the registered manager and the support she provided to the staff.

The registered manager had failed to notify the commission about a safeguarding concern and four expected deaths.

We spoke with three people who lived at the service, one visitor and two staff members. People who used the service told us, "I am happy here. I am well looked after", "I am very happy at the home" and "I feel quite settled and comfortable". A visitor said, "I am satisfied with what I have seen. She appears to be quite happy". The people we spoke with were satisfied with the facilities and services provided at this care home.

All the people we spoke with said the food was good and that they had a choice of meals.

Plans of care contained sufficient details for staff to be able to provide effective care.

People who used the service said the home was always kept clean and they could personalise their rooms to their tastes.

The recruitment process was robust and helped ensure the employment of staff was safe.

There was an accessible complaints procedure for people to raise any concerns.

We carried out this inspection to check on the progress made after our unannounced follow up visit to the service on 21st February 2013.

People spoken with told us they were happy with the care and support they received at the home. One person told us, “They’re good to us here and they look after me very well. I’m happy here”.

We saw people resting in the communal areas of the home and in their own rooms. We saw staff asking people about the way they wanted their care to be delivered. We observed staff treating people in a kind and respectful manner.

We noted that a new manager had been recruited to the home. The manager told us that following the last inspection in February 2013 they had begun to review all of the care records that belonged to people who used the service.

We looked at the care records of three people and found these had been modified updated and reviewed to meet their identified needs, conditions and circumstances.

Relatives spoken with made positive comments about them providing information to their mother's care plan. They said, “This is much better than before, we know what mum likes and needs. We’ve enjoyed writing this especially knowing that it helps the staff to help my mum”.

We found that improvements had been made to address the shortfalls associated with people’s individual risk assessments. These improvements ensured people were protected against the risk of unsafe or inappropriate care.

We carried out this inspection to follow up the progress made following our scheduled visit to the service on 28th November 2012.

People spoken with told us they were happy with the care and support they received at the home. We saw people resting in the communal areas of the home or watching the television after breakfast. We saw staff asking people about the way they wanted their care to be delivered. We saw staff treating people in a kind and respectful manner.

The manager told us that following the last inspection in November 2012 they had reviewed and updated all of the care plans and associated records. They told us they had introduced a key worker system to the home. (Key working is a system for providing individualised care through a named person). We found the staff had an understanding of the key worker system and they told us it was working well.

We looked at six care plans and associated records and found these had been updated and reviewed. We found that some changes to the care plan records had been made to meet the regulation. However, we found the risk assessments were general and not based on peoples individual conditions and circumstances, which meant there was a lack of proper information in order to protect people against the risk of unsafe or inappropriate care.

Therefore this meant the service remained non compliant with this regulation.

We spoke with three people who used the service. They told us they were happy with their care and accommodation and said they were treated well by the staff at the home. They told us, "The manager is very busy and she makes sure we are clean and tidy“ and “It’s nice here, we’re like one big family”. We also spoke with five relatives of people who used the service. They made comments about the service which included, “We can’t remember seeing a service guide” and “It’s alright here” also “The cook is really nice and my mum loves the food here “. Another relative told us, “My uncle is so happy. He said it’s a wonderful place”.

People living at Braeside said they were satisfied with the care and services they received. They said, “It’s very nice here I like everything about it, the owner is very nice”. “I would give the home 100% in every way”. “I mostly do whatever I want”

However, we found improvements were needed with ensuring instructions are detailed in ‘care plans’, so that care workers know how to provide for peoples’ individual needs. Also, ways of monitoring and developing systems and practices needed to be introduced, to minimize the risk to peoples’ wellbeing and safety.

People said they were getting support with healthcare needs and that they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs. One person said, “The doctor comes whenever needed and the chiropodist and opticians visit”.

People spoken with made positive comments about the catering arrangements. Choice menus were available and specific preferences were being provided for. People said, “I enjoy the food we have two things to choose from”. “The food is not bad”. “The food is very good, we have a choice, they ask us everyday, we get plenty to eat”.

Positive relationships were being encouraged and we were told visitors were made welcome at the home. One person explained, “I get a lot of visitors, I can see them in my room if I want, I just ask the staff”. People were generally satisfied with the activities on offer. They said, “There’s enough going on for me, we have games such as dominoes and bingo”. “I watch TV and read, sometimes we have entertainers coming in”.

People described the staff as, helpful and nice. They said, “The staff are very obliging”. “The cleaner is very good, she keeps things clean and empties the bin every day”. “They are friendly, we have a good laugh”.