This inspection was carried out on 4 July 2017 and was unannounced.

Brambling House provides residential care for up to 20 older people, some of whom may be living with dementia. There were 16 people living at the service. The home benefits from having three communal spaces downstairs, one small lounge, a dining room and a large conservatory area. There is a flat garden leading from the conservatory with seating and flower beds. All parts of the home are accessible to people via a passenger lift. Accommodation comprises of 16 single rooms and two shared rooms and is situated in the village of Sheperdswell near Dover.

There was a registered manager in post. A registered manager is a person who is 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.

We last inspected the service in July 2016. We found significant shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated when moving people and managing behaviours that might challenge. The provider had failed to ensure there were enough staff on duty at all times to meet people’s needs. The systems to monitor, identify and assess risks to the health and safety of people were not sufficiently effective and records were not completed accurately. The provider had failed to notify the Care Quality Commission (CQC) when an application to deprive someone of their liberty had been authorised, in line with current guidance.

We asked the provider to send us an action plan to explain how they were going to make improvements to the service. At this inspection we found that improvements had been made.

People told us and indicated that they felt safe and happy living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

There were environmental risk assessments in place including fire risk assessment and personal emergency evacuation plans, so that people could be evacuated safely in the event of an emergency. Accidents and incidents were recorded and analysed to identify and patterns or trends to mitigate the risk of them happening again.

There were sufficient staff on duty. The registered manager ensured that extra staff were available at busy times, such as early morning and at mealtimes, to ensure that people’s needs were fully met.

Staff knew about abuse and what to do if they suspected any incidents of abuse. They were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised with the management team would be investigated to ensure people were kept safe.

Staff were recruited safely, the registered manager followed the provider’s recruitment policy to make sure staff were of good character. New staff completed induction training and a training programme was in place to ensure that staff had the skills and knowledge to perform their roles. Staff had one to one meetings and a yearly appraisal with their line manager to discuss their training and further development.

Staff knew the importance of giving people choices and gaining people’s consent. People were supported to make decisions. When people lacked capacity to make specific decisions, systems were in place to enable a best interests meeting to take place with people who knew them well. The Care Quality Commission had been notified as required, when people had been deprived of their liberty in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Each person had a care plan that centred on them and their choices and preferences. Care plans were regularly reviewed and

The inspection was unannounced and took place on 28 July and 2 August 2016. Brambling House provides residential care for up to 20 older people, some of whom may be people living with dementia. There were 18 people living at the service. The home benefits from having three communal spaces downstairs, one small lounge, a, dining room and a large conservatory area There is a flat garden area leading from the conservatory with seating and flower beds. All parts of the home are accessible to residents via a shaft lift. Accommodation comprises of 16 single rooms, and 2 shared rooms and is situated in the village of Shepherdswell.

There was a registered manager in post. A registered manager is a person who is 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 told us and indicated they were happy living at the service. People told us the staff were always busy but usually around when they needed them. There were times during the day, such as early morning, evenings, and meal times that there was not enough staff on duty to ensure that people needs were fully met.

Potential risks had been identified but the measures to reduce these risk were not detailed enough to give staff the guidance to ensure people were safe. This included moving and handling risk assessments, environmental risk assessments and behaviour risk assessments.

Staff took appropriate action to support people when accidents occurred and sought medical advice if necessary. The registered manager analysed these for trends but further analysis would be beneficial to look at people’s behaviour and triggers to reduce the risk of further events

Each person had an individual personal emergency evacuation plan (PEEP) with guidance for staff about how to evacuate people from the building; however, additional information was required to give staff guidance to support people with their behaviour when an emergency arises.

Medicines were being administered safely, further guidance was required to ensure that ‘as and when’ medicines have clear guidelines and infection control procedures are being followed.

People were treated respectfully and with dignity however there were times during the day when dignity was compromised due to the lack of staff on duty to support people to eat their meals.

Care plans had been regularly reviewed, but some people’s needs had changed and the care plans had not been amended to reflect these changes.

Quality audits and checks had been carried out. Some action plans were in place, however not all of the shortfalls found at this inspection had not been identified.

The Care Quality Commission was not routinely informed as required when people had been deprived of their liberty in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us they felt safe living at the service. Staff had received training on how to keep people safe and how to raise concerns. They were aware of the whistle blowing policy and were confident that the registered manager would listen to their concerns.

The requirements of the MCA had been met. Staff supported people to make decisions. When people lacked capacity to make a specific decision, systems were in place to enable best interests meetings to take place with people who knew them well. Staff offered people choices of what they wanted to eat, or where they wished to sit.

Staff were recruited safely with all the necessary checks to ensure they were of good character. New staff received induction training and a training programme was in place to ensure that staff had the skills and knowledge to perform their roles. Staff received one to one meetings with their line manager and a yearly appraisal of their

Some people using the service had dementia. This meant they were not always able to tell us their experiences. We observed how people interacted with the staff and management of the service. We spoke with the manager, staff, four people who lived in the home and visitors.

Visitors told us that they were happy with the care provided to their relatives and told us that staff were, “Kind and considerate”.

The atmosphere in the home was calm. Interactions we saw between staff, management and people who lived in the home were positive.

Staff understood the needs of the people who lived in the home and supported them appropriately. Staff were able to tell us about people’s individual needs.

People enjoyed their meals and there was a range of snacks and drinks available throughout the day. There was a lack of choice available in relation to main meals and nutritional monitoring lacked some detail.

Staff knew what to do if they had any concerns about the people who lived in the home.

Staff had been suitably trained to meet the needs of the people who lived in the home.

There were systems in place to regularly assess and monitor the quality of service that people received. People and their representatives had been asked their opinion about the service but we found that no action had been taken with regard to this feedback.

During the inspection we spoke with the Deputy Manager, senior staff and two members of staff at the time of our visit.

We spoke with six people who received a service and two relatives. All of the people spoken with told us that they were satisfied with the service. People using the service said: "I could not be in a better place; I have been here a long time and have no complaints whatsoever". "The staff make sure I have everything I need here".

We saw that people using the service were receiving the care and support they needed. We found that medication was stored safely and people received their medication in a timely manner. Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

People and relatives told us they did not have any complaints but would not hesitate to speak to the manger or staff if they had any concerns.

We used a number of different methods to help us understand the experiences of people using the service, because the most of the people using the service had complex needs which meant they were not able to tell us their experiences.

Two people told us they were satisfied with their care. People were being supported to make decisions about their day to day lives. They were able to move around the home and choose where they wished to be. We spoke to three relatives who said that staff were polite and caring. They said that when required they had been included in their relatives care plan reviews. One person told us how she went out with her relatives on a regular basis.

There were checks in place to make sure the service ran smoothly and people were satisfied with their care. Relatives said that if they had any concerns they would not hesitate to speak to the staff or manager.