This inspection took place on 1 and 2 March 2017 and was unannounced.

Accommodation for up to 63 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 53 people using the service at the time of our inspection.

A registered manager was in post and was available throughout the 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were safely managed.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005.

People received sufficient to eat and drink, though the mealtime experience in one dining area and the completion of fluid chart documentation could be improved. External professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care, though documented evidence of this could be improved. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the management team and that appropriate action would be taken.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and two relatives and asked them for their views. We also spoke with two care workers, a team leader, a nurse, the recently appointed home manager and the area manager. The named registered manager had recently left the service, but the provider had not informed us of this. The provider had recruited a new manager who started work three weeks prior to our visit and they told us they would be applying to become the registered manager within the next month.

We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found people’s care and support was not planned and delivered in a way that ensured their safety and welfare. Systems in place to ensure people received their medication safely were not always followed and medicines were not always safely administered.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager informed us after the inspection they had made one application and was waiting for the result of this and the required policies and procedures were in place for this. The manager said relevant staff will be trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider had effective systems to involve people in planning their care, and obtaining people’s consent for this to be provided. A person who used the service told us, “We talk about my care, they keep me happy.”

We found staff were not always effective at meeting the care and welfare needs of all the people who used the service. A relative told us they had some concerns about the night time care of their relation. The documentation completed did not make this clear so staff could not effectively answer the relative’s concerns.

The number of staff employed and how they were deployed had been identified as reasons why staffing arrangements in the home were not effective and action was being taken to resolve this.

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. People who used the service told us staff made them feel safe and well cared for. A person who used the service told us, “The care here is very good, they don’t forget you. The food is very nice too.”

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. We saw people who used the service were asked for their views by staff over every day matters.

We found staff responded appropriately to the care and welfare needs of people who used the service. A person told us, “Staff make sure I am alright, I feel safe here. They come and move me to stop me getting sore.”

Is the service well-led?

We found the provider did not protect the rights of people who did not have the capacity to consent as staff did not know how to complete an assessment to determine if a person had the capacity to make a decision.

The manager told us they were putting management systems, including quality assurance systems into place and these would be used to make improvements to the service. A person who used the service told us the new manager, “Knows what she is doing, she gets things done.” A relative said, “I have faith in her, she know what to do.”

People expressed their views and were involved in making decisions about their care and treatment. One person told us, “Staff have got to know me and what I like. They ask me what I want and give me choices.”

We saw that people’s individual needs and risks had been assessed and had been reviewed regularly since our last inspection. During our inspection we observed that staff interacted well with people who used the service.

We noted that nutrition care plans were in place with completed risk assessments which had been updated on a regular basis. We also noted that people’s food and fluid intake charts had been completed regularly.

We saw policies were in place in relation to the prevention and control of infection. We saw improvements had been made by the service regarding the prevention, control and management of infection.

During our inspection we observed that maintenance work had been completed in line with the provider’s action plan. One staff member told us, “I use the maintenance book and jobs are dealt with as quickly as possible.”

We saw that regular supervision meetings and appraisals were held between the staff and the manager. We noted that the staff training matrix had not been fully updated at the time of our inspection.

We found that people’s care plans were stored and secured appropriately. We saw that records were completed appropriately and information in people’s care plans was updated regularly.

We found at times that some staff were task centred in their approach with people and some staff used a patronising tone of voice and language when speaking with some people who used the service.

The expert by experience (ex by Ex) talked with three people using the service and one visitor. All of them were full of praise for the establishment. One person said, “You can get up and go to bed when you want”. There is a good response to the bell if it’s rung in the night.” Another person said, the staff were “very good”.

We found there had been some improvement in respect of the organisation of the care files and more personalised information was available. However further improvement was still required to ensure all the necessary information was available for staff to follow. Improvement was also needed to ensure some staff supported people in line with their plan of care.

The Ex by Ex spoke with people in respect of the food on offer. One person told them the food was good and they said, “I can choose what I have”. Another person told them there was no time limit for breakfast and they said, “Every choice is on offer for breakfast.”

One person also told them that sandwiches and “small bits” were served at teatime but then there was nothing else until breakfast.

We found staff had not always followed the instructions within plans of care for those people assessed as nutritionally being at risk.

One person told the Ex by EX they had experienced people walking into their room at times, and this made them feel unsafe. They also told them that the staff had listened to this and responded to their concerns and they now felt safe.

We found the home was mostly clean and tidy in all areas. However minor improvements were still needed to ensure people were cared for and supported in a clean environment at all times.

The provider had changed some communal areas and added additional bedrooms. An additional lounge area had been created to ensure there was still communal space for people to use. One person told us there have been improvements in respect of the environment and they particularly enjoyed sitting in the sun room. We found that minor improvements were still needed in respect of the environment; however the provider was acting upon these.

The people using the service who we spoke with did not raise any concerns about the competency of staff.

We saw staff had attended additional training sessions and some staff had undertaken a supervision. However improvement in this area was still needed.

We found improvements had been made in respect of the storage and completion of records but the provider was not fully compliant with this outcome area in that people’s personal records were not always accurate and fit for purpose.

Since our previous inspection of Bramcote Hills Care Home there has been a change of ownership of the registered provider, Savace Limited t/a Bramcote Hills Care Home.

We spoke with seven people who were using the service and three visitors who told us about the improvements they had noticed in the quality of services provided in the weeks leading up to this inspection. We were told, They take good care of me," and "there's been a vast improvement."

We looked at care plans and other records, spoke with staff and observed care practice. Some of the care plans contained good person centred information about people, including their care needs, likes and dislikes. Other care plans were not well developed and lacked information for about how to support people's health and personal care needs.

People commented on the improvements they had noticed in staffing levels and said this had a positive effect on people who lived at the service. People were also provided with opportunities to share their views with the provider and manager.

We saw some people had been involved in the care planning process and personalised information was available. In other cases there was no record that people had been involved.

We spoke with four people who were using the service on the day of our visit. Each of the people we spoke with told us staff were polite and treated them with dignity and respect. One person said, “Yes they are very nice, I have no complaints in that respect.” Another person said, “I receive all the care that I need and the staff are good at what they do. The only issue is that sometimes I have to wait a while to be seen.”

Each of the people we spoke with told us they felt safe and had no concerns about living at the service.

We saw there was a lack of structure and organisation and staff were extremely busy. We spoke with four people who were using the service during our visit and asked if they felt there were enough staff to care for people. One person said, “I would say they could do with more staff. I sometimes have to wait a few minutes when I press the buzzer.”

We spoke with four people who were using the service and asked if they felt they could express their opinion on the quality of service provided. We were told, “I’ve not been formally asked. I guess I would speak to the manager if I needed to.” None of the people we spoke with were aware of ways in which they could give their opinion on the quality of the service.

No one we spoke with had seen their personal care plan although one person told us their relative was involved in planning their care. One person told us, “I’m not asked what my needs are.” People gave us mixed opinions as to whether their privacy and dignity was respected by the service. One person had experienced the embarrassment of being left naked on their bed with their bedroom door left open.

People also gave us mixed opinions on whether their needs were met by the service. One person said, “I’m treated as if I have dementia.” But their records showed that they did not have dementia. Another told us, “The staff are lovely, they all know me.”

Regarding daily stimulation, one person said there were, “no activities.”

Not all people, we spoke with, felt safe living at the service. One told us, “If I am ill, staff may not come straight away [when I call for them]. Staff don’t know my needs well…they are not organised.” Some people, we spoke with, felt they were treated with respect, but not all. Two people were unhappy about one particular member of staff who spoke disrespectfully to them. People we spoke with were satisfied with the cleanliness of the home.

People we spoke with gave us mixed opinions about whether they were given their prescribed medicines in a safe way. One person said they were but the other person said that they have been, “occasionally offered other people’s tablets and [staff] don’t always give them at the right time…I know what tablets I have.” Not all people felt that staff were competent at their job. One person told us, “Some are, some not…they do their best.”

The people we spoke with thought there were not always enough staff to meet their needs. One person said they were, “frequently” kept waiting. Another told us, “I may wait 10 minutes after using the buzzer.”

People’s opinion on the quality of the service they were receiving ranged from, “contented” to, “Fair to acceptable…not overly impressed.” Not all people felt listened to by staff and management and their concerns sometimes took a while to be addressed. One person told us they had reported the excessive heat in their bedroom, “three or four weeks ago” and nothing had been done.

This inspection took place on 30 and 31 July 2015 and was unannounced.

Accommodation for up to 58 people is provided in the home over five floors. The service is designed to meet the needs of older people and provides nursing care.

At the previous inspection on 5 and 6 March 2015, we asked the provider to take action to make improvements to the areas of safe care and treatment, safeguarding people from abuse and improper treatment, person-centered care and good governance. We received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all of these areas, though further work was still required in the area of safe care and treatment.

There is a registered manager and she was available during the 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 felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Medicines were safely managed.

People’s rights were not fully protected under the Mental Capacity Act 2005. Documentation was not always fully completed to show that all people had received full support to minimise the risk of skin damage. Staff received appropriate induction, training and supervision. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate.

Staff were kind and caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care.

People’s needs were promptly responded to. Care records provided sufficient information for staff to provide personalised care. Activities were available in the home. A complaints process was in place and complaints were handled appropriately.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the registered manager would take action. There were systems in place to monitor and improve the quality of the service provided.