Bramley Court 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. Bramley Court is registered to provide personal care and accommodation for up to 72 people. At the time of the inspection there 68 people living in the home. The home is divided into three units; one on each floor, called Damson, Pear, and Cherry. Shops and other amenities are a short walk away.

This unannounced inspection was carried out on the 22 and 28 August 2018.

At the time of the inspection there was a registered manager in place. However, they were not present for 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.

At the previous inspection in June 2017 the home was rated Good. However, at this inspection the rating has changed to Requires Improvement. The registered manager had not submitted notifications to the Commission about serious injuries acquired in the home, as required by the regulations. The Commission requires notification of these events to assess if there has been any avoidable harm or if people are at risk from further harm. You can see what action we told the provider to take at the back of the full version of this report.

Staff were aware of how to keep people safe from harm and what procedures they should follow to report any harm. Action had been taken to minimise the risks to people. Risk assessments identified hazards and provided staff with the information they needed to reduce risks where possible.

Medicines were managed safely. Staff received training and competency checks before administering medicines unsupervised. Medicines were stored securely. The records were an accurate reflection of medicines people had received.

Care plans gave staff the information they required to meet people’s care and support needs. People received support in the way that they preferred.

There was an effective quality assurance process in place which included obtaining the views of people that lived in the home, their relatives and the staff. Where needed action had been taken to make improvements to the service being offered.

Staff were only employed after they had completed a thorough recruitment procedure. Staff received the training they required to meet people's needs and were supported in their roles.

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 supported this practice and staff worked within the guidance of the Mental Capacity Act 2005.

Staff were motivated to provide care that was kind and compassionate. They knew people well and

were aware of their history, preferences, likes and dislikes. People's privacy and dignity were respected.

People were supported to maintain good health as staff had the knowledge and skills to support them. There was prompt access to external healthcare professionals when needed.

People were provided with a choice of food and drink that they enjoyed. When needed staff supported people to eat and drink.

There was a varied programme of activities including activities held in the service, trips out and entertainers that came into the home.

There was a complaints procedure in place. People and their relatives felt confident to raise any concerns either with the staff or manager. Complaints had been dealt with appropriately.

Bramley Court is registered to provide accommodation for up to 72 people who require personal care and/or nursing care. At the time of our inspection there were 67 people living in the home. The home is located in the village of Histon, near Cambridge. The home is divided into three units; one on each floor, called Damson, Pear and Cherry. Shops and other amenities are a short walk away. The home has wheelchair access for those who may require this. The home has recently had building work taking place which has included the addition of outside space on each floor.

This inspection took place on 29 June 2017 and was unannounced.

There was 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.

Staff had taken action to minimise the risks to people. Risk assessments identified risks and identified how to reduce them where possible. Staff were competent to administer medication. They were following the correct procedures when administrating, recording and storing medication so that people received their medication as prescribed. Staff were aware of the procedures to follow if they thought anyone had been harmed.

Staff were only employed after they completed a thorough recruitment procedure. There were enough staff on shift to ensure that people had their needs met in a timely manner. Staff received the training they required to meet people’s needs and were supported in their roles.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider had completed some capacity assessments and DoLS applications. The provider could demonstrate how they supported people to make decisions about their care and the principles of the MCA were being followed.

Staff were kind and caring.They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were respected and promoted.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed. People were given the right amount of support to enable them to eat and drink.

There was a varied programme of activities including in-house group activities, one-to-one activities, entertainers and trips out. Staff supported people to maintain their interests and their links with the local community to promote social inclusion.

Care plans gave staff the majority of information they required to meet people’s care and support needs. People received support in the way that they preferred and met their individual needs.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or manager. Complaints had been dealt with appropriately.

There was an effective quality assurance process in place which included obtaining the views of people that lived in the home and their relatives and the staff. Where needed action had been taken to make improvements to the service being offered.

We carried out an unannounced comprehensive inspection of this service on 5 and 6 April 2016. At this inspection we found two breaches of the legal requirements. This was because the provider had failed to notify the local authority safeguarding team and the Care Quality Commission about a safeguarding incident that had taken place. The provider also did not make sure that there were sufficient staff to meet people’s needs.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that 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 ‘Bramley Court’ on our website at www.cqc.org.uk.

Bramley Court provides accommodation, personal care and nursing for up to 67 people including those living with dementia. Accommodation is located over three floors with one unit per floor, called Damson, Pear and Cherry. There are communal areas for people and their visitors to use. There were 59 people living at the home when we inspected.

At the time of this inspection there was a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our focused inspection on 12 December 2016, we found that the provider had followed their plan, which they had told us would be completed by 3 July 2016, and legal requirements had been met.

People who lived at the home were supported by staff in a kind and respectful way. Staff understood their role and responsibilities to report poor care and suspicions of harm. The local authority safeguarding team and the Care Quality Commission were notified about any safeguarding incidents that had occurred within the home.

We saw that there was a sufficient number of staff to meet the needs of people living at the home. A dependency tool (people’s assessed dependency support needs) was used by the registered manager to determine safe staffing levels.

Whilst improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

We will review our rating at the next comprehensive inspection.

Bramley Court provides accommodation and personal and nursing care for up to 67 people, some of whom were living with dementia. There are three units, one on each floor, called Damson, Pear and Cherry. There are external and internal communal areas for people and their visitors to use.

This unannounced inspection took place on 5 and 6 April 2016. There were 65 people receiving care at that time.

The service 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.

There were not always sufficient staff on duty to ensure people’s needs were met safely. People’s safety was not always managed effectively. Staff were aware of the procedures for reporting concerns. However, these systems were not always followed and concerns were not always investigated.

Staff were only employed after the provider had carried out comprehensive and satisfactory pre-employment checks. People received their prescribed medicines appropriately and medicines were stored safely.

Staff were well supported by their managers. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s dietary needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making and applications had been made to the authorising agencies for people who needed these safeguards. Staff respected people choices and were aware of the key legal requirements of the MCA and DoLS. People were involved in decisions about their care.

People received care and support from staff who were kind, caring and respectful to them and their visitors. Staff treated people with dignity and respected their privacy.

Care records were detailed. However, these did not always provide staff with sufficient guidance to provide consistent care to meet each person’s individual needs.

People had access to information on how to make a complaint and were confident their concerns would be acted on. However, we could not be confident that all complaints had been fully investigated.

There was a varied programme of events for people to join in with and opportunities for people to develop hobbies and interests. Staff supported people to spend their time in a meaningful way.

The registered manager was supported by a staff team that including registered nurses, care workers, and ancillary staff. The service had a quality assurance system in place. However, although areas for improvement were identified, actions were not always taken to bring about improvements to the service.

People and relatives were encouraged to provide feedback on the service in various ways and their views were listened to and acted on. People benefitted from good links with the local community.

We found two breaches of the Health and Social Care Act (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.

We carried out an unannounced, comprehensive inspection of this service on 26 and 31 March 2015. As a result of our findings we found a breach of two legal requirements. We asked the provider to make improvements to the management of medicines and consent. The registered manager wrote to us detailing how and when improvements would be made.

However, since the last inspection we have received concerns in relation to safety and the quality of people’s care which the registered manager had investigated. We also looked at these areas of concern during the inspection.

As a result we carried out a focused, unannounced inspection to check those improvements had been made. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link Bramley Court on our website at www.cqc.org.uk.

During this inspection on 23 November 2015 we found the provider had made improvements and that the regulations had been complied with.

Bramley Court is a service that provides nursing and personal care for up to 67 people, some of whom are living with dementia. There are three units called Cherry, Pear and Damson. All bedrooms have en-suite bathrooms and there are external and internal communal areas for people and their visitors to use. At the time of our inspection on 23 November 2015 there were 66 people living at the service.

The service 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.

People received their prescribed medicines appropriately. Medicines were managed safely by staff who had received appropriate training and whose competency had been assessed.

Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting and escalating concerns to protect people from harm. Risks were regularly reassessed to take account of people’s changing needs.

People told us they were encouraged to make choices about their everyday lives. The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We found people’s rights to make decisions about their care were respected.

There were sufficient staff to meet people’s assessed needs. Staff were appropriately trained to meet people’s needs. People’s health, care and nutritional needs were effectively met. However, people had mixed views about the quality of food served. In addition some people experienced a long time gap between their meal one day and the first meal the next and this was not their preference.

People received care and support from staff who were kind, caring and respectful. Staff respected people’s privacy and dignity and helped people’s spiritual needs to be met. Staff welcomed visitors to the home.

People’s rights to give consent to their support and care were respected. Where a person was not able to give this consent, there were legal systems in place to ensure that the person received support, care and treatment that they needed.

Most of the people had positive comments to make about the standard and quality of their support, care and treatment. However, improvements are needed to ensure that people’s support, care and treatment needs, including any changes in these, are monitored, reviewed and recorded.

There were systems in place to make sure that people were protected from the use of unsafe equipment. People were generally satisfied with the aids and adaptions to support their comfort, care and safety needs.

We received positive comments about members of staff’s attitudes and their suitability. Recruitment systems were in place although improvements are needed with these, to ensure that vulnerable people are protected from unsuitable staff who were employed to work at Bramley Court.

People were aware of the complaints procedure, although the written information about it was out-of-date and incomplete. Some, but not all, of the people said that they were confident that actions would be taken in response to their comments. Improvements are needed.

We found Bramley Court to be clean, comfortable and well maintained. One person told us, "The staff look after me". Another said, "I feel safe here".

Relatives we spoke to were very positive about the care provided. One relative said, "Mum is very well looked after". Another family told us, "Staff are wonderful. They cope with difficult situations". We found that people and their families were involved in decisions about the care provided.

Staff we spoke to told us they enjoyed their work and felt supported. One said, "I absolutely love working here. I am proud to work for the company". However, some expressed concern there were not enough staff. The new manager told us about the plans to address this, with additional staff currently being recruited.

Staff we spoke to all told us they received an annual appraisal. However, we did not find records to support this consistently. The provider already had an action plan in place to put this right.

We saw that a variety of activities were offered to people. On the day of our inspection, people enjoyed a visit from a 'pets as therapy' dog. We also saw that a hairdresser was present.

As the purpose of this review was to assess improvements made in relation to shortfalls identified during our previous review of compliance undertaken in December 2011, we did not request information directly from people using the service. However, during our previous visits in August and December 2011 we did speak to people about their experience of living in the home and they told us that they enjoyed living at Bramley Court, that staff were available when they needed them and that the food was good.

The purpose of this review was to assess improvements made in relation to shortfalls identified during our previous review of this home in August 2011. In addition to assessing imporvements we spoke to two people specifically about their bathing and showering needs. Both people reported that they did not get as many baths as they would like and one person told us she hadn’t had a bath, “In a long time”.

The registered provider of the home recently changed its name from Carebase(Guildford) Limited to Carebase (Histon) Limited and references in this report to shortfalls found at our previous visit refer to the home when the provider was known as Carebase(Guildford) Limited. However the manager and staff have not changed and continue to provide care and support.

Bramley Court is a home providing nursing and personal care for up to 67 people, some of whom are living with dementia. There are three units called Cherry, Pear and Damson. All bedrooms have en-suite bathrooms and there are external and internal communal areas for people and their visitors to use.

This unannounced inspection took place on 26 and 31 March 2015 and there were 62 people living at the home.

Our last inspection took place on 15 April 2014 and as a result of our findings we asked the provider to make improvements to staffing levels. We received an action plan detailing how and when the required improvements would be made by. During this inspection we found that the necessary improvements had been made and that there were sufficient staff to safely meet people’s assessed needs.

The service 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.

There were sufficient staff to safely meet people’s assessed needs. Staff were trained and well supported by their managers and were only employed after satisfactory employment checks had been carried out.

Although staff were trained to administer medicines, poor record keeping meant we could not be confident that people were receiving their medicines as prescribed.

The CQC monitors the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguarding (DoLS) which applies to care services. We found that people rights to make decisions about their care were respected. However, where people did not have the mental capacity to make decisions, they had not been well supported in the decision making process. DoLS applications were in progress and were being submitted to the authorising body.

Systems were in place to ensure people’s safety was effectively managed. Staff were aware of the procedures for reporting concerns and of how to protect people from harm. Regular safety checks of equipment were carried out.

People received care from staff who were kind and caring. Staff respected people’s privacy and dignity. People’s health, care and nutritional needs were effectively met. People were provided with a balanced diet and staff were aware of people’s individual needs. People were supported to pursue a range of hobbies and interests, both in groups and individually.

Care records were detailed and provided staff with sufficient guidance to provide consistent care to each person. Care records were reviewed an updated so they reflected people’s current health and care needs

The registered manager was supported by senior staff, including qualified nurses, care workers and ancillary staff. The home was well run. People’s views were listened to and acted on.

People and their relatives were encouraged to express their views about the service provided through meetings and surveys.

We found a number of breaches of the Health and Social Care Act (Regulated Activities) Regulations 2010, which corresponded to the Health and Social Care Act (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.