This inspection took place on 27 and 28 October 2016 and was unannounced.

Brampton Lodge is registered to provide personal care and accommodation for up to 26 older people. There were 22 people using the service during our inspection; some of whom were able to live quite independently and others who needed more support from staff. The service offers respite care as well as permanent placements and keeps rooms available, where possible for people who may benefit from short-term stays.

Brampton Lodge is a very large detached house situated in a residential area of Folkestone. There was a comfortable, well-decorated lounge with homely sofas and seating looking out over the attractive and enclosed garden to the rear. The dining area was well-furnished with padded seats and a restaurant-type feel.

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. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We received wholly positive feedback about Brampton Lodge from people, relatives and visiting professionals. We heard about exceptional standards of care which improved the quality of people’s lives and gave their families peace of mind. We observed warm, caring attitudes from staff and a real drive to provide the best possible service for people.

People were kept safe because staff knew how to recognise and report abuse, and a range of environmental and personal checks were regularly made to make sure risks and hazards were minimised. The service was exceptionally clean and hygienic so the chance of infection spreading was limited. Medicines were kept safe and managed properly, and people received them as the prescriber had intended.

Staff were well-trained and encouraged to develop their skills. There were plenty of staff on duty and people’s needs were met promptly and effectively by staff who knew people and their preferences very well. People praised the competency of staff to us and the registered manager carried out routine checks of staff knowledge and capability.

People’s health was carefully monitored and professional advice sought quickly and efficiently as needed. The service had forged excellent working relationships with professionals who reported that staff were aware of health changes and escalated these promptly.

The meals on offer were plentiful and of good quality; home cooked and made with local ingredients. People were extremely complimentary about the choice and taste of food. There was a wide range of stimulating activities available, which people enjoyed and were pitched at the right level for people.

Staff were knowledgeable about the principles of the Mental Capacity Act (MCA) 2005 and demonstrated these in practice. The registered manager had made applications under the Deprivation of Liberty Safeguards (DoLs).

There was notable affection between staff and people and this was evident in actions such as the registered manager visiting people in hospital in her own time. The care people had been given at the end of their life received much praise from relatives and staff showed commitment and maturity in supporting people and their families at that time; often volunteering for extra shifts to ensure people were not alone at the end.

People received care that was tailored to them individually. The provider had responded to the particular needs of some people, by investing in special equipment for their personal use; designed to enhance their experiences. Extra services such as free taxis and funded occupational health sessions had been put in place to benefit people and promote their independence.

The registered manager encouraged an open culture; and people, relatives, visitors and staff were all enabled to speak out with any concerns; so that they could be put right. Standard

At the time of the inspection there were 20 people living at the service. We met and talked with seven people living in the home, five members of staff, three relatives and one visiting professional. The deputy manager was present throughout the inspection and assisted us with providing documentation for us to view. We looked at people’s care plans and other records relating to the management of the service.

We looked at the answers to five questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

People we spoke with told us they felt safe living in the home and the staff supported them well. Relatives told us that they felt reassured that their relative was safe living at the service.

Risks associated with people’s care delivery were identified during assessments. However not all risks had sufficient guidance for staff to follow to make sure they took a consistent approach to reduce the risks, so that people remained safe. We spoke with staff who were aware of how to minimise risk and support people safely but not all details were included in the risk assessments.

There were systems in place to make sure that the staff learnt from events such as accidents and incidents, complaints, concerns, and investigations.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. No DoLs applications had needed to be submitted, but policies and procedures were in place should the need arise. Relevant staff had been trained to understand when an application should be made, and how to submit one. Staff had been trained in regards to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and were able to support people to make decisions about their daily lives.

Is the service effective?

People told us that they were very happy with the care that had been delivered and their care needs were fully met. They told us that there were lots of things to do in the service and they could choose which activities they preferred.

Although the care plans lacked some individual details of people’s personal routines staff knew the people well and demonstrated they knew how to care for the people in line with their preferences and choices. Care plans had been regularly reviewed to make sure staff were aware of people’s changing needs.

People told us that they received appropriate support from health care professionals when required and they also gave examples of how well they were looked after by the staff when they were feeling unwell.

The staff were complimentary about the support they received from the registered manager. We saw that regular meetings had taken place between individual staff members and the registered manager. Staff told us they were able to discuss issues with the registered manager at these meetings, or at any time they had a concern.

Is the service caring?

Relatives spoke positively about the staff and felt that staff were kind and respectful. They told us that they were happy with the care that had been delivered to their relative and their care needs were fully met. People told us that the activities in the home were varied and they had lots of choice to participate or sit quietly in their rooms. People said the staff really cared and made sure that they had the opportunity to join in the activities of their choice.

People told us that their relatives had the opportunity to have lunch with them and join in the social activities so that everyone was given the chance to enjoy themselves and be involved in the service.

People told us that the staff were always around when they needed them and nothing was too much trouble. We saw that staff interacted well with people and knew them well; they knew how to relate to them and how to communicate in a caring and respectful way. People living in the home made positive comments about the staff, with remarks such as: “There is always enough staff; they are patient, kind and compassionate”. “The staff are very good treating people with dignity and respect”.

Is the service responsive?

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that the staff listened to people, and took appropriate action to support them in their daily routines. We saw staff respond promptly to people’s requests, for example making drinks or escorting them to the dining room for lunch.

We observed that when people were in their rooms and pressed the call bell staff responded quickly. People told us that the staff were always around to support them and they did not have to wait long for them to arrive when they called them.

People’s privacy was maintained. People could lock their bedroom doors if they wished, and there were places available where they could meet friends and relatives in private. Staff understood their responsibilities and they ensured that people’s privacy and dignity was respected. A relative said: “They have the balance right here, the staff treat people with dignity and respect and also manage to have a laugh and joke”.

Is the service well-led?

Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. They said: The management team is very good, any problems we just see the manager”. “You can really talk to the management team, they are very approachable”.

Systems were in place to ask people who used the service, relatives and staff for their views about the service. This meant that people were being given the opportunity to have their say about the services being provided.

The service had systems in place to provide ongoing monitoring of the care being provided. This included care plan reviews, the management of medication and checks for the environment.

On the day of our inspection, there were 18 people using the service, 13 of which lived at the home permanently. 5 people were receiving respite (short-term) care.

People who used the service had access to a range of information about the service, in a variety of formats, to help them make an informed decision about their care, treatment and support.

People told us that they were happy with their care and that staff had a good understanding of their individual needs and responded to them promptly. One person told us “nothing’s too much trouble” and "staff know my needs”.

Care records were detailed and contained appropriate risk assessments to minimise identified risks, so that staff were able to follow safe practices and keep people as safe as possible.

The home was clean and tidy with no unpleasant odours. We saw that cleaning schedules were in place and regularly checked and signed by staff. We saw that people were provided with appropriate equipment to support their needs, for example, mobility aids and specialist bathing facilities.

Staff told us that they felt well supported by the manager and that essential training and some opportunities for development were provided.

The home had a formal complaints procedure, as well as a day-to-day comments book. We found that complaints and comments had been addressed and investigated appropriately and outcomes conveyed to the complainant.

We used a number of different methods to help us understand the experiences of the people who used the service. Although most of the people who lived at Brampton Lodge were able to speak directly to us, we also looked around the service, observed how staff interacted with people, spoke with staff, visitors and the Deputy Manager and read documents such as care plans and health records.

The people we spoke with who used the service told us that they enjoyed living there they spoke positively about the environment, the staff and the meals. Comments that people made included “I feel very relaxed living here it’s spacious, nicely decorated and comfortable. I enjoy the meals, the food is wonderful”. Another person told us “I find Brampton Lodge a very pleasant place to live, it doesn’t feel like a care home to me. The staff are all attentive and kind, they stop for a chat”.

When we looked around the service we saw that it was well decorated and furnished to a good standard. People commented that they enjoyed spending time in the communal lounge area which overlooked the garden and provided access to it. They spoke of enjoying the garden in the summer months and the variety of activities that the service arranged which included massage therapy and gentle exercise, music, arts and craft. People told us that they benefitted from other activities such as outings for country drives, going to see shows and the occasional pub lunch.