Brampton View Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Brampton View Care Home is registered to accommodate up to 88 people; at the time of our inspection, there were 72 people using the service. The service provides nursing care and support to older people, including people living with dementia and people with physical disabilities.

At the last inspection in February 2016, the service was rated Good. At this inspection, we found the service remained Good. However, the rating under the key questions Safe, has deteriorated to Requires Improvement, as further work is needed to improve medicines administration.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were not always safely administered. Staff did not consistently administer medicines following the administration guidelines, which placed some people at risk of having their medicines given outside of the prescribed frequency / times. The actions put in place to learn from medication errors had not been effective in improving the medicines administration practice. Anticipatory medicines, designed to ease the symptoms of pain, anxiety and distress during palliative / end of life care, were not always arranged in advance for people receiving end of life care. This meant people receiving palliative / end of life care may have been at risk of not having medication readily available to provide effective symptom control.

Staff had a good understanding of what abuse was and of the safeguarding procedures to follow in reporting any concerns of abuse. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. Staffing levels were sufficient to meet people's current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were completed to ensure only suitable staff worked at the service.

Infection control procedures were followed to prevent the risks of illness due to poor hygiene practices. Staff were trained in infection control and used appropriate personal protective equipment to perform their roles safely.

People’s needs and choices were assessed and their care provided in line with up to date guidance and best practice. They received care from staff that had received training and support to carry out their roles effectively.

People were supported to access advice and support from other health and social care professionals and to attend appointments with healthcare professionals. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

People were supported to eat and drink enough to maintain a balanced diet. Their needs were met by the adaptation, design and decoration of premises and bedrooms were decorated and furnished to reflect people’s individuality.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act (MCA) 2005 were met. 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 support this practice.

Staff treated people with kindness, dignity and respect and spent time getting to know people and their specific needs and preferences. People were happy with the way that staff provided their care and support. People were encouraged to make decisions about how their care was provided.

People views were acknowledged and acted upon and their care and support was delivered in the way that people chose and preferred. Care plans were person centred and reflected how pe

This inspection took place on the 23 and 24 February 2016 and was unannounced. The service is registered to provide accommodation for people who require nursing and personal care for up to 88 people. The service caters for people with physical disability, degenerative conditions and people living with dementia. At the time of our inspection there were 79 people living there.

There was a registered manager in post at the time 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.

Systems were in place to ensure people were protected from abuse; staff had received training and were aware of their responsibilities in raising any concerns about people’s welfare. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The provider had robust recruitment systems in place; which included appropriate checks on the suitability of new staff to work in the home. Staff received a thorough induction training to ensure they had the skills to fulfil their roles and responsibilities. There were enough suitably skilled staff deployed to meet people’s needs.

People’s care was planned to ensure they received the individual support that they required to maintain their health, safety, independence, mobility and nutrition. People received support that maintained their privacy and dignity and systems were in place to ensure people received their medicines as they were prescribed. People had opportunities to participate in the organised activities that were taking place in the home and were able to be involved in making decisions about their care.

There was a stable management team and effective systems in place to assess the quality of service provided.

At our inspection in November 2014, we concluded that the overall rating for the service was ‘Requires improvement’. This was because the provider was in breach of Regulation 22, of the Health and social care act 2008 (regulated activities) Regulations 2010: Staffing. This was because there were insufficient numbers of suitably qualified, skilled and experienced staff employed for the process of carrying on the regulated activities. This deficit impacted on all aspects of the service that people received. We asked the provider to send us an action plan setting out the action that they would take to stabilise staffing levels within an appropriate time frame. During this inspection we found that there were sufficient numbers of suitable qualified and skilled staff employed and that people received of a good level of care and support from staff that they knew and understood their needs.

Also during our inspection November 2014 we also found the provider was in breach of regulation 10 of the Health and social care act 2008 (regulated activities) Regulations 2010 Assessing and monitoring the quality of the service provision because quality assurance systems were not robust. The provider had not identified, assessed and managed the risks relating to the health; welfare and safety of the people who used the service and others who may have been at risk. We asked the provider to send us an action plan setting out the action they would take to strengthen quality assurance systems and the management of the home; within an appropriate time frame. During this inspection we found that quality assurance systems had been improved and that the management of the home had been strengthened. All of the people we spoke with told us they had confidence in the management and recognised the improvements that had been made.

This was an unannounced inspection which was conducted on the 3 November 2014.

Brampton View Care Home provides nursing and personal care for up to 88 people for people with physical disability, dementia and care for adults over 65 yrs. At the time of our inspection there were 86 people living at the home.

There was a registered manager in post at the time of our inspection, however they resigned shortly afterwards and an interim manager was appointed. 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 enough staff on duty to ensure people received the individual support that they required in maintaining their safety, independence, mobility and appropriate assistance with eating their meals.

The provider had a robust recruitment system in place which included appropriate checks on their suitability to work in the home and new staff received a thorough induction training to ensure they had the skills to fulfil their roles and responsibilities.

The provider had appropriate systems in place to ensure people received their medicines as and when they required them.

There was a lack of formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

People did not always experience care and support to maintain personal routines because staffing levels were unstable. The support they received was chaotic and did not always maintain their dignity. The people who used the service lacked confidence in the management of the home because they viewed the staffing arrangements as chaotic.

Because staff did not have time people spent significant periods of time with little interaction or stimulation from the staff. No organised activities were taking place on either of the dementia units because the activities staff were working as carers because of staff shortages.

There were systems in place to assess the quality of service provided; however it was not always clear what action the management had taken to address people’s concerns, particularly in relation to the staffing levels and the management had not formally assessed the number of staff required to meet peoples’ needs.

Records were not always fully completed therefore management could not assure themselves that people received the care and support that had been specified.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with 10 people during our inspection at Brampton View. All of the people we spoke with told us they were well cared for and the staff knew the care they needed and how they wished to be supported. One person said “The care is excellent, I have never had a problem, the staff are very nice”.

People told us they were supported to be able to eat and drink sufficient amounts to meet their needs. One person told us “We get drinks regularly, morning and afternoon; I get offered biscuits, cakes and fruit and my water jug is there on the table within my reach”.

Six out of the 10 people we spoke with told us their enjoyment of the food at Brampton View was variable. One person said “I have a mixed opinion about the food, it’s of variable quality. I told the chef who comes in to see me every day. We also have tasting sessions to try out new recipes. There is a choice of options; it’s usually hot food and the plate is hot”.

People told us the environment was clean and hygienic. One person said “It’s a very pleasant environment and there is a good standard of care”. All the people we spoke with told us that they thought the staff had the skills they needed, to care for them and that they were well looked after by the staff at Brampton View. One person said “The personal attention is great, the staff always stop and chat, a lot of them have been here for some time”.

We spoke with four people during our inspection at Brampton View, two of the people that we spoke with provided specific feedback in relation to consent. They told us that the staff involved them in decisions about their care and explained their care needs to them before carrying out any procedures. This meant that people were provided with information, were able to make informed decisions and provide informed consent to the care and treatment that was offered.

All the people we spoke with told us that they were well looked after at Brampton View and that the staff knew how they needed and wished to be supported. One person commented “the care is excellent here and I am very satisfied with the way that I am treated”. Another person also told us “the staff know how I need to be cared for, they are very good here”.

People told us that they thought that the staff had the right skills to care for them safely. One person said “the staff are excellent; I have no concerns at all”. Another person commented “the staff are very good; they know how I need to be cared for”. People also told us that the staff were respectful towards them and that they felt safe living at Brampton View. People also told us that they knew how to complain should they need to do so.

Most of the people we spoke to told us that they were very happy with the quality of the service provided at Brampton View. People felt that they were well cared for and most felt that there were enough staff on duty to care for their needs. People told us that there were activities that they could either organise themselves or join in with.