This inspection took place on 09 December 2016 and was unannounced.

Brenan House is a large Victorian building situated in front of a tree lined square, and provides care and accommodation to up to 16 older people.

Accommodation is set over three floors with two lounges, one upstairs on the first floor and one on the ground floor with an adjoining conservatory that leads out to a rear courtyard. There is a shaft lift for people to access all floors.

One of the owners is the registered manager and was present on the day of 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 our last inspection in October 2015, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The provider sent us an action plan outlining how they would rectify those breaches. At this inspection all the regulations were met.

There were enough staff to keep people safe. Staff were checked before they started working with people to make sure they were of good character and had the necessary skills and experience to support people effectively. Staff had received sufficient training and guidance to make sure they knew how to support people safely and in the way they preferred. Staff received regular supervision and support from the registered manager who worked alongside them some of the time.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them. Consideration had been given to people’s safety and potential risks had been assessed. People had the equipment and support needed to prevent unnecessary accidents and incidents.

The registered manager and team had worked hard to update and review the care planning system. Each person had a care plan that included their preferences and all the information necessary to meet their individual needs. People were involved in the assessments and planning and staff had a good understanding of making sure people had the right support to make decisions and give consent to care. This included support needed in regard to the Mental Capacity Act.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People were treated with kindness, patience and respect. Staff said they had built up good relationships with people and people were complimentary of the kind and caring nature of the staff. A person said, “The owners and staff are kind and good, and all the people are alright in here. I would recommend this home.”

People were supported to eat and drink healthily. There was a good variety of homemade cooked food and people were complimentary of the meals provided. Relatives told us that people were well fed and the food always smelled good.

People were supported to keep well and healthy and if they became unwell the staff responded promptly and made sure that people accessed the appropriate services. Visiting health professionals including district nurses and doctors were involved in supporting people’s health and wellbeing as needed. People received their medicines safely and when they needed them, by staff who were trained and competent.

People, staff and relatives told us that the service was well led and that the registered manager and st

People and relatives said they were satisfied with the service. They said the staff came promptly when they called them and they were polite and respectful.

People and relatives told us that they would not hesitate to raise any concerns with the manager or staff. They told us they were satisfied with the service.

People said: "I have no complaints, the staff are very good". "I feel comfortable living here".

We saw that staff were responsive in the company of people using the service. Staff listened to people and supported them to be where they wanted to be. They gave the people time to respond and answered their questions in a way they could understand.

The staff we spoke with understood people's needs and knew their routines and how they liked to be supported.

Some of the people living in the home were unable to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Some people and their relatives told us they were satisfied with the service. They said that the staff were polite, respectful and caring and there was usually enough staff on duty.

The staff we spoke with spoke with understood people's needs and knew about their routines and how they liked to be supported.

This inspection took place on 09 and 12 October 2015 and was unannounced.

Brenan House is a large Victorian building situated in front of a tree lined square, and provides care and accommodation to up to 16 older people. There is a courtyard garden to the rear of the building. The home offers residential accommodation over three floors with two lounges, one upstairs on the first floor and one on the ground floor with an adjoining conservatory that leads out to the courtyard. The first floor lounge and conservatory have tables for dining. There is a shaft lift for people to access all floors. The home is suitable for people with some mobility difficulties although there is limited space for people who need large pieces of equipment. There are eight single and four double bedrooms. Seven of the bedrooms have an en-suite toilet/washroom. The home has one bathroom and one shower room. At the time of the inspection 16 people were living in the home.

There was a registered manager working at the service. 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 and their relatives talked about their decision to move into the home. People said they had been concerned about giving up their independence and coming into a care home. A relative said, “We were so glad to find this home. The manager was so welcoming and reassured us. Now we know that when we leave X, she is safe.” Peoples’ needs were assessed before they moved in and this information was used to develop a care plan. Not all care plans were up to date to show when peoples’ needs had changed.

Although the registered manager kept their skills and knowledge up to date this was not always reflected in the care that was provided to people in the home. Audits and checks had not always picked up improvements that were needed. Following a quality audit by the Local Authority recommendations for improvements to the service had been made and the registered manager had started to address these but the regsisterd manager had not picked these issues up previously. This included improvements to fire safety and evacuation procedures and care planning.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). At the time of the inspection no DoLS authorisations had been applied for. Some people were at risk of having their liberty restricted and the registered manager was seeking advice about this. People using the service needed to have their mental capacity assessed to make sure consideration was given to any possible restrictions to their freedom. Not all mental capacity assessments had been completed to assess how people were involved in planning their care.

People said staff were very busy but were kind and considerate when giving care. Our observations suggested that the staffing levels needed to be reviewed. Staff were polite and took their time with people when giving care but there were long periods of time when people were left unattended. There was a call bell system but people relied on calling staff as they went past if they were in the lounge or conservatory because there were no call points accessible in these areas. The registered manager said that the call bells in each person’s bedroom were detachable, so they could take them with them to other parts of the home and said that from now on they would make sure that this happened.

Staff said that they were able to access training and could talk to the registered manager if they wanted to discuss anything including concerns or their development. There was no regular system of supervision and appraisal in place which was discussed with the registered manager as an area for improvement.

The registered manager demonstrated a commitment to the development of the staff and provided a variety of training to give the staff the skills they needed for their role.

Some people said there was some flexibility in the routines of the day and they could get up and go to bed when they preferred, but most comments suggested that generally the routines were organised on a turn taking basis and people fitted in as time allowed. People said the staff had got to know them and they had the opportunity to let staff know their preferred way of being supported. Some people commented they tried to maintain as much independence as possible. Some people said they had mobility aids to get around the home and one person said, “I try to do as much for myself as I can.”

People said the home was a friendly, family style home. A person commented, “It’s as good as it can be as it’s not your own home.” People’s friends and relatives said they visited any time and felt welcomed. Various activities were organised each day and people joined in when they wanted to or watched what was happening around them. Some people preferred to stay in their rooms most of the time and others liked to be in the lounges. A party was organised around Christmas time each year to give people the opportunity to all get together with friends and relatives at the home and to meet everyone.

People were supported to keep well and healthy and if they became unwell the staff responded in a timely way and made sure that people accessed the appropriate services. Visiting health professionals including district nurses and doctors were involved in supporting people’s health and wellbeing as needed. Some people had lived locally and maintained the services including the same doctor’s surgery that they had always had. One of the rooms had been made into a treatment room so that if people required treatment, for example, dressings from a district nurse, this was given in private. Peoples’ medicines were managed safely.

Some people preferred to stay in their room and this was respected. One person said, “ I do go downstairs sometimes but like to be in my room most of the time.”

People were complimentary of the food in the home and visitors were offered refreshments when they were in the home too. People said they were able to choose what they ate and there was always plenty. If people were not eating or drinking enough their food and fluid intake was monitored.

People said they felt safe in the home. Staff showed a reasonable understanding of different forms of abuse and knew what to do if they witnessed or suspected abuse. Risks to people were assessed and the manager was updating the risk assessments. The complaints procedure was displayed and people knew if thy complained it would be investigated and resolved.

Some improvements had been made to the environment and there was an on-going plan to make sure the improvements continued. Checks on the equipment and the environment were carried out and emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

We found a number of breaches of the Health and Social Care Act 2008 (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.