About the service: Brendoncare Park Road is a residential care home that was providing personal and nursing care to 39 people at the time of the inspection.

People’s experience of using this service:

• People were safely supported with personal care, medicines, health, wellbeing and nutrition.

• Staff received regular safeguarding training and could recognise signs and symptoms of possible abuse.

• Regular checks of the premises ensured risks from such as legionella minimised environmental risks to people.

• The premises were clean and staff were trained in infection prevention and control.

• Care plans were devised with people and reviewed with them each month.

• Staff were safely recruited and completed an in-depth induction and mandatory training before working in the service.

• Staff were supported by their line managers and received regular supervisions and annual appraisals.

• Regular GP visits and other healthcare professionals such as dentists enabled people to maintain health and well-being.

• The provider worked to the principles of the MCA 2005.

• Staff were warm and caring and supported people with empathy. There was a warm, homely atmosphere in the service.

• A range of activities were provided and the service was actively reviewing these to ensure they were appealing to people.

• Staff had recently completed a recognised end of life care training course and were cascading their learning to the rest of the team.

• The registered manager completed a range of audits to ensure care was provided safely and as planned.

• There were plans in place to re-provision the service to a different location in Winchester where a purpose-built home is planned.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection: Brendoncare Park Road was rated as Requires Improvement at the last inspection on 17 January 2018.

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the service and inspect again as per our re-inspection schedule.

We last carried out an inspection of this home in December 2016 when we found the service needed to improve on the recognition of the risks associated with people’s care and person centred care planning. Audits in the service were not always effective and people were concerned that there were not always enough staff available to meet people’s needs.

We carried out an unannounced inspection of this home on 17 and 18 January 2018. At this inspection we found some of these concerns had not been addressed. Risks associated with people’s care had not always been identified and actions taken to mitigate these. Care records lacked order and were not always an accurate reflection of people’s needs. However, care plans were more person centred and audits in the home had improved although timely actions had not always been taken to address issues identified. There were sufficient staff available to meet people’s needs.

Brendoncare Park Road 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. Brendoncare Park Road accommodates up to 46 older people in one adapted building. There were 29 people living at the home at the time of our inspection. Accommodation is arranged over two floors with access to all areas by stairs and lift.

A registered manager was in post. 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.

Risks associated with people’s care had not always been identified and assessed to ensure actions were taken to mitigate these.

Medicines were administered, stored and ordered in a safe and effective way. However some risks associated with medicines had not been identified.

Whilst care plans were person centred and held information on peoples likes, dislikes and preferences these lacked consistent, accurate and orderly information to support staff in meeting the needs of people.

The registered provider had a robust system of audits in place to ensure the safety and welfare of people. However, the action from audits of care records had not been completed in a timely way.

Staff had a good understanding of how to protect people from the risk of infection and policies and procedures were in place for the management of infection control.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse, discrimination and harassment and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff deployed to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Incidents and accidents were clearly documented and investigated. Actions and learning were identified from these and shared with all staff.

People were encouraged and supported to make decisions about their care and welfare, although this was not always clearly documented. Where people were not able to consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom.

People received nutritious meals in line with their needs and preferences, in an environment which provided a calm and relaxing dining experience for them. Those who required specific dietary were supported to manage these.

Staff were calm, kind and gentle in their interactions with people and supported them to remain independent whilst maintain their safety and welfare. People’s privacy and dignity was maintained and staff were caring and compa

The inspection took place on the 19 and 20 December 2016 and was unannounced.

Brendoncare Park Road to be referred to as the home throughout this report, is a home which provides residential and nursing care for up to 49 older people who have a range of care and nursing needs. The home is situated close to the town of Winchester. The home comprises of three units one of which is over two floors in the original Brendon House. All other rooms are at ground floor level and facilities include two dining rooms and two lounges with a secure rear garden. At the time of the inspection 41 people were using the service.

The home has a registered manager in post. 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 told us they felt the service was safe most of the time. We received some feedback about occasions when people had not felt safe.

Risks to people’s safety had been assessed and guidance was provided for staff to manage these risks appropriately. However, the information staff were required to record so that risk management plans could be evaluated was not always completed to show people had received the care and treatment they required. This included: records to confirm people’s food and fluid intake when they were at risk of poor hydration and nutrition and records to confirm people had received their topical medicines (prescribed creams and lotions applied to the skin) to prevent a deterioration in their skin integrity. Some equipment such as air flow mattresses used to prevent pressure sores developing were not set at the correct setting according to the person’s weight. People’s repositioning needs had not always been recorded as carried out as required. This meant there was a risk people could experience deterioration in their health when actions to reduce risks were not recorded or monitored as carried out so people’s treatment could be effectively evaluated.

Information available to staff at handover about people’s needs and risks was not fully completed or effectively communicated to all staff. This meant there was a risk that staff who did not know people well would not be fully briefed about people’s needs and risks.

People’s medicines were safely managed and administered appropriately with the exception of those medicines that are prescribed to be given at a specific time to help people manage their symptoms. We found these were not always given at the prescribed time which could result in less effective treatment for the person.

The registered manager took prompt action to address these concerns however more time was required for these improvements to be fully embedded into practice.

Most people we spoke with said there were not always enough staff readily available, staff were hurried at times and could take a long time to respond to call bells. Some staff told us staffing levels were ‘stretched’ and they did not always have time to spend with people to meet their emotional or social interaction needs. Some actions had been taken to improve staffing levels and more actions were planned, however; more time was required to implement and embed these improvements across the service.

Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people. Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff.

People were supported by staff who had relevant up to date training available which was regularly reviewed to ensure staff had the skills to proactively meet people’s individual needs.

People, where possible, were supported by staff to make their own decisions about their ca

People's choices and consent to care and support were observed to be respected at all times during our visit. We observed staff supporting people with day to day activities, and the interaction was observed to be sincere, respectful and responsive to individual support needs.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected. A family member told us "since he has been here he has improved dramatically. He is happy settled and safe here and we feel the same".

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas singing with staff and interacting with each other. During our inspection we observed people spending time in their bedrooms listening to music and talking to family members. We also saw one person spending time in their room completing crosswords and another knitting.

Staff were seen supporting people to eat and were patient and went at their pace. During the inspection one person declined the choices that were offered for lunch. The person was asked what they would like and requested an omelette which was prepared by the chef. This showed that people's wishes and choices were respected and acted upon.

During our visit we spoke with nine people who lived at Park Road, with four relatives and with five staff and the manager. People told us that they were well treated by staff and they liked the home. One person said, "The staff are friendly and look after me well" Another person said "It is safe and comfortable. They (staff) are all on your side". Staff we spoke with said that they enjoyed working at the service and felt well supported by management.

People were given clear information about the home before they moved in to help them to make an informed decision about whether the service would be appropriate for them.

People's health care and welfare needs were recorded accurately and staff had a good understanding of the support that people required. Staff told us that the training that they received enabled them to do their job effectively.

People said that they felt safe at the home and said that they were confident that any concerns that they had would be addressed. There were good quality monitoring systems in place which meant that the service was operating effectively to manage the needs of the people using the service.