This was an unannounced inspection that took place on 6, 7 and 9 March 2018.

Brendoncare Ronald Gibson House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home with nursing is registered for up to 56 people. There are three units at the home. Windsor unit is an intermediate care unit, providing short term rehabilitation services for people to support them to return home, after injury or illness. Wessex unit provides care for people living with dementia. Warwick unit provides care for frail or older people, some of whom were receiving palliative care.

The home had a registered manager. 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 and associated Regulations about how the service is run.

At the last comprehensive inspection of this service in January 2016, it was rated good overall with a rating of requires improvement in effective. This was because people's rights were not being protected in accordance with the Mental Capacity Act 2005. We conducted a focussed inspection in September 2016 and found the service was now meeting this requirement, however, we could not improve the rating for effective from requires improvement as to do so requires consistent good practice over time. At this inspection, in March 2018, all key questions are rated good and the service is rated good overall.

People and their relatives were very satisfied by the care and support that the home provided particularly regarding the pleasant, friendly and relaxed atmosphere that staff created. There were suitable numbers of staff who met people’s needs in a kind, thoughtful and person centred way.

The home had thorough recording, auditing and quality assurance systems that were comprehensive and up to date. The systems consistently monitored and assessed the quality of the service provided and information was regularly reviewed and recorded in a clear and easy to understand way.

People’s health needs were discussed with them and they had access to community based health professionals as well as nursing and care staff. People had balanced diets that also met their likes, dislikes and preferences and protected them from nutrition and hydration associated risks.

People and their relatives said the meals provided were of good quality and there was a variety of choice. Staff supported people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy the experience.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff were familiar with the people they supported and were appropriately skilled and trained to meet people’s needs well. They were also aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

Staff thought the registered manager and organisation provided excellent support and there were opportunities for career advancement.

People and their relatives said they found the registered manager and staff were approachable, responsive and encouraged feedback from them.

We conducted an inspection of Brendoncare Ronald Gibson House on 25 and 26 January 2016 where we found a breach of regulations in relation to consent. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this area.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to the breach found. We also received some information of concern prior to our inspection related to the care being provided to one person and the effect this was having on other people using the service. We therefore conducted this inspection to also look into those concerns. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Brendoncare Ronald Gibson House on our website at www.cqc.org.uk.

Brendoncare Ronald Gibson House is a care home with nursing for up to 56 people. There are three units at the home, all overseen by a deputy manager who is a registered nurse. Windsor unit is based on the ground floor and is an intermediate care unit, providing short term rehabilitation services for people to support them to return home, if appropriate, after injury or illness. Wessex unit, also on the ground floor provides care for people living with dementia. Warwick unit provides care for frail or older people, some of whom were receiving palliative care.

There was a registered manager 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.

At our previous inspection we found that staff were not always meeting the requirements of the Mental Capacity Act 2005 to ensure that people’s rights were protected.

During this inspection we found people’s rights were observed under the MCA 2005. Where restrictions were imposed to keep people safe this was done in their best interests using the least restrictive option to ensure their safety and DoLS applications had either been authorised or were pending with the local authority.

Prior to our inspection we were notified of the concerns relating to one person in relation the management of their behaviour and their effect on those around them. These concerns related to the people living on one unit. We therefore looked at these people’s care records to assess the safety of care being provided. We found risk assessments and support plans contained clear information for staff. All records were reviewed every month or earlier where the person’s care needs had changed. People were supported with their health needs and were supported to access a range of healthcare professionals. Care staff were aware of people’s needs and had a good knowledge of identified risks and how to manage these safely to keep people safe.

We conducted an inspection of Brendoncare Ronald Gibson House on 25 and 26 January 2016. The first day of the inspection was unannounced. We told the provider we would be returning for the second day.

We undertook a focussed inspection of this service in August 2015 to check that the provider had followed their action plan in relation to breaches previously found in February 2015 in relation to medicines management and good governance. During that inspection we found improvements had been made in relation to medicines management, but some inconsistencies remained in relation to assessing people’s pain and in record keeping. The provider sent a plan after this inspection setting out how they planned to address these issues. We also found improvements had been made in relation to good governance, but found some gaps and inconsistency in completing some aspects of record keeping. We conducted this inspection to check that improvements were being sustained in accordance with the provider’s latest action plan and that remaining issues had been addressed.

Brendoncare Ronald Gibson House is a care home with nursing for up to 56 people. There are three units at the home, all overseen by a deputy manager who is a registered nurse. Winsor unit is based on the ground floor and is an intermediate care unit, providing short term rehabilitation services for people to support them to return home, if appropriate, after injury or illness. Wessex unit, also on the ground floor provides care for people living with dementia. Warwick unit provides care for frail or older people, some of whom were receiving palliative care.

There was a registered manager 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.

Staff had completed medicines administration training within the last year and were clear about their responsibilities. Pain assessments were carried out appropriately and these were monitored by the GP.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. However we saw examples of people’s rights not being observed under the MCA 2005.

Most staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People who used the service gave us good feedback about the care workers. Staff respected people’s privacy and dignity and people’s cultural and religious needs were met.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

People were encouraged to participate in activities they enjoyed and people’s feedback was obtained to determine whether they found activities or events enjoyable

Brendoncare Ronald Gibson House is a 56 bed nursing home divided into three units caring for elderly people some of whom have dementia. The home had a registered manager in post who was supported by a team of nursing and care staff. On the day of our visit there were 41 people using the service. Overall, people who used the service were happy with the care and support they received. Relatives we spoke with told us that staff were "Kind", "Friendly" and "Caring".

We looked at eight people’s care records and saw that these contained a photograph, a medical history and a short resident profile and biography. We saw that a range of risk assessments had been carried out including falls and mobility, pressure ulcer and personal care. However, we found several falls risk assessments where risk scores had been incorrectly calculated. We also found that turning charts in place to record repositioning where a person was at risk of developing pressure ulcers were not always completed and/or signed or more worryingly, completed retrospectively without comment to indicate a retrospective entry had occurred.

There were a range of activities available for people who used the service. This included singing and craft sessions and various outings. The activities co-ordinator we spoke with informed us that one to one activities also took place in people's rooms although we did not observe this happening on the day of our visit.

We saw that people had call bell systems in their rooms although these were not always within easy reach or answered in a timely manner. The registered manager told us that 90% of staff had completed first aid as part of their mandatory training. When we spoke to staff we were told that the emergency services would be contacted in the event of a medical emergency.

Staffing levels were in line with the provider’s policies though concerns about staffing levels had recently been raised by the visiting GP and a relative. We noted staff were busy at most times throughout the day. One person who used the service told us they had been calling for assistance for some time and that no one had responded to his calls.

A recent safeguarding investigation had resulted in an embargo on the referral and admission of people with palliative care needs to the elderly frail care unit. Issues around the storage and administration of medicines, particularly pain relief medication had been identified as needing action. We found that recommendations in regards to this matter had still not been acted on and that checks and controls were inconsistent.

Our inspection on the 26 October 2012 found that staffing levels on the first floor nursing unit required further review to fully ensure peoples’ needs were being met.

During our unannounced visit on the 2nd May 2013 we saw improvements had been made to staffing levels. New staff had been employed, including a manager for the service.

We spoke to three people who used the service, one family member and six members of staff. We looked at four care plans. Staff told us that the home could be very busy and many residents needed two staff to help them. People we spoke with told us. “Staff are very good, they are kind and helpful”. A family member we spoke with told us, “Everyone is very kind and the care has been great”

We spoke to fourteen people who use the service, four carers and / or family members and six staff members during our unannounced visit to Brendoncare Ronald Gibson House on the 26th October 2012. A further unannounced visit to look at the records kept by the service took place on the 1st November 2012.

Meetings had been held by the host Local Authority in June and July 2012 due to a number of serious concerns that had been raised about the service. An action plan had been put in place by the provider to address the highlighted issues along with a voluntary embargo on long term placements. Updates provided to CQC prior to this inspection showed positive progress had been made by the home and we were informed that placements had now resumed at the time of our visits.

Overall comments from people living at the home were positive and included 'it's nice here', 'I would recommend it', 'I'm quite happy' and 'I think it's great'.

Carers and / or family members told us 'I'm quite impressed', 'they try, that's the important thing' and 'the staff are hardworking'. Individuals spoken to said that the home had improved in recent months and were positive about the current management of the service. Feedback included 'it has improved' and 'it has got better'.

People told us that they enjoyed living at the home, though some said they would like more information about the activities taking place and the meals that they will be getting.

Some people said they would like more time with the staff, where one stated that “..the only conversation I get is when they give me my meal...”.

We saw that most staff treated people with respect and spoke to people in a courteous manner. We saw that staff took time to listen to what people said and responded to people’s requests.

However, we found that the service does not actively seek the consent of the people who use the service, that care plans are not regularly reviewed or stored appropriately. Staff do not receive regular supervision in their work and there is also no registered manager in post.

We carried out an unannounced comprehensive inspection of this service on 10, 12 and 16 February 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to safe medicines management and good governance.

We undertook this focused inspection on 5 and 7 August 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements in relation to the breaches found. 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 Brendoncare Ronald Gibson House on our website at www.cqc.org.uk

Brendoncare Ronald Gibson House is a care home with nursing for up to 56 people. There are three units at the home, all overseen by a deputy manager who was a registered nurse. Windsor unit is based on the ground floor and is an intermediate care unit, providing short term services for people to support them in regaining their independence and their return home if appropriate after an injury or illness. There were nine people on this unit on the day of our inspection. Wessex unit, also on the ground floor, is a 16 bedded unit for people living with dementia. There were 15 people on this unit on the day of our inspection. Warwick unit on the first floor is a 24 bedded unit for frail or older people, some were receiving palliative, end of life care. At the time of our inspection 19 people were in residence there.

There was a registered manager 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. The registered manager was being supported by a peripatetic manager at the time of the inspection.

At our last inspection we found that people were not protected from the risks of inappropriate and unsafe medicines management. There was a continued breach of regulation in relation to medicines management as controlled drugs were sometimes not recorded and administered correctly to people who used the service which could have affected their health. We also found that records relating to people’s care were not always fully completed which put them at risk of receiving inappropriate or unsafe care.

During this inspection we found that improvements had been made. Changes had been made to help ensure that people received their medicines safely and accurate records for controlled drugs were being kept. Regular medicines audits were being carried out so that any issues could be identified and addressed promptly. We noted some inconsistencies in the assessment of pain and inconsistencies in recording on some medicines records.

We found that record keeping had improved. For example, risk assessments were completed, reviewed and updated as required. In addition monitoring systems had been introduced to help ensure that care records were accurate and updated as needed.