This inspection took place on 14 and 20 June 2017. The first day was unannounced and the second day announced.

At the last comprehensive inspection in 12 April 2016 and 18 April 2016 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and breaches were found for safe care and treatment, management of medicines and governance of the home. It was rated as Requires Improvement.

Our regulatory response to these breaches in relation to the unsafe care and treatment and management of medicines was a warning notice informing the provider of the actions they had to take to meet the regulations. In relation to good governance we asked the provider to send us a report that said what action they were going to take to make improvements.

On the comprehensive inspection In April 2016, in addition to the breaches we made a recommendation about staff providing more frequent person-centred activities in the home and community. We also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. People told us some staff restricted them from having drinks or snacks at night. Also several bedrooms, corridors, furniture and furnishings were unclean and unhygienic.

We carried out a focused inspection visit on 31 January 2017 and checked what progress had been made in relation to the breaches. We saw during the focused inspection, the service had made improvements and were no longer in breach of the regulations. People received safe care, medicines were managed safely and governance of the home had improved. However we needed to see these improvements were sustained so the rating was not changed on the focused inspection. Neither did we look at the recommendations from the April 2016 inspection.

There had been a change of manager since the last comprehensive inspection. They were registered with the commission just after this inspection visit. 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.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to the public transport.

Although a small number of people had limited verbal communication and were unable to converse with us, we were able to speak with six people who lived at the home. People told us they felt safe at the home. They said staff were friendly and supportive and looked after them. Procedures were in place and risk assessments had been modified and improved and reduced the risks of unsafe care or actions. People told us they were treated with kindness and respect. We observed staff provided supportive and sensitive care during the inspection.

People said there were enough staff to give them the support they wanted. We saw there were enough staff to provide safe care and supervision and for people to receive support to go out in the local area.

Staff had acted on the recommendation made at the last comprehensive inspection to provide more activities and introduced various games, gardening and walks. We had also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. We saw this had been acted upon and best interest meetings held. At the last comprehensive inspection people told us some staff restricted them from having drinks or snacks at night. The registered manager had provided people with facilities for drinks whene

We carried out an unannounced comprehensive inspection of Bronswick House on 12 and 18 April 2016. At which we found breaches of legal requirements. This was because the provider had failed to ensure safe care and treatment and management of medicines. They had also failed to operate systems to assess, monitor and reduce risks to people and improve the quality and safety of the services provided. Our regulatory response to these breaches in relation to the unsafe care and treatment and management of medicines was a warning notice informing the provider of the actions they had to take to meet the regulations. We asked the provider to send us a report that said what action they were going to take in relation to good governance.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 31 January 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Bronswick House on our website at www.cqc.org.uk.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to public transport. At the time of the inspection visit fourteen people lived at the home.

There was a registered manager in place. However, although they were overseeing the service, they had withdrawn from the day to day management of Bronswick House. A new manager had day to day responsibility for Bronswick House and had started the process to apply to become 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 2008 and associated Regulations about how the service is run.

At our focused inspection on 31 January 2017, we found that the provider met the warning notice regarding safe care. They had followed their plan which they had told us would be completed by August 2016 and legal requirements had been met.

Risk assessments were in place, reviewed and informative to reduce any potential risks of harm to people. They were dated and signed by the person who completed them. Staff were observant and provided safe care and supervision to people, particularly those who were most vulnerable.

Risk assessments had been amended and improved and were dated and signed so staff had clear guidance on the care and support people needed. This helped keep people safe.

Staff managed medicines safely with appropriate gaps between the times of administering them. They were stored securely and not left unattended.

Care records had been amended and developed so they were informative, personalised and involved people in their care.

People were encouraged to discuss any improvements they wanted in the home. Audits and checks were carried out frequently and findings promptly acted upon.

We could not improve the rating for safe, responsive or well led from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This inspection took place on 12 & 18 April 2016 and was an unannounced inspection.

On the day of inspection there were twelve people who lived at the home.

Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to the public transport.

A scheduled inspection of the service was last carried out in August 2013. The service was not meeting the requirements of the regulations inspected at that time. There were breaches in nutrition, staffing, safety and suitability of premises and assessing and monitoring the service. A follow up inspection was carried out in November 2013 to check if the home had become compliant with those regulations. On that inspection they were meeting the assessed regulations.

At this inspection in April 2016 we noted a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found for safe care and treatment, management of medicines, accurate records and quality assurance.

You can see what actions we have asked the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in place. 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 responsible for Bronswick house and another care home in the town.

People told us they felt safe living at Bronswick House. There were risk assessments for some risks but other risks were not assessed. This reduced people’s safety and people were not always kept safe. A serious incident showed staff had not kept a person safe or ensured the safety of other people. Staff did not carry out checks over a long period to make sure the person was safe and in the home. The person had left the home unnoticed. During this time the person had been agitated, distressed and unsafe.

Risk assessments were not always in place or informative. They highlighted risks but did not give staff guidance on how to reduce any risks. Where people had behaviour that challenged the service, there was no guidance for staff or strategies to reduce behaviours or diffuse situations

Staff were aware of how to raise a safeguarding concern and told us the steps they would take if they became aware of abuse. The registered manager reported safeguarding concerns, accidents and incidents to CQC and where appropriate to the local authority.

Care records were not always dated and signed so it was not clear whether they were current or older.

There were procedures in place to monitor the quality of the service and audits were being completed regularly. However these were not effective as the issues we raised on the inspection had not been identified by the home’s audits

Medicines procedures were not always followed or medicines given as prescribed.

We looked at the environment on the first day of the inspection. Several rooms, corridors, furniture and furnishings were unclean and unhygienic. Bedding was worn and stained. On the second day there was some improvement. Painting had started in some rooms, the home was cleaner and new bedding was in place.

There were some social and leisure activities available and staff engaged with people.

We have made a recommendation about staff providing more frequent person-centred activities in the home and

We carried out this review to check whether Bronswick House had taken action in relation to: -

Outcome 5 – Meeting nutritional needs

Outcome 10 – Safety and suitability of premises

Outcome 13 – Staffing

Outcome 16 – Assessing and monitoring the quality of service provision

This was because the home was not compliant at the previous inspection.

We spoke with a range of people about the home. They included the manager, staff and people who lived at the home. We also had responses from external agencies including the local authority contracts team. This helped us to gain a balanced overview of what people experienced living at Bronswick House.

We saw that people were relaxed and happy during engagements with staff. Service users were supported with their nutritional needs and offered menu options. Food hygiene and safety had improved.

The provider had developed maintenance systems and addressed issues we found with the environment. Additionally, the manager had addressed our concerns with staffing levels. New auditing systems had been introduced to regularly monitor the quality of service provision.

We spoke individually with the manager and two staff at Bronswick House. We also discussed care with two people living at the home. We reviewed care records, staff files, policies and procedures, audits and risk assessment documentation.

The service ensured that people were cared for in a supportive and dignified manner. One person told us, “I’ve been here a long time and I’m happy living here”. There were environmental issues, some of which were addressed at the time of completing this report.

Meals were nutritious, but there was no choice offered to residents on a daily basis. There was an issue with a cat having access to the small kitchen where snacks were prepared. Although staff had adequate training and supervision, we had concerns about staffing levels. These were not always adequate in meeting people’s needs whilst continuously monitoring all service users.

Care records were of a good standard. Care plans and risk assessments were in-depth, signed and regularly reviewed. However, Bronswick House did not have appropriate processes in place to monitor the quality and environmental safety of its service.