The inspection took place on 14 August 2017 and was unannounced. At the last inspection of the service on 15 and 16 June 2016 we found no breaches of regulation. However, the overall rating was ‘requires improvement’ because we wanted to be certain that improvements made since the previous inspection of the service in 2015 would be maintained. At this inspection we found no breaches of regulation and the service is rated as Good.

Bronte is registered to provide accommodation for up to 20 older people who require personal care. At the time of this inspection there were 20 people living there.

The service is run by the providers, one of whom is also the 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.

People told us they were happy living in the home and felt safe. Comments included, “I am very glad to be here” and “They know the risks my father faces so I think he is safe”. Safe recruitment procedures had been followed before new staff began working in the home. Checks and references had been taken up to ensure they were suitable to work with vulnerable people. Staff received induction training at the start of their employment. They also received further training and updates each year to ensure they remained knowledgeable and competent to meet the needs of the people living in the home. All staff had received training on safeguarding adults and knew how to recognise and report any suspicions of abuse. There were sufficient staff to meet people’s needs safely

Medicines were stored and administered safely. People told us staff made sure they received their medicines at the right times.

People received effective support from staff who understood their health and personal care needs. Care plan files contained sufficient information about each person’s health and personal care needs and preferences. Risks to people’s health and safety had been assessed and staff knew how to support people to keep them safe. Staff sought medical advice and treatment promptly when needed. Systems were in place to make sure people attended medical appointments, assisted by staff where necessary. People and relatives we spoke with were confident their health needs were being met. Comments included, “I get all the health treatment I need”

People received a varied range of meals to suit their individual dietary needs and preferences. Comments included, “The food is beautiful. I get a good choice of food” and “Nice wholesome food with lots of vegetables – quite a good selection”

People received care and support from staff who were kind and caring. Staff knew people well and understood their needs. Comments included, “Staff are kind. That goes a long way” and “I love the staff – I am very happy here.” One person told us the staff were always caring, and said, “They put their arms around people and hug them.” We saw staff treated people with kindness, friendliness and helpfulness.

People were cared for by staff who knew them and understood their needs. A care plan was in place for each person living in the home. The care plan files contained sufficient information about each person’s health, personal care needs, risks to their health and safety, and their likes and dislikes. Staff understood the importance of giving people choices and enabling them to make decisions about their daily lives. The service acted in line with current legislation and guidance where people lacked the mental capacity to consent to aspects of their care.

People’s social needs were assessed and people were offered opportunities to engage in a range of activities to suit their needs and preferences. Two activities organisers were employed to provide a range of gr

This inspection was unannounced and took place on 15 and 16 June 2016.

The service provides accommodation and personal care for up to 20 older people. On the day of this inspection there were 12 people living there.

The service was inspected on 19 June 2015 when we found a number of serious concerns. The service was rated as ‘inadequate’ and we placed them in ‘special measures’. The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example to cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

We imposed a condition that the service must not admit any further people until we were satisfied that all breaches of compliance had been addressed and the service was safe. We carried out another inspection on 4, 5 and 11 February 2016 when we found some actions had been taken, but these were not sufficient to ensure the service was fully compliant. The rating of the service remained ‘inadequate’.

We carried out this inspection to check if improvements had been made. During this inspection we found the providers and staff had worked hard to address the previous breaches to ensure that people’s needs were met. Improvements had been made in all areas and the service was fully compliant. The service will now be removed from special measures but we have rated the service as ‘requires improvement’ because it is too early to be certain the service will maintain full compliance in the future. We will continue to monitor the service until we are satisfied the good practice found during this inspection has been embedded and maintained.

People living in the home, staff and visitors told us the service had improved significantly over the last year. There was a cheerful and lively atmosphere with lots of smiles and friendly conversations between people living in the home, visitors and staff. Comments included “They really do try hard. I have no problems at all” “No trouble here. I like it here. I am very happy” and “The staff are all very, very kind. They are all marvellous.”

One of the providers is the registered manager of the service and the other provider is responsible for the day to day management of the service and is referred to in this report as the duty 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.

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before a new staff member started working in the home. This meant that new staff were suitable for the job they had applied for and there was a robust recruitment process in place. Staffing levels had increased since the last inspection. There was an extra member of staff on duty each day therefore we found the staffing levels were adequate to meet people’s needs. People rec

This inspection was unannounced and took place on 4, 5 and 11 February 2016.

The service provides accommodation and personal care for up to 20 older people. On the day of this inspection there were 18 people living there, including one person who was in hospital.

At the last inspection of the service on 19 June 2016 we found many improvements were required. The service was rated as ‘inadequate’ overall and placed in special measures. We imposed a condition that the service must not admit any more people until such time as we were satisfied they had made improvements to address the failings we had found. At this inspection we found some actions had been taken to address the breaches of regulation, but these were not fully effective and the service continued to be in breach of a number of regulations. People continue to be at risk due to staff not having the right skills, training and knowledge to meet their needs. Risks are not clearly identified and staff were not given instructions about how to manage risks.

The providers are a husband and wife team. One of the providers is the registered manager of the service and the other provider is responsible for the day to day management of the service and is referred to in this report as the duty 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.

Safe procedures had not always been followed when recruiting new staff. Checks and references had not always been carried out before new staff began working with people. This meant it was not possible to show that new staff were entirely suitable for the job they had applied for.

Medicines were not administered safely. Medicines were administered by staff who had not received suitable training. Poor practice was observed including medicines left on top of an unlocked medicines trolley while the member of staff took medicines to people in their rooms. Safe procedures were not followed when recording medicines. Medicines administration records (MAR) were not always accurate. There were unexplained gaps in the medicines administration records. Audits of medicines had only just started and were incomplete. We also found improvements were needed in the way the service managed creams and lotions.

Staff had received training on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted for most people living in the home. However, the provider had not assessed people’s capacity to give consent, or to make important decisions about their care and treatment. The care plans did not explain to staff about each person’s capacity to make decisions, or guide staff to gain consent before providing care. We observed staff seeking consent before carrying out care tasks.

Staff did not have sufficient information on people’s needs to ensure people received care that met their individual needs. New care plans had been drawn up in consultation with the resident, some family members, the deputy manager, the duty manager and the registered manager. However, the new care plans had not yet been introduced to the staff. They had been written in recent months and had not been reviewed. Some of the information was incorrect or out of date. The providers planned to introduce the new care plans to the staff in the very near future. The providers told us they did not expect the new care plans to be fully operational for at least another two months. This meant staff were continuing to work without the right information to assist them in providing safe and effective care.

Risks to people's health had not been fully assessed or regularly reviewed. Some improvements were noted but some areas were still not fully met. Some peop

Bronte is registered to provide accommodation with personal care for up to 20 older people who require accommodation and personal care. On the day of our inspection there were 18 people living there. The inspection took place on 19 June 2015. The visit was unannounced and was carried out by two inspectors

At our last inspection of the service on 24 June 2014 we found they were not compliant with record keeping. We asked them to provide us with an action plan showing how they planned to address the issues we found. After our inspection the provider sent us information telling us they planned to update all care plans to incorporate risk assessments including moving and transferring, falls, skin care and nutrition and associated recording forms. They told us they were in the process of completing this, although they did not give a timescales to say when it would be completed by.

The providers are a husband and wife team. One of the providers is the registered manager of the service and the other provider regularly manages the service and is referred to in this report as the duty 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.

People who lived at Bronte were not safe. Prior to the inspection the local authority safeguarding team shared concerns with us about the quality of care people were receiving. During this inspection we identified areas of concern that showed people were not receiving a safe level of care.

There were insufficient staff employed to meet people’s needs. The providers had experienced difficulty recruiting new staff and this had resulted in some staff working long hours to cover vacant shifts. Staff recruitment records showed safe recruitment procedures were followed before new staff commenced work in the home. The provider told us all new staff received induction training at the beginning of their employment. However, they were unable to provide evidence of this during our inspection. Some of the care practices we observed showed staff were not following current accepted good practice. Training on some topics had been provided to staff but there was no method of identifying individual training needs, or planning the future training needs for the whole staff team. This meant some staff may not have the skills or knowledge to help them support people effectively.

Care plans did not provide accurate or up-to-date information about each person’s needs. Some care plans provided only brief details about the support each person needed, and two people who had been admitted in recent months did not have a care plan in place that identified their care needs. Risks to people’s health and welfare, for example pressure wound prevention and care, malnutrition, dehydration, falls and moving and handling, had not been fully assessed. Where risks had been identified these had not been regularly reviewed, and staff had not been given sufficient information about the care they should provide to reduce or address each risk. People had not been involved or consulted in drawing up or reviewing their care needs.

There was a risk medical appointments may be missed because the systems for recording and planning medical appointments were not fully effective. Where people required staff to accompany them to medical appointments this had not always been planned effectively.

There was a lack of awareness by the managers and staff of recent changes in legislation and good practice guidance. Some staff had recently attended training on the Mental Capacity Act 2005 (MCA) but this had not been attended by the registered manager. Some people living at Bronte may have their liberty restricted. One Deprivation of Liberty Safeguards (DOLS) application had been submitted by the registered manager after advice from the local safeguarding team. However, the registered manager had not considered the need to apply for other people whose liberty may have been restricted. The duty manager was also unaware of the need to notify the Commission of serious accidents or incidents, or of any deaths that may have occurred.

Medicines were not managed safely. Staff had not received adequate training on safe administration of medicines. We saw medications were left with people in pill pots at lunch and not observed while they took the medications. There were no systems in place to check stock levels or audit medicine administration processes on a regular basis.

People were not offered an adequate choice or variety of food at mealtimes. Staff told us they knew what foods people liked or disliked, but we observed staff giving people food at lunchtime without explaining what foods were being offered, or giving any choice of alternatives.

Two people required assistance from staff to help them eat their meals. We saw one member of staff assisting two people at the same time, and this meant they were unable to give each person sufficient attention, or check they were able to eat their food safely or comfortably.

Staff provided care to people in a calm and efficient manner, but often failed to ask people if they wanted assistance, or explain how this would be provided. This meant that staff did not always demonstrate a caring approach.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This unannounced inspection was undertaken as part of our ongoing monitoring but also to follow up on required improvements which had been identified following our previous inspection in June 2013. Following that inspection the provider sent an action plan to us detailing the improvements being made.

At the time of this inspection there were 13 people living at Bronte. We were supported on this inspection by an expert by experience. This is a person who has personal experience of using or caring for someone who uses this type of service. They were also able to speak with those people whose first language was not English. There were five people who spoke Chinese, Cantonese or Hakka.

We spoke with 10 people and five relatives about their experiences of the care provided at Bronte. We also spoke with a community nurse who regularly visited people living there. We spoke with the provider and manager and with five staff.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic.

Care plans had been improved since the previous inspection. However, where risks had been identified there remained insufficient written guidance on how to minimise those risks. From our discussions with staff, people living in the home, and with relatives, we were satisfied that staff had the knowledge and experience to meet people’s needs safely.

At our last inspection we noted the front door was left open and unattended. The providers told us they would take appropriate action to improve the security of the home. When we arrived at this inspection the front door was again open and unattended. The providers told us this was a mistake and gave assurance they would take action to make sure security of the home was maintained.

Is the service effective?

The service was effective because we saw and heard evidence to show people were satisfied with the care they received. Where health needs were identified the home liaised closely with health professionals to ensure people received the treatment and care they needed. Staff received training and support to ensure they delivered effective care in accordance with assessed needs. For example the local community nurses had provided training for staff on moving and handling to ensure individual needs were met safely.

Is the service caring?

We observed staff supporting people during the day in a gentle, sensitive and caring manner. We saw staff and people smiling and chatting to each other while staff were assisting people to move around the home. People told us they were happy with the care they received. For example, a relative told us a person had been poorly recently and they had wanted them to remain at Bronte rather than going to hospital as they were confident Bronte was the best place to provide the care the person needed. They felt the staff knew their relative well and understood how they wanted to be cared for. Comments included, “The carers are good and they look after me well” and “They can’t be more helpful. They help me to get washed and dressed in the morning and put me to bed. They also give me a bath about once a week.”

Is the service responsive?

The service was responsive because they had systems in place for ensuring people's views were listened to, including annual questionnaires and quarterly resident’s meetings. We saw they had taken action to address any areas where changes or improvements were needed.

Where people's needs had changed the service had taken actions to ensure care was adjusted to meet those needs.

The service did not always respond fully to people’s dietary preferences. Most people told us the food was satisfactory. The manager and cook told us people were offered a choice of meals each day. However, it was the perception of most people we spoke with that they were not offered a choice of meals and they could not ask for an alternative if they did not like the meals they were given. Comments included “The food is pretty good. Not much choice, I mean it’s the same food all the time”, “The food is alright. You just eat what you’re given. There’s no choice” and “I don’t really like the food. There is no choice.”

Is the service well-led?

The service was well-led by the registered manager and provider. They lived close to the home and were fully involved in the day to day care of people and daily maintenance of the home and gardens.

Bronte residential care home provides care and support for frail older people. We carried out this inspection with the support of an expert by experience. This was so we could communicate with the people living at the home whose first language was not English.

There were 15 people living in the home at the time of our inspection. We spoke with 13 people who lived at the home, five staff and three people visiting the home. We also spoke with the GP practice who visited the home. We looked at the care records of five people and the records of four staff.

People living in the home told us they were happy with the care they received and told us they felt safe in the home. One person said, “I am happy here and the care they provide for me is good”. Whilst another said, “The carers are kind to me and they talk to me. I feel safe”. However we found that the way people were supported was inconsistent and there was a risk of people’s care needs not being met because staff did not follow guidance in care plans or because care plans were not up to date.

People’s nutritional needs were met but improvements could be made in the way the menu was promoted in the home and people’s choices and preferences were listened to.

In December 2012, we made a compliance action to improve hygiene and infection control measures. Whilst we saw some improvements had been made there were still concerns about the way this aspect of care was managed. However the provider listened positively to our concerns and told us about measures they would put in place to improve the areas of concern.

Staff recruitment was carried out in line with the policies of the provider. This included checking on people’s suitability to work with vulnerable people through references and checks required by the UK border agency.

We saw some improvements in the provider’s quality assurance processes since our inspection in December 2012 where we highlighted compliance actions. However, there were still areas for improvement, for example gaining people’s views, checking on hygiene and infection control and maintaining records. Care records were not routinely updated following incidents or changes in a person’s condition and staff were not familiar with the detail in some people’s care files.

Bronte residential care home provides care and support for frail older people. We talked with six people who lived at the home, five staff and two people visiting the home. We looked at the care records of six people and the records of five staff.

There were 15 people living in the home at the time of our inspection. The people living in the home told us they liked the home and were happy with the care being provided by the staff. One person who lived in the home said “I’m happy living here” and “the staff are kind and hard working”. A visitor we met told us staff were “observant and kept a close eye on the needs of people in the home”.

People appeared comfortable whether in their own rooms or in the public areas of the home. We saw that staff had a good knowledge of the needs of people in the home. Staff were observed to address people by their preferred names and were polite and respectful at all times.

People we spoke with said they always found the home clean and tidy however we found some aspects of cleanliness and hygiene were not always appropriate. For example we found some equipment and surfaces needed cleaning and routine wearing of protective equipment didn’t always take place.

We saw that people were safe in the home however the provider didn’t always have quality assurance processes in place to monitor the quality of their service; for example safe storage of equipment and routinely maintaining documents relating to people and the running of the home

During the visit there were 14 people living at the home and one other person arriving that day. We met with everyone who lived at the home, spent time with five people and spoke to one relative.

People told us that they were very happy living at Bronte. One person said that they really liked it there and that even if it was not their real home they were happy there. We heard and saw that there was a happy atmosphere at the home and that people felt free to do what they want; such as potter outside in the generous gardens, visit the large koi carp pond or spend time in their rooms.

We heard how people felt that they were able to share any concerns with staff and that any issues were dealt with as soon as they were communicated.

We saw that care records were well maintained, being person centred and accounting for people’s preferences and choices but they could be better organised to ensure that information is easily accessible.

People’s needs were identified and met by sufficient numbers of caring and respectful staff.