Brownscombe House Nursing and Residential Home is a care home which provides accommodation for up to 36 older people who require nursing and personal care. At the time of the inspection 29 people were using the service. Some of the people who lived at the service needed care and support due to dementia, sensory and /or physical disabilities.

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. 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.

We inspected Brownscombe House Nursing and Residential Home on 29 November 2016. The inspection was unannounced. The service was last inspected in September 2014 when it was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “Yes I feel very safe,” and a relative told us, “Oh yes, it is very good here, excellent really. There is consistency so (my relative) feels safe as he sees the same team.”

People told us they received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard.

Staff had been suitably trained to recognise potential signs of abuse. Staff told us they would be confident to report concerns to management, and thought management would deal with any issues appropriately.

Staff training was delivered to a good standard, and staff received updates about important skills such as moving and handling at regular intervals. Staff also received training about the needs of people with dementia.

Recruitment processes were satisfactory as pre-employment checks had been completed to help ensure people’s safety. This included written references and an enhanced Disclosure and Barring Service check, which helped find out if a person was suitable to work with vulnerable adults.

People had access to medical professionals such as a general practitioner, dentist, chiropodist and an optician. People said they received enough support from these professionals.

There were enough staff on duty and people said they received timely support from staff when it was needed. People said call bells were answered promptly and we observed staff being attentive to people’s needs.

The service had a programme of organised activities, and an activity organiser was employed. These activities included activities such as board games, manicures, trips out, and sing-alongs. Some external entertainers such as musicians and singers visited.

Care files contained information such as a care plan and these were regularly reviewed. The service had appropriate systems in place to assess people’s capacity in line with legislation and guidance, for example using the Mental Capacity Act (2005).

People were very happy with their meals. Everyone said they always had enough to eat and drink. Comments received about the meals included, “The meals are very good and nutritious,” and people said they had a choice. People said they received enough support when they needed help with eating or drinking.

People said if they had any concerns or complaints they would feel confident discussing these with staff members or management, or they would ask their relative to resolve the problem. They were sure the correct action would be taken if they made a complaint.

People felt the service was well managed. We were told, “The manager is very nice.” There were satisfactory systems in place to monitor the quality of the service.

We carried out this inspection to check whether action had been taken to improve the service since the previous inspection in June 2014. At the time of the inspection there were 25 people living at the service. We spoke with six people who used the service and seven members of staff including the acting manager.

We found that action had been taken and as a result people's care and safety had improved.

People were treated with respect and staff asked their permission before they delivered care and explained to people what they were doing during that care. One person said, "The staff are lovely they always help me and ask me what I want". Another person said, "The girls are so kind they ask me before they do anything and they come when I need them". We observed the staff asking someone's permission before they helped them to move from one room to another and then kindly explaining each step of the process so the person was reassured. We heard this person thanking the staff after they were made comfortable.

People's needs had been assessed and planned and staff were delivering the care that people required and preferred. The care plans had been reviewed and updated and people or their relatives had been asked to contribute their opinions and agreement to their plan of care. The staff had read people's care plans and they knew each person's needs and how to care for them.

Staff had been recruited and trained appropriately and people were being cared for by enough staff with suitable qualifications and skills.

The acting manager had submitted their application to register with the commission and this was in the process of being considered. The acting manager had completed audits to assess and monitor the quality of the service and an action plan was being completed to make the required improvements. The provider's representative was supporting the acting manager to ensure the improvements were sustained.

The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff who supported them and from looking at records.

If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Is the service safe?

People were not protected from the risk of inappropriate or unsafe care. This was because the provider failed to have effective systems in place to assess, plan, review and monitor the care and support provided to people who used the service. In addition procedures were not in in place to identify, assess and manage risks to the health, safety and welfare of people and others in relation to activities and incidents. People did not have access to choice or to remain in control of decisions about their care and lives.

Relatives of people who used the service commented that the lack of staff effected people's care. One relative said, "People can call out for the toilet for a long time." Another relative said, "People have to wait for help." We found that the staff did not understand the care individual people required or preferred. This was partly due to the lack of recorded information but also because some staff had never worked in the home before and had not had time to read the information that was available about how to meet people's needs. Our observations confirmed that the lack of adequate staff numbers affected the care the staff could provide and meant people were at risk of unsafe or inappropriate care.

The two permanent members of staff we spoke with had a clear understanding of how to report any concerns related to safeguarding and protecting people form abuse and we saw form the records they had completed a training course in safeguarding.

We saw that emergency equipment was in place and staff had been trained to use this. There was a plan for staff to follow in the event of an emergency.

Is the service effective?

People’s care needs had not been assessed effectively and care had not been planned to take into account people's needs, preferences, likes and dislikes. People had not always been involved in planning their care and the staff were unaware of peoples' needs. We observed ineffective care being delivered at times which meant people were at risk. This particularly related to manual handling practices which were unsafe.

Not all the staff had received training to meet the needs of the people who used the service. The agency staff who were working in the home had not worked there before. They had not been trained to use the equipment or to deliver appropriate care to people and they relied on being told what to do by more experienced staff. We observed times when they delivered care without guidance from permanent staff.

We spoke with five people and three relatives of people who used the service. They were complimentary about the care and kindness of the staff apart from comments related to a lack of adequate staff numbers and the care provided by one member of staff. One person we spoke with said, “The staff are kind and caring." One relative said, "There are not enough staff to help although the staff do an exceptional job considering."

All of the people who used the service were registered with a local GP practice and we saw that when a G.P had visited this had been recorded. People told us that they could relay on staff to call a doctor when this was needed.

We asked staff about one person and was told they had received dental treatment recently but there was no record of this despite them having continued dental health problems. It was not clear that further advice had been sought or that the continuing problem had been reported to senior staff as it had not been documented. Therefore, people could not be assured that there was a plan to protect their health or to ensure health advice was followed.

Is the service caring?

People were generally supported by kind and caring staff. We witnessed interactions between people and staff which were caring and compassionate. However, we also witnessed interactions where staff provided care without explanation to the person. On one occasion we saw care was provided for 15 to 20 minutes without the member of staff speaking to the person they were with.

Is the service responsive?

The service had a number of systems in place to monitor care quality including audits and visits by the provider's representative. Although these systems were in place they had not been used effectively to identify shortfalls or to make improvements to the service.

People and their relatives had opportunities to share their views at meetings but these had not always been responded to or acted upon.

Is the service well-led?

At the time of the inspection there was no registered manager in post. The acting manager had been employed for five months. The staff all told us that they lacked leadership and support. The provider's representative told us they were surprised to hear our feedback following the inspection because they had not been alerted to the failures by the acting manager. The provider's representative told us that they had met with the manager regularly and visited the service at least eight weekly. This meant that people could not be assured that the registered provider was operating an effective system to monitor the quality or safety of the service.

We spoke with eight people who told us that they were treated as individuals and that they were given information and choices in relation to their care. One person said “they are very good here, I do as I like and there are no problems”. Another said “I like my own company but the carers always come when I need them”. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations.

We spoke with four members of staff who told us they all enjoyed caring for people and worked well as a team. During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided that day before doing so.

We were shown examples of person centred care records which were organised into separate sections. This provided clear guidance for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

During our inspection of Brownscombe House we spoke with six people who used the service and a family member. We also spoke with the manager and four staff members. We spent time observing the interaction between people and staff in the home.

We found the interactions between staff and people who used the service to be positive, sensitive and friendly. People told us they were happy with the care and support they receive. People told us that they were treated with respect and their privacy and dignity was maintained.

One person said, "Staff treat me well and I have no concerns. I would not like to live anywhere else".

Another person said, "I like living here, it is very homely and comfortable and i wouldn't change a thing".

We spoke with with staff who told us that they were very happy working in the home. They told us the home had a relaxed and happy atmosphere. They felt supported in their work and felt the management was open and supportive.

People using the service told us that they thought the staff were kind and helpful and that they had no complaints about the service provided at Brownscombe.

Some people were complimentary about certain staff members and said that the service was friendly and homely.

People said they enjoyed the activities provided and if they didn’t want to join in staff listened to what they had to say.