The inspection took place on 16 and 17 September 2017 and was unannounced.

Brun Lea 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.

Brun Lea accommodates 20 older people and people living with dementia. The home is in a single storey building. There were 18 people living at the home on the day we inspected. Fourteen people had been diagnosed as living with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager was also managing another of the provider’s homes. People told us that this meant they did not see much of the registered manager and would raise concerns with the head of care for the home.

This was the second consecutive time the home has been rated Requires Improvement. We saw that improvements had been made in the safe and responsive key domains but more work was needed in the effective, caring and well led domains.

We found that the care provided was safe and people’s needs were met. However, people’s experience of living in a care home could be enhanced if the provider and registered manager implemented areas of best practice within the home.

We have made a recommendation about keeping up to date with guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the home support this practice.

The registered manager monitored staffing levels and ensured that there were enough staff to meet people’s needs. Staff received appropriate training and support to allow them to meet people’s needs safely. However, staff were focused on the tasks they were completing and failed to personalise the care to people’s individual needs.

Staff had received training in keeping people safe from harm and concerns were raised appropriately and investigated. Risks to people were identified and care was planned to keep them safe. The registered manager and staff worked with other care providers to ensure that information was shared when needed and that people received the care and support they required.

The environment was clean and staff knew how to keep people safe from the risk of infection. The home was also nicely decorated; however, it did not fully support the independence of people living with dementia.

People were happy with the quality of the food provided and were monitored to ensure they were eating enough to stay well. However, at times the care provided for people at mealtimes was not personalised to individual needs.

People had been involved in developing their care plans and were supported to make choices about their care. People’s care at the end of their lives was planned to respect their wishes and to keep them comfortable. People were happy with the activities provided.

The provider had effective systems in place to monitor the safety of the care provided. They also gathered the views of people living at the home and their relatives to make positive changes in the care they receive.

Brun Lea Care is registered to provide accommodation for up to 20 older people requiring nursing or personal care, including people living with dementia.

We inspected the home on 19 July 2016. The inspection was unannounced. There were 16 people living in the home on the day of our inspection.

The home had a registered manager (the ‘manager’) in post. A manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for nine people living in the home and was waiting for these to be assessed by the local authority.

We found some areas in which improvement was needed to ensure people were provided with safe, effective care that met their expressed needs and wishes.

The activities programme was poorly organised and did not provide people with sufficient stimulation or occupation. The provider’s use of best interests decision making processes was inconsistent which meant some people may have been deprived of their legal rights under the MCA. The provider’s approach to risk management and review was also inconsistent, presenting an increased risk to people’s safety. Audits and other systems used to monitor the quality of service provision were not always effective.

In other areas, the provider was meeting people’s needs effectively.

There was a homely, peaceful atmosphere and staff provided kind, person-centred care. Staff knew people as individuals and reflected this knowledge in the care and support they provided.

People were provided with food and drink of good quality.

Staff worked closely with local healthcare services to ensure people had access to specialist support whenever this was required. People’s medicines were well-managed.

The manager demonstrated an open and responsive management style and provided strong, passionate leadership to the staff team. The owners of the service maintained a regular presence in the home and were seen as friendly and supportive by staff at all levels.

There were sufficient staff to meet people’s care needs and staff worked together in a friendly and supportive way. The provider supported staff to undertake their core training requirements and encouraged them to study for advanced qualifications. Staff knew how to recognise signs of potential abuse and how to report any concerns.

People had confidence in the manager to resolve any concerns and any formal complaints were well-managed.

A single inspector carried out this inspection. 18 people were using the service at the time of the inspection, and we talked with four of these and two visitors. We observed the care being provided and looked at five people’s care records. We talked with two staff and the senior care worker on duty. The manager was on leave and not present during the inspection. We examined training records and documentation of quality audits.

This helped us to answer the questions below.

Is the service safe?

People told us they felt safe. Staff understood their role in safeguarding the people they supported and safeguarding procedures were robust.

Systems were in place to record accidents and incidents and reduce the risk of recurrence.

A policy was in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. We saw mental capacity assessments had been completed and decisions made in the person’s best interest when they were unable to make decisions for themselves.

Individual risk assessments had been carried out and care was planned in response to these. This meant care and support was planned in a way that was intended to ensure people’s safety and welfare.

Is the service effective?

Assessments of each person’s care and support needs were undertaken and care plans provided information on the support they required. They were reviewed regularly and updated as necessary to ensure the support provided was appropriate to each person’s individual needs.

Specialist equipment was in place to meet the needs of people using the service.

The service worked in collaboration with other agencies and professionals, ensuring care was effective and specialist input obtained where necessary.

Is the service caring?

People were treated with respect and dignity by staff.

People told us they were very happy at the home and they praised the attitude and attentiveness of staff.

People’s preferences, interests, and diverse needs were recorded and care and support was provided in accordance with their wishes.

People were supported to maintain their links with the local community and groups they enjoyed.

Is the service responsive?

We saw the service responded to the changing needs of individual people using the service and took account of their preferences.

People were given the opportunity to give their views on the service provided and action was taken to respond to these.

People knew how to make a complaint if they were unhappy. Information on the complaints process was provided in the entrance area of the home.

Is the service well led?

Policies and guidelines were in place to ensure safe and effective services were delivered.

There was a structured training programme in place to ensure staff maintained and further developed their knowledge and skills.

Staff felt well supported by the manager. They were encouraged to contribute their views to improve the service.

There were 18 people living at Brun Lea Care on the day we visited. We spent time observing care and spoke to one person living at the home and two relatives who visited during the inspection.

We saw assessments of people’s capacity to make decision for themselves or to consent to the care they received had been completed.

We spent time observing care. We saw staff were polite and courteous to people and called people by their preferred name. Staff checked with the person if it was ok to perform care for them.

People we spoke with told us they were happy with the care they received. A relative told us, “I didn’t want mum to be swamped in a big home. We have got on extremely well here. She has been here for two years.” Another relative said “We are very happy.”

People told us they were asked what they wanted to eat. One person said, “I enjoy the food, I have no complaints. They ask us what we would like for dinner.” A relative told us, “The food is good and if there are any problems they will give us a call.”

Appropriate checks were completed on staff before they were allowed to work with vulnerable people.

The provider had a complaints policy and records showed they had responded to complaints appropriately.

As the majority of people at Brun Lea had some form of dementia and could not tell us about the care they received, we completed a Short Observational Framework for Inspection (SOFI) over lunchtime. SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw there was a calm and relaxed atmosphere and people enjoyed their food. We saw where people needed support to eat; this was given at a pace that suited them.

We asked one person who could speak with us if the staff looked after them well. They told us, “They jolly well are, they are doing more than what is necessary.”

Records showed people where involved in their care. Where people did not have capacity decisions were taken in their best interest. One person we spoke with told us, “It doesn’t matter what you want or ask for they do it, everything is lovely.”

Medication was obtained, stored and disposed of appropriately. We saw people were given an explanation of what medication they were being given.

Care plans, staff records and management information were accurate, accessible and stored safely.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Some of the people that we spoke with were unable to answer direct questions about their care and welfare but in our conversations with people they seemed relaxed and at ease in their surroundings.

One relative we spoke with said “If anything is not right you can tell them and they accept it and put it right, the senior is brilliant.” They went on to say “There is a nice homely feel, it’s not institutionalised and the food is fantastic and looks appetising.” Another person told us “They look after you very well, nothing is perfect but this is quiet near to perfection.”