This inspection took place on 20 and 22 September 2017 and it was unannounced. At the last comprehensive inspection in November 2016, we asked the provider to take action to make improvements to the personalised care people received to ensure that care provided met people’s needs and reflected their preferences. We received a provider action plan which stated the service would meet the regulations by March 2017.

At this inspection we found that there had been improvements in the service and was no longer in breach of regulation; however there were still areas in need of improvement.

Brunswick Court Care Centre is registered to provide accommodation and nursing care for up to 91 people. Some people may be living with dementia. At the time of our inspection there were 80 people living at the service with one person having recently been admitted to hospital.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of our inspection the registered manager was unavailable to participate in the inspection process because they were on annual leave. A deputy manager was however overseeing the service in their absence. Another registered manager from the provider organisation came to the service to provide support to the deputy manager and to assist the inspection process on both days.

We received mixed views regarding the attitudes of staff. Most people we spoke with felt that staff were kind and respectful however we received reports of two incidents where people had experienced being spoken to in an abrupt or rude manner. People felt that privacy and dignity was maintained and promoted throughout their care.

People's needs had been assessed prior to admission at the service and individualised care plans took account of their needs, preferences and choices however we found that two care plans with regards to specific clinical needs were not in place. Care plans and risk assessments had been regularly reviewed and updated to ensure that they were reflective of people's current needs. People felt involved in deciding the care they were to receive and how this was to be given.

People felt safe. Staff were knowledgeable with regards to safeguarding people and understood their responsibilities to report concerns. There were effective safeguarding procedures in place and staff had received safeguarding training.

Potential risks to people’s health, safety and wellbeing had been identified and personalised risk assessments were in place. Incident and accidents were recorded and analysed by management to help ensure that action was taken to reduce the risk of reoccurrence.

People received their medicines as prescribed. There were effective systems in place for the safe storage and management of medicine and regular audits were completed.

There were sufficient numbers of staff on duty to meet people's needs. Staff recruitment was managed safely and robust procedures were followed to help ensure that staff were suitable for the role they had been appointed to, prior to commencing work.

Staff received regular supervisions and appraisals and felt supported in their roles. A full induction was completed by staff when they commenced work at the service followed by an ongoing programme of training and development.

People were supported to make decisions about their care and support. Decisions made on behalf of people were in line with the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Consent was gained from people before any care or support was provided.

A varied menu was offered at the service and people were satisfied with the meals provided

We carried out an unannounced inspection on 1 November 2016.

Brunswick Court Care Centre is registered to provide accommodation and nursing care for up to 91 people.

The service had recently employed a manager who was in the process of registering with the Care Quality Commission. 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 provider had effective recruitment processes in place, but people did not always feel that there was sufficient staff to effectively support them. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by staff who were not always caring and respectful towards them. They also felt that some staff did not know them well. Staff felt that they knew the people they supported well. Relatives we spoke with described the staff as caring.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices but these were not always carried out in practice. Staff were unable to support people with their choices on how they wanted their care to be delivered.

This is a breach of Regulation 9: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Person-centred care.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The service supported people with health care visits such as GP appointments, optician appointments, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. The provider also had quality monitoring processes in place.

We carried out an unannounced inspection on 21 January 2016.

Brunswick Court Care Centre is registered to provide accommodation and nursing care for up to 91 people. At the time of the inspection, there were 84 people being supported by the service.

The service had recently employed a manager who was in the process of registering with the Care Quality Commission. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who they felt knew them well. Staff also felt that they knew the people they supported well. Relatives we spoke with described the staff as very good and caring.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits such as GP appointments, optician appointment, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

During our inspection on the 30 August 2013 we found that the home was not meeting the standards relating to consent to care, care and welfare of the people and staffing.

During this inspection we set out to find if the home was now meeting the needs of people’s and to answer our five key questions; Is the service caring, responsive, safe, effective and well led?

The inspection was carried out by two inspectors over one day.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We considered our finding at our previous inspections and paid particular attention to staffing levels to ensure people were kept safe.

We found that people who used the service were protected from the risk of harm. Staff who worked at the service were aware of people's individual needs and how to keep people safe. Staff members demonstrated that they knew how to support people safely and minimise risk. We saw records which evidenced that staff members had received training in the protection of vulnerable adults. The staff we spoke with were able to describe what constituted abuse and the process they followed if they needed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for ten people who lived at Brunswick Court. We found that the care plans contained appropriate person centred information to inform care staff how to support people in an individualised way. We saw that the home had included the person or their representative in care planning. People told us that the staff always get the consent before care was delivered.

Is the service caring?

By caring, we mean that staff (involved and) treated people with compassion and kindness.

We observed the staff to be caring, compassionate and spent quality time with people who used the service. We noted that staff knew the people they were supporting and were aware of people's abilities and needs. We observed the staff to be patient with people who used the service.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. We found the staff responded appropriately when required. We saw evidence that the staff were aware of how to respond to people both in a planned way and also in response to their needs when required. People told us that their call bells were answered promptly both during the day and at night.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care. We found that the home was managed in the best interests of the people who lived there. We saw that there were audits in place that ensured all aspects of care delivery was audited and where necessary action were put in place to address any areas of concern.

There had been some improvement since the last inspection. The administration of medication was found to be compliant and the storage of records had improved. However we found the compliance actions we made in relation to respect and dignity and to the staffing levels had not been met. We also found that the care and welfare of the people was not always promoted.

We found that the activities in the home were not tailored to meet the personal needs of the people. Activities were held in an activities room on the middle floor of the home, the timing of the activities was not always convenient or appropriate; some of the people were not up and dressed in time to join in the activities.

People told us that while some of the staff were kind and lovely they said that they were always busy and that they sometimes didn't call for assistance because their call bell didn't always get answered.

some people told us that they liked to sit in the garden but that staff did not always offer them the opportunity to sit outside. People told us that they had to wait until their relative visited so they could take them into the garden. We did note that some people had been assisted by staff to spend time in the garden but most of the people had been assisted by their visitor/s.

People told us that they were not always offered a bath or shower and that their personal care needs were usually met by having a ‘bed bath’.

People told us they like living at Brunswick Court care centre, because the staff are very kind and caring.

The people who use the service told us that the staff always asked how they were and told them what they were going to do to assist them. One person told us that the staff were respectful and gentle. Another told us that they are treated with respect. Another said that they have a nice chat with the staff while they are washing and dressing them. One person told us that the staff are good fun and that they make meal times the best part of the day.

During the two days of our visit we observed positive and respectful interaction between the people who lived at Brunswick Court Care Centre and the staff who supported them.

People gave a variety of views about their experiences. Individuals told us that the staff were, “caring” and “looked after them well”. Other people told us they had to wait if they called staff and did not have regular showers. We were told that the staff, “seem to be very busy” and there “were not enough of them around”.

We assessed that people’s nursing needs were being met and that they had access to a range of community health care professionals, where specialist services were required.

The staffing levels and skill mix we observed meant that people had to wait to have their care needs met and choices about how they spent their time were limited. People described not being able to attend activity sessions because it was not their turn to get up early or staff were not available to take them.

People were not being protected against the risk of infection because a medical device had not been cleaned appropriately and attention was needed regarding the cleanliness of the environment and catering equipment.

We identified that people had experienced their medicines not being available as they had run out.

People’s privacy had not been protected as patient records had not been stored securely.