Brymore House 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. Brymore House is registered to accommodate up to 52 people. The service has two units, one with 27 beds which provides nursing care to older people and the other with 25 beds which provides intermediate care and rehabilitation. There were 52 people living at the home when we visited.

This unannounced inspection took place on 21 December 2018. At our last inspection in June 2016 the service was rated ‘Good’. At this inspection we found the service continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. We found the service remained Good.

The service had a registered manager when we visited. 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 management plans in place which provided guidance to staff to reduce risks to people. Staff were trained on safeguarding adults from abuse and knew the procedures to follow to report abuse and to protect people. There were sufficient staff to meet people’s needs and recruitment checks were conducted before new staff were employed.

The health and safety of the environment was maintained. Staff were trained in infection control and followed procedures to reduce risks of infection. People’s medicines were managed in line with safe medicine administration and management guidelines. Records of incidents and accidents were maintained, and the registered manager reviewed them to ensure lessons were learned and to reduce the risk of repeat occurrence.

People’s needs were assessed, planned and delivered in a way that met their individual needs and requirements. People were supported to eat and drink enough to meet their nutritional needs. Staff received training, support and supervision to provide effective care to people and to carry out their duties effectively. People had access to healthcare services they needed to maintain good health. The provider had arrangements and systems in place to ensure people received well-coordinated care and support.

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 service supported this practice. People gave consent to the care and support they received. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Relatives and healthcare professionals were involved in making decisions for people in their best interests where this was appropriate.

Staff understood people’s emotional needs and gave reassurance and comfort when needed. Staff provided people with reassurance and comfort when needed and treated them with respect and dignity. Staff supported people to maintain and gain independence with activities of daily living. Staff also communicated with people in a way they understood.

Staff were trained in end-of-life care. People’s end-of-life wishes were documented in their care plans, to ensure these were implemented appropriately. People were also encouraged to participate in activities they enjoyed. The service supported people’s needs with regards to their disabilities, culture and religion. Staff had received equality and diversity training.

The service obtained th

We carried out this inspection on 14 and 24 June 2016 and the inspection was unannounced.

We last inspected this service on 29 September 2014 and the service was meeting all areas inspected.

Brymore House Care Home with Nursing provides care, treatment and accommodation for up to 53 people. The service has two units, one with 31 beds which provides nursing care to older people and the other with 22 beds which provides intermediate care and rehabilitation.

The service had a registered manager in post. 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 were protected against the risk of avoidable harm and abuse. Staff had undertaken safeguarding training. Staff were aware of the different types of abuse and the appropriate process in reporting concerns of alleged abuse. The service had risk assessments in place that were regularly reviewed and identified known risks. People were not deprived of their liberty unlawfully. The registered manager and staff had sufficient knowledge of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] and their responsibilities within the legal framework. People’s consent to care and treatment was obtained prior to care being delivered.

People received care and support from sufficient numbers of suitable staff to meet their needs. The service had robust procedures in place to ensure suitable staff were employed. Prior to employment the service obtained Disclosure and Barring Service [DBS] checks, references and photo identification for all staff.

People received their medicines safely. The service had robust systems in place to ensure medicines were administered, recorded, stored and disposed of in line with good practice. Staff had comprehensive knowledge of the medicines they administered and the correct procedure in ensuring identified errors were addressed immediately.

People were supported by staff that were skilled and knowledgeable in meeting their needs and reflected on their working practices. Staff underwent on-going training to ensure they were able to meet people’s needs. Staff received all mandatory training, for example, first aid, moving and handling, safeguarding and mental capacity. Staff received supervisions and annual appraisals where they looked at areas of improvement, training needs and best practice.

People were provided with sufficient amounts of nutritious food and drink. Staff monitored people’s food and fluid intake and were aware of the importance of sharing any concerns with health care professionals. People were supported to access health care services to ensure their health was monitored and maintained.

People were encouraged to make decisions about the care and support they received. People’s views were sought by the service through quality assurance questionnaires. Action was taken to address any concerns raised in a timely manner. People’s privacy and dignity was respected, staff were aware of the importance of maintaining people’s confidentiality at all times.

People’s care was person centred and responsive to their needs. Care plans were comprehensive and contained vital information about people’s history, diagnosis, preferences, medical needs and goals. Care plans were reviewed regularly to reflect people’s changing needs and input from health care professionals was sought.

People knew how to raise their concerns and complaints. People were able to raise their concerns without fear of reprisal. The service responded to complaints in a timely manner and sought to achieve a positive outcome for all. Lessons were learnt from complaints and appropriate action taken. The service had a comprehensive complaints policy for staff to f

One inspector carried out this inspection at Brymore House Care Home with Nursing. During the inspection, information was gathered to answer five key questions; is the service safe, effective, caring, responsive and well-led? We spoke with eight people who used the service, six staff members and five relatives. Below is a summary of what we found.

Is the service safe?

Staff were trained to support people safely. Risks were assessed for people and plans were in place to address identified risk. Staffing levels were adequate, staff were trained and competent in their roles and the home was staffed 24 hours per day.. There was a plan for how staff should respond to emergencies. Medicines were handled and administered safely.

The home was clean and in a good state of repair. Health and safety systems were in place and risk assessments were carried out and actions plan implemented. People told us they felt safe living at the home. Appropriate moving and handling equipment was provided for people who had mobility needs and staff had received training in using them.

Is the service effective?

People’s care was planned and delivered in a way that met people’s individual needs. The provider involved other healthcare professionals in the planning and coordination of people’s care and treatment. People were supported appropriately to achieve their goals through rehabilitation programmes. People were supported to take part in activities at the service and in the community.

Is the service caring?

Staff understood the needs of people they supported. People who used the service told us that they were treated with dignity and respect and staff were caring and nice to them. Staff interacted and responded to people in an open and positive manner and spent time with them doing activities they enjoyed. We observed that staff knocked on people’s doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

Care plans and risk assessments were reviewed monthly and reflected people’s changing needs. People were given the assistance they required to eat and drink. The provider liaised with other health and social care professionals to address any concerns about a person’s care and welfare. Staff responded to people’s calls for assistance promptly.

Is the service well-led?

There was a registered manager in post who demonstrated an understanding of the service and provided leadership to staff. The home had a stable management and staff team. The turnover of staff was low. Staff we spoke with demonstrated understanding of their roles and told us they enjoyed their jobs.

There was a range of quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People and their relatives had meetings with managers and discussed concerns. The provider carried out monthly reviews of the service. A customer satisfaction survey was conducted annually and feedback was acted upon.

The Care Quality Commission had received concerns regarding the care of people using the service, and criticism of the food being provided.

We spent time observing how people were looked after in the main lounge, and also observed lunch. We found staff were responsive, attentive and treated people in a kind and considerate manner.

We saw that people were offered a choice of meal for lunch, which was hot, well presented and appetizing. The catering staff were wearing appropriate clothing in the kitchen and the chef was carrying out daily temperature checks of the hot food.

We also reviewed care records, as the provider had not been compliant in this area at the last inspection. We found that there had been a number of improvements in the record keeping however some records were still not accurate.

The care records we examined on the nursing unit were up to date however those we reviewed on the rehabilitation unit had not been reviewed or updated in line with the provider's own policy. We also found that fluid charts were not accurately kept.