This unannounced inspection took place on 30 July 2018.

The Brambles Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 32 people. At the time of the visit there were 25 people who received support with personal care. Nursing care is not provided at this service.

The service was managed by a 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.

At the last inspection in January 2016, the service was rated ‘good’.

At this inspection in July 2018 we found shortfalls in relation to medicines management, safety checks, staff training and development, and good governance management. We found breaches of Regulations 12,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines management practices in the home were not robust and staff had not received up to date training and competence checks. Emergency lighting inspections had not been undertaken in line with regulations. The governance and quality assurance systems were not effective in ensuring the shortfalls were identified and rectified before the inspection. You can see what action we told the registered provider to take at the back of the full version of the report.

Improvements were required to the management of medicines in the home. People told us they received their medicines as prescribed and some staff had been trained in the safe management of medicines. However, we noted that further improvements were required to ensure people’s medicines were robustly managed. Medicines audits were not effectively identifying shortfalls and areas of improvement. There were shortfalls in the medicines storage practices and the management of ‘as required medicines’ were not robust.

Some of the staff had received induction and training. However, there were significant shortfalls in staff training and competence checks in various areas. The training policy needed to be reviewed to ensure it was up to date with current regulatory requirements.

The registered manager and registered provider used a variety of methods to assess and monitor the quality of care at The Brambles Rest Home. There were checks in various areas such as medicines administration, health and safety and infection prevention and control. However, we found the internal audit and quality assurance systems needed to be improved in areas such as medicines management staff training to ensure they could effectively identify areas of improvement and any shortfalls to the quality of the service. There were policies and procedures in place. However, some of these needed to be reviewed to ensure they were in line with current guidance and regulations. There was no evidence on how the registered provider had checked that registered manager was compliant with regulations. They informed us of the plans they are introducing in respect of this.

We received positive feedback from people and their relatives regarding the quality of care and staff approach. Views of a professional we spoke with were also positive. People who lived at the home told us that they felt safe. There was mixed feedback about the staffing levels in the home from visitors and visiting professionals. Visitors and people who lived at the home spoke highly of the registered manager and the care staff.

Staff knew how to report concerns to safeguarding professionals however 15 out of 19 did not have up to date safeguarding training. Accident and in

The inspection took place on 01 October 2015 and was unannounced. The inspection was undertaken by two adult social care inspectors.

At our last inspection on 08 & 09 May 2014, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to; Care and welfare of people who use services (Regulation 9), Staffing (Regulation 22), Assessing and monitoring the quality of service provision (Regulation 10) and Records (Regulation 20). Following that inspection, we received an action plan from the provider which explained changes they planned to make to improve the experience of people who used the service.

During this inspection, we looked at whether the provider had made the changes they had planned and whether they had improved the standard of the service provided. We found the changes that had been implemented had resolved the issues we identified at our last inspection.

The Brambles Rest Home is a large detached residence, situated in a residential area of New Longton near to the city of Preston. The home provides 24 hour personal care and accommodation for up to 32 older people. All bedrooms have ensuite toilet facilities, some have showers and there are five different communal areas. There is a passenger lift to the first floor and all areas are wheelchair accessible. There are extensive gardens with outdoor seating areas and a large car park.

The service had a long-standing 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 experienced safe care and support form staff that had been properly recruited and were skilled and knowledgeable. The service identified and managed risks to people's health, safety and well-being and kept them under review.

The service had systems and processes in place to ensure the safe management of medicines. Staff who administered medicines had been trained appropriately and their competence checked. A quarterly visit from the local medicines optimisation team took place, with the aim of improving the overall experience for people who received medicines at the home.

Staff received regular one-to-one supervision sessions with the registered manager to discuss performance, training, aspirations and other topics. Staff told us they felt well supported by the manager and had access to the training they needed.

People were complimentary about the selection and the quality of the food provided. We saw people enjoyed the mealtime experience.

People were able to access external healthcare services, such as dentists, doctors and chiropodists, which helped to maintain their overall healthcare needs.

The staff team were described as 'friendly', 'kind' and 'caring'. We saw that people's privacy was respected and dignity promoted by staff at the service. However, there were occasions when staff seemed to be rushing to complete tasks which affected the quality of interactions with people in their care. The provider assured us they would address this following our inspection.

People were involved and consulted with regard to planning their care and had their individual needs and preferences taken into account in the way care was delivered. Regular review of people's needs and plans of care helped to ensure that the care delivered was safe and suitable for them.

Feedback from people who used the service, their relatives, staff and visiting professionals was sought via a range of means. The feedback we saw and were given by people we spoke with was complimentary. The provider had implemented a suitable complaints procedure and people knew how to raise concerns or complaints.

The service was led by an experienced manager, with a committed staf