This inspection took place on 14 and 20 June 2017. The first day was unannounced and the second day announced. At the last comprehensive inspection in 12 April 2016 and 18 April 2016 the registered provider did not meet the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and breaches were found for safe care and treatment, management of medicines and governance of the home. It was rated as Requires Improvement.
Our regulatory response to these breaches in relation to the unsafe care and treatment and management of medicines was a warning notice informing the provider of the actions they had to take to meet the regulations. In relation to good governance we asked the provider to send us a report that said what action they were going to take to make improvements.
On the comprehensive inspection In April 2016, in addition to the breaches we made a recommendation about staff providing more frequent person-centred activities in the home and community. We also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. People told us some staff restricted them from having drinks or snacks at night. Also several bedrooms, corridors, furniture and furnishings were unclean and unhygienic.
We carried out a focused inspection visit on 31 January 2017 and checked what progress had been made in relation to the breaches. We saw during the focused inspection, the service had made improvements and were no longer in breach of the regulations. People received safe care, medicines were managed safely and governance of the home had improved. However we needed to see these improvements were sustained so the rating was not changed on the focused inspection. Neither did we look at the recommendations from the April 2016 inspection.
There had been a change of manager since the last comprehensive inspection. They were registered with the commission just after this inspection visit. 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.
Bronswick House is registered to provide personal care for fourteen people whose needs are associated with their mental health. The home offers support for life and does not offer rehabilitation services. It is set on two floors with three bedrooms on the ground floor and ten on the first floor. It is situated in a residential area, and is close to the public transport.
Although a small number of people had limited verbal communication and were unable to converse with us, we were able to speak with six people who lived at the home. People told us they felt safe at the home. They said staff were friendly and supportive and looked after them. Procedures were in place and risk assessments had been modified and improved and reduced the risks of unsafe care or actions. People told us they were treated with kindness and respect. We observed staff provided supportive and sensitive care during the inspection.
People said there were enough staff to give them the support they wanted. We saw there were enough staff to provide safe care and supervision and for people to receive support to go out in the local area.
Staff had acted on the recommendation made at the last comprehensive inspection to provide more activities and introduced various games, gardening and walks. We had also made a recommendation about staff supporting people who lacked capacity to make decisions in a timely way. We saw this had been acted upon and best interest meetings held. At the last comprehensive inspection people told us some staff restricted them from having drinks or snacks at night. The registered manager had provided people with facilities for drinks whenever they wanted them.
At the last comprehensive inspection, several bedrooms, corridors, furniture and furnishings were unclean and unhygienic. On this inspection infection control practice had improved. The home was clean and hygienic. The décor of the home and the environment had started to improve. The registered manager had arranged for several rooms to be painted and maintenance work to be completed. However, a rolling programme of redecoration and maintenance was needed to continue to improve the quality of the environment.
We looked at the recruitment of two recently appointed members of staff. We found appropriate checks had been undertaken before they had commenced their employment. This reduced the risk of appointing unsuitable staff. Staff had been trained and had the skills and knowledge to provide appropriate care to the people they supported. We saw regular support and supervision was provided to staff.
Medicines were managed safely. People said staff supported them with their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.
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 told us the meals had improved and they enjoyed them. People were offered a choice of nutritious meals. One person said, “The meals have improved so much since [registered manager] came. We get home made rice pudding now, which I love.”
We saw staff were knowledgeable about and acted promptly to support people with their health care needs. Care plans had been developed to be more informative and personalised, involved people and where appropriate their relatives and were regularly reviewed.
People said they knew how to complain if they needed to. They said they had opportunities to express any comments or complaints and were listened to and action taken.
People told us the registered manager and staff team were approachable and supportive and listened to them. They said they felt the home had improved and they were more involved in decisions since the registered manager’s arrival. Staff said the registered manager was supportive and encouraging.
We found systems and procedures were in place to monitor and assess the quality of the service. These included seeking views of people they supported through informal discussions, formal meetings and satisfaction surveys.