This inspection took place on 22 and 23 February 2017 and was unannounced.

Arden Grange Nursing Home provides accommodation and nursing care for up to 45 people. On the days of our inspection 42 people were living there.

At the last inspection on the 8 and 9 February 2016 we identified that improvements were needed regarding all five of the key questions. These were, is the service safe? Is the service effective? Is the service caring? Is the service responsive? And is the service well-led? We identified one breach of regulation 12, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider sent us an action plan in August 2016 telling us what they would do to make improvements and meet legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to ensure the quality of care people experienced had improved.

A registered manager was in post and present throughout this inspection. 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 received help with their medicines from staff who were trained to safely support them. Medicines were stored safely and in accordance with their individual risk assessments.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. People had individual assessments of risk associated with their care. Staff knew what to do in order to minimise the potential for harm.

The registered manager and provider had contingency plans in place for times of emergency to ensure people did not receive disruption to the care they received.

People were supported by enough staff to safely meet their needs. The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if needed.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an introduction to their role and were equipped with the skills they needed to work with people. Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People and staff felt able to express their views and felt their opinions mattered. People had positive relationships with the staff members who supported them. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently. People were supported to eat and drink sufficient amounts to maintain good health.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and their families and encouraged feedback. People felt confident they were listened to and their views were valued.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that the service was safe because people were protected against the risks associated with the use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

Staff employed to work at the home were suitable and had the necessary skills and experience.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

We found care plans for managing medicines were detailed and gave clear guidance to care workers about how to administer and handle medicines appropriately.

People told us they were generally happy with the care they received and their needs had been met.

From speaking with staff it was evident they had a good knowledge of the people they supported.

Is the service effective?

We found care plans for people were detailed and gave clear guidance to care workers about how to support people.

People told us they were generally happy with the care they received and their needs had been met.

Staff were knowledgeable about people’s needs. One person who used the service told us, “They’re all wonderful here.”

Is the service caring?

People were supported by kind and attentive staff who knew them well and spoke positively about people as individuals. Care records showed people were cared for using individual approaches.

Is the service responsive?

People’s needs were assessed before they were provided with support by the service. People’s needs were regularly reviewed and their health monitored. Where appropriate referrals were made to other health professionals this was done in a timely manner.

Is the service well-led?

We saw systems for quality assurance and monitoring at the home. These included medicines, infection control and accidents and incidents. It was clear that the registered manager carried out regular audits which ensured people received good care and support.

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People who could talk to us told us they felt involved in the running of the service and felt their opinions mattered. Staff were clear about their roles and responsibilities.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are very helpful” and another said, “The staff are wonderful”.

The provider had developed a system whereby they can monitor how well the home was meeting the needs of the people who live there.

We saw maintenance, repair and improvement work being carried out in communal and private areas within the home. This involved such things as new flooring, decorating and installing new doors in the corridors.

You can see our judgements on the front page of this report.

Some of the people who lived in this service were unable to talk with us. Because of this we looked at records, talked with staff and observed the way that the care was provided.

Some people were able to say that they were well looked after. They said the staff always asked them how they would like things to be done, were always mindful of their privacy and treated them with respect. They told us staff talked to them about how they would like their support to be provided.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “Staff are very good”.

We visited this home on 24 July 2012.

A number of the people who lived in this home were unable to tell us about their experiences. To understand what they experienced we looked at the records that the home had developed about five people. We found that this information was accurate enabling us to ask questions in a way that would allow people to understand what we were asking and therefore express what they thought.

We also used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

People who lived in the home told us that the staff had explained to them what care and treatment they would be receiving.

People told us that they had a range of meals that they could choose from and that it was well prepared and presented. One person said, “It’s pretty good and plenty of it”.

We were also told that there was a range of activities available for people to take part in should they wish to.

We also talked to people who were visiting friends or relatives. They told us that the home had always made them feel welcome.

The people who lived in this home told us that they felt able to raise any concerns with the manager or one of the staff.

Those people also told us that they felt safe living in this home. They were very complimentary about the people who work in the home saying such things as, “They are a helpful lot” and another person described them as “a very nice bunch”.

People who were able to share their experiences of living at Oldfield were positive about the care they receive. They told us that staff respect them and “are very caring”. People considered that their privacy and dignity is upheld and said staff “work very hard” to meet their individual needs. They felt that that there is enough staff to look after them. People told us that they have opportunity to partake in activities if they desire and that their visitors are always made welcome and offered refreshments. People said they enjoy their meals and that their bedrooms are comfortable and warm.

A professional told us that they are always made welcome when they visit the home and that they have no concerns in relation to staff competency. Another professional told us that staff, “are very keen to learn” in the best interests of the people they care for.

Two visitors told us that their relative has a “good quality of life” at Oldfield. They said they are always made welcome and are kept well informed about the care and welfare of their relative. They told us, “Staff are very kind and have implemented suggestions we have made”. They said that they were happy with the staffing levels and that they have noticed many changes being made to personalise the home. They said, “The home is relaxed and well managed”.

Staff told us that the home has “definitely improved over the last few months”. They reported that staff morale is “brilliant” and “very good” and that changes made to the team has had a positive impact on the home and the service people now receive. They said that staff sickness and use of agency staff has “significantly reduced” therefore providing greater continuity of care for the people living at Oldfield. Staff reported they receive lots of training opportunities to meet the individual needs of the people using the service and that they receive support through regular team meetings, handover meetings and formal supervision.

This inspection was unannounced and took place on 8 and 9 February 2016.

Arden Grange Nursing Home provides accommodation and nursing care for up to 45 people. On the days of our inspection the home was fully occupied.

It is a condition of this provider’s registration that they have a registered manager but there has not been one in post since August 2015. The provider had appointed a manager in November 2015. The manager told us they had not submitted an application to register 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.

People were not supported appropriately to take their prescribed medicines and they did not always receive their treatment. Staff were nearby to support people with their care needs. Staff had access to risk assessments to promote their understanding about how to care for people safely. People felt safe living in the home but not all the staff knew about external agencies to share concerns of abuse with.

Some parts of the premises were unsafe and fire safety systems had not been maintained to ensure the safe evacuation in the event of an emergency. Practices within the home did not always support people’s privacy or dignity. People had a choice of meals but menus did not always reflect what was on offer and practices did not always ensure people had enough to eat.

People’s privacy and dignity was not always promoted but the majority of staff were kind and caring. People were not involved in their care planning but were happy with service they had received.

People had access to healthcare services but services were not always obtained on their behalf in a timely manner. People were supported by staff who had access to routine training but staff were not regularly supervised. Best interest decisions were made on behalf of people who were unable to make a decision.

People were not supported to pursue their specific hobbies and interests. Complaints were not always managed appropriately to resolve concerns and to improve the service where needed.

There were no systems in place to enable people to have a say in the way the home was run. People were not supported to maintain links with their local community. Some people were unaware of who the manager was but those who did said they were approachable. Systems to monitor the quality of the service provided were not effective to identify the shortfalls we found and people were at risk of not receiving a high standard of care.