This inspection was carried out on 20 September 2016 and was unannounced. At their last comprehensive inspection in November 2015 the service was found to be in breach of Regulations 9, 10, 13 and 17 of the Health and Social Care Act (Regulated Activities) 2014 Regulations. We undertook a focused inspection on 15 March 2016 to check that the provider had followed their action plan and to confirm that they had addressed the legal requirements. At the inspection in March 2016 we found that improvements had been made however, we could not improve the rating of the service at that time because to do so requires consistent good practice over time.

Benslow Nursing Home provides accommodation and personal care for up to 35 older people, some of whom live with dementia. At this inspection 28 people were living at the service.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

People felt safe and staff knew how to identify the risk of abuse. We found that individual risks were assessed and managed. There were sufficient staff to support people and they had been recruited safely. People’s medicines were managed safely.

People were supported by staff who were trained and supervised. People had their capacity assessed and consent sought and Deprivation of Liberty applications had been applied for appropriately.

People were supported to eat and drink sufficient amounts and there was regular access to healthcare professionals. Professionals were positive about the service.

People were treated with dignity and respect and were involved in the planning of their care. We found that confidentiality was promoted.

The provision of activities required some development and the service was without a regular activities organiser due to long term leave. The registered manager was trying to recruit to the temporary post.

People received care that met their needs and new care plans were being introduced, these were clear and informative. People and their relatives knew how to make a complaint and these were responded to appropriately.

People knew the registered manager well and were positive about them as well as the management systems. There were systems in place to monitor the quality of the service. The staff were clear on the role and shared the same ethos as the registered manager.

We carried out an unannounced comprehensive inspection of this service on 10 November 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 9, 10, 13 and 17 of the Health and Social Care Act (Regulated Activities) 2014 Regulations.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Benslow Nursing Home on our website at www.cqc.org.uk

Benslow Nursing Home provides accommodation and personal care for up to 35 people. There were 30 people living at the home on the day of our inspection.

The service had a registered manager in post. 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 and associated Regulations about how the service is run.

People received care that met their individual needs. This was in relation to personal care, pressure care management, and support with mobility and continence care. Support was carried out safely with staff working in accordance with risk assessments, care plans and the training they had received. Following our last inspection, targeted training had been provided to address the shortfalls we identified.

There were systems put into place to oversee staff practice and to provide them with guidance and support. New roles had been developed to give staff responsibilities to help instil and sustain good practice. These roles were champions in specific areas such as falls, nutrition and dementia care. Staff were more positive and working in line with the management team’s aims and ethos.

The management team were open and honest and had shared lessons learned with the staff team and also people who used the service and their relatives. People, their relatives and staff were all positive about the management of the service and the recent improvements across the home.

This inspection was carried out on 10 November 2015 and was unannounced. We inspected the service in response to concerning information we had received about the care people received. We found the concerns to be accurate and people had not consistently received good care at Benslow Nursing Home.

Benslow Nursing Home provides accommodation and personal care for up to 30 older people, some of who live with dementia. There were 28 people living at the service on the day of our inspection. There was a registered manager in post. 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 and associated Regulations about how the service is run.

When we last inspected the service on 13 May 2015 we found them not to be meeting the required standards in relation to the management of medicines. At this inspection we found that they had addressed the issues in relation to medicines and they were now managed safely.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. The manager and staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty. However, we noted that one person may have been unlawfully deprived of their liberty due to the use of bed rails.

People’s care needs were assessed and documented. However, care was not always provided in accordance with these needs, training or guidance and as a result people were at risk of inappropriate and potentially unsafe care. Staff were aware of people’s needs but there were gaps in training provision.

People’s weight and health was monitored. However, there were concerns in relation to the risk of missed meals and fluids. We also found concerns in relation to the use of pressure relieving equipment as mattresses were not set correctly and cushions were not in use where they were required. People were on their own in their room for long periods of time with limited engagement from staff and consideration to the environment, such as lighting and things to occupy people were not considered by staff.

There were systems in place to monitor the quality of the service. However, they were ineffective as they had not identified all the concerns we found during our inspection.

We found that the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.

This inspection was carried out on 13 April 2015 and was unannounced.

Benslow Nursing Home provides accommodation and personal care, which includes nursing care, for up to 35 older people. There was a registered manager in post. 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 and associated Regulations about how the service is run.

When we last inspected the service on 20 June 2013 we found them to be meeting the required standards. At this inspection we found that they had not met one of the standards because medicines were not always managed safely. The quantities held in stock of some medicines did not accurately reflect the records that were held.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People living at the service and their relatives said their needs were being met in a way they preferred. Everyone spoke highly of the management and staff team. People were given choice and their dignity was respected.

People told us they felt safe and staff knew how to promote people’s safety. They knew what to do if they were concerned a person was at risk of abuse. Staff were aware of people’s individual risk and the manager reviewed accidents and events to minimise further occurrences.

Staff knew people well and responded to them appropriately. Care plans were in place and included people who were living at the service and their relatives where appropriate. These were reviewed monthly.

Some training was overdue. However, staff refresher training was planned for all staff to ensure they continued to have the appropriate knowledge and guidance for their role. Staff felt sufficiently supported.

There were systems in place to assess monitor and improve the quality of the service. People, their relatives and staff were regularly asked for their feedback and which was acted upon.

During our inspection, we found that people were well cared for and actions had been taken to address previous areas of non compliance.

We found that staff asked people for consent and acted in accordance with their wishes when providing care and treatment for people at the service. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. For example, one person had a deprivation of liberty documentation in place to protect them from leaving the service unescorted. Staff were aware of how to support people to make decisions about their care and how to use the mental capacity act to promote their best interests.

People’s needs were assessed and person centred care and treatment was planned to ensure people’s safety and welfare. Care plans and risk assessments were regularly reviewed, and activities provided to support their individual needs. People we spoke with and feedback from their relatives told us they were happy with the care being provided. People were supported to be able to eat and drink sufficient amounts to meet their needs and care plans were in place to support this.

Staff received regular mandatory and refresher training, and were given opportunities to develop professionally, through additional courses, supervision and appraisal. Feedback from people and relatives using the service were used along with audits of the service to assess and monitor the quality of the service.

We spoke with one person who used the service, two relatives and a visiting professional. We spoke with five members of staff. The person who used the service was happy with the care they received. Relatives told us that they thought the care was good and that they felt involved in decisions. The professional considered the care to be good and the staff to be responsive. We saw that staff demonstrated warmth towards people and that they knew people's individual needs and preferences. Staff spoke to people with respect and courtesy although we did note the use of the term 'feeds' to describe people who need support to eat. This may not maintain people's dignity and self esteem.

We looked at care records which were detailed and individualised. The records outlined people’s needs and equipped staff with good quality information. This enabled staff to support people well.

We looked at staffing rotas and found that adequate numbers of suitably experienced and qualified staff were on shift.

We found that people's views were sought about the quality of the service. These views were not formally taken forward and developed into an action plan to demonstrate what changes the service intended to make.

The service had a call alarm system. Call buttons were placed out of reach for two people and could not be located in two other instances. This meant that if people had needed to contact staff they would have been unable to, potentially placing them at risk of harm.

The people who live in Benslow Nursing Home, their relations and representatives told us that the people who live in the home are well cared for. They told us that they are cared for in a manner that promotes their dignity, independence and health. They told us that the staff and manager treat them in a respectful manner and ensure that they are consulted on how their care is delivered.

They told us they know how to complain though they never had an occasion to do so.