Bickerley Green Care Home with Nursing is registered to accommodate up to 60 people. The home provides personal care and nursing care for older people some of whom may be living with dementia.

The inspection took place on the 30 of November and the 1 December 2016 and was unannounced.

The service had 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.

People told us they were safe and well cared for at the home. People knew how they could raise a concern about their safety or the quality of the service they received.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff deployed to provide the support people needed. People received care from staff that they knew and who knew how they wanted to be supported.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people. People were included in decisions about their care.

Staff knew how to identify abuse and protect people from it.

People were provided with meals and drinks that they enjoyed. People who required support to eat or drink received this in a patient and kind way.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Mental Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

People and relatives were asked for their views on the service and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

Our inspection of 4, 14 and 16 October 2013 found that the service was not always meeting people’s care and welfare needs. People were not protected from the risks of inadequate nutrition and dehydration, or against the risks of abuse and infection. There were not enough qualified, skilled and experienced staff to meet people's needs. The provider did not have an effective system to regularly assess and monitor the quality of service that people received. The provider wrote to us in November 2013 and told us the measures that were being taken to address the issues and comply with the regulations.

At this inspection we looked at these areas to check the progress the provider had made. We found that the provider had met the compliance actions we had set. We spoke with 11 people who use the service and four relatives. We also spoke with the registered manager, deputy manager and 16 staff, including nurses, care workers, domestic and kitchen staff. We looked at care and treatment records for eight people who use the service.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found –

Is the service safe?

The service is safe because there were enough qualified, skilled and experienced staff to meet people’s needs. We saw that staff wore personal protective equipment, such as gloves and aprons when providing personal care and when serving food. Staff we spoke with were aware of those people on their units who needed support and encouragement to eat and drink sufficient amounts. This helped to ensure that people were protected from the risks of inadequate nutrition and dehydration. Staff were also aware of the systems that were in place to safeguard people who use the service from abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. This procedure is to ensure that an individual's liberty is restricted only when it is in their best interests and there is no other way to take care of that person safely. Since the last inspection a new application had been submitted. Proper policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

The provider had taken steps to improve the effectiveness of the way that care was delivered. Peoples’ needs were assessed and care and treatment was planned and delivered in line with their needs. For example, people had care plans and equipment in place to support skin integrity and there was a clear process in place for the recording of wound care.

Although systems were in place to identify and deliver the social and emotional support that people may need, for two people these had not yet been effective in identifying suitable responses to their needs. While we saw evidence of significant and continuing improvement, there were still a few inconsistencies in peoples’ care records. However, staff we spoke with demonstrated their understanding of the needs of people using the service and how to support them.

Is the service caring?

People who use the service commented positively about the care they received. One person told us “The care is very good here” and another said “The staff are very kind”. Another person commented “We are well looked after in here; the staff often come and have a chat with me”. One person’s relative told us “The staff are wonderful”; and another said “They’re very good here”.

Work had been done to create an environment that supported people who had dementia. The atmosphere in the home was calm and we observed that staff interacted with people in a friendly, respectful and caring manner. Staff knew peoples’ names and chatted with them while providing support and carrying out tasks. We saw that people who were being cared for in bed had things around them that were meaningful to them. For example, one person had a soft toy that they were holding and there were pictures of their family within their line of vision. The person’s bed was placed so that they could look out of the window.

Is the service responsive?

The service acted responsively to peoples’ changing needs. Staffing levels had been increased since the last inspection and were kept under review. For example, an additional member of staff had recently been allocated to the nursing unit to respond to the increasing dependency of people who lived in this area of the home. We saw records of consultations with General Practitioners and other health care professionals, in order to review people’s health needs.

There was a system in place to monitor and respond to any concerns or complaints about the service. The manager showed us a record of a complaint, the action taken in response and the outcome.

Is the service well led?

We found the service was well led and action had been taken to address the issues that were raised in the previous inspection report. We also saw that regular audits of the quality and safety of the service took place and were recorded. Following a recent incident involving a person with a hot drink, the home had now acquired non-tip, easy grip beakers. This showed that learning from incidents took place and appropriate changes were implemented.

People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on. We saw that surveys were carried out to gather people’s views about the quality of the service they received. The results of one survey showed that all of the respondents had said they were satisfied with the overall care. There was evidence on record that the manager had followed up comments about areas where the service could improve. We saw that managers walked around the home and spoke with people who use the service.

We talked to three people and one set of relatives. They told us that the medicines were handled well by the staff. They did not have problems in the past and were happy with the way their medication was managed. We found that good systems were in place and new audit systems were implemented to ensure that people received their prescribed medicines as the doctor intended.

People that we spoke with told us that they were looked after well but one person told us they sometimes had to wait too long to receive care. We found that people were not always protected against the risks of receiving inappropriate or unsafe care as their needs were not always assessed.

We saw that nutritional assessments had been completed. One person told us, “Food is very good. I often ask for something that isn’t on the menu and they make it.” We saw that there were two people who had no verbal communication and required support to drink to ensure that they were protected from the risks of dehydration. There were no fluid charts in place to monitor their daily fluid intake and staff were not clear about how much fluid they had received.

People were not always protected from the risk of abuse. We saw that one person had unexplained bruising on their body. Staff had not taken any action to respond to this concern. People who used the service were not protected against the risk of unlawful or excessive control or restraint because the provider had not ensured that details of agreed restrictions were recorded.

People were not fully protected from the risk of spreadable infections because appropriate guidance had not been followed.

There were not enough qualified, skilled and experienced staff to meet people’s needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.