What life is like for people using this service:

Following the inspection of 26 and 30 April 2018 we identified three breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe care and treatment, the ineffectiveness of the quality assurance systems used to drive improvements and the failure in the requirement to display their previous inspection rating.

At this inspection we found that substantial improvements had been made and these regulations were now met.

People were safe living at Danesford Grange Nursing Home. We found there were systems and processes in place for people's needs to be safely met.

Staffing levels were supportive of people's individual care needs.

People received their medicines on time and staff understood each person's abilities and health needs.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible.

The provider’s policies and systems supported staff practice and staff understood legislation around people's ability to make decisions.

Staff had a kind and caring approach towards people. They respected people’s privacy and dignity.

People enjoyed meaningful activities and there were appropriate opportunities to engage with the activities coordinator in groups or on a one to one basis.

Systems and processes for assessing and monitoring the quality of the provision, including identifying and analysing risk, had been robustly implemented. Audits were now thorough and there was evidence of management oversight of the service.

People, relatives and staff spoke highly of the management team and the way the service was run.

More information is in Detailed Findings below

Rating at last inspection: Requires improvement (report published 19 June 2018)

About the service: Danesford Grange is a nursing home that was providing personal care to 30 people at the time of the inspection, some of whom were living with dementia. It is registered for a total of 33 beds.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service had improved and was rated Good overall

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was an unannounced comprehensive inspection carried out on 26 April 2018, with a further announced visit on 30 April 2018. At our last comprehensive inspection of the service on 26 January and 8 February 2017, the overall rating for the service was judged to be ‘Requires Improvement.' At this inspection we found that some improvements had been made however further concerns were found. We have rated the service as 'Requires Improvement'.

Danesford Grange is a 'care home'. People in care homes received accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Danesford Grange accommodates up to 33 people within one building and a newly built extension and provides care and support for older people. At the time of our inspection there were 29 people living at the home, some of whom were living with dementia.

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.

During this inspection we identified three breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safe care and treatment, the ineffectiveness of the quality assurance systems used to drive improvements and the failure in the requirement to display their previously inspected rating.

Fire risk assessments were not completed in relation to alterations to the physical environment at Danesford Grange. Maintenance tasks were not effectively completed and infection prevention and control measures had not been imbedded into staff or managerial practice and oversight. This placed people at an increased risk of harm.

Management and governance systems were not always effective. There was no clear policy or strategy in relation to the effective monitoring of the quality and safety of services. Care plans and risk assessments did not always accurately reflect people's current needs or the person’s ability to effectively make decisions.

Information in care plans was sometimes contradictory and misleading about people's needs. The assessment of people’s mental capacity and decision making was not always clearly recorded for staff to follow. Incident and accidents forms were not always reviewed by management to ensure all appropriate actions had been taken. People’s individual communications needs had not been clearly identified or recorded.

The previous inspection rating was not displayed at the premises as required.

People were supported by enough staff to meet their needs safely and in a way they preferred. People were engaged in activities they found stimulating and enjoyable. People were treated with dignity and respect by those supporting them.

People received their medicines as prescribed by trained and competent staff members. People were supported by staff who were trained to support them and who were supported by a management team.

People were cared for at the end of life by staff members who knew their individual preferences and supported their personal wishes.

People and staff members found the management team to be open, supportive and transparent. People felt well informed and engaged in decisions about where they lived.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 26 January and 8 February 2017 and was unannounced.

Danesford Grange provides nursing and personal care for up to 33 people. At this inspection they were providing care and support for 32 people.

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 differing experiences from staff members some of which were caring and respectful whilst others were not. People were not always given the information they needed in order to make decisions about things that affected them. There were inconsistencies in the way people were treated by those supporting them.

People were not always engaged in social activities that they enjoyed and found stimulating. There were inconsistencies in the way opportunities to engage in activities were presented in order to people to gain their involvement.

People were not consistently engaged in decisions or changes in their home. People were not always asked for their views and the provider did not have systems in place to consistently obtain people’s opinions. Small amounts of information was available to people and visitors through a regular newsletter. However, this did not provide sufficient information for people to make informed decisions.

People had care and support plans that were individual to their personal needs. People received care from staff members who knew their individual likes and dislikes. People and their relatives were encouraged to raise any issues. The management team had systems in place to address any concerns or complaints.

People had regular contact with the provider and registered manager and found them approachable. The provider had systems in place to monitor the quality of support given and to make changes when needed.

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 members knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained to safely support them. 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 induction 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.

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’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

The registered manager and provider undertook regular quality checks in order to drive improvements.