This was an unannounced inspection which took place on 26 and 27 January 2017.

We last inspected the service on 8 and 9 September 2015, we rated the overall service as Requires Improvement. At that inspection we identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to the management of medicines and staffing.

This inspection was to check satisfactory improvements had been made and to review the ratings.

We saw evidence to confirm that action required had been taken.

Marple Dale Hall-The New Windsor, is registered with the Care Quality Commission (CQC) to provide 24 hour nursing care and accommodation for up to 66 people with a wide variety of conditions and frailties. People are cared for in purpose built accommodation designed to meet the care and support needs of the people who live there. Accommodation is provided over two floors. The ground floor of the home provides specialist care for younger people who have a physical disability and those with an acquired brain injury or learning difficulties. The first floor of the home provides nursing care for older people with a wide variety of frailties and conditions and people living with dementia.

A registered manager was in place at the home. 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 who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. People spoken with said, “We are happy with the service provided and overall our needs are being met.” Two relatives spoken with told us the nurses and care staff were extremely attentive and the care provided was always person centred.

People were supported by sufficient numbers of suitably trained staff. Care staff and nurses we spoke with told us they had undergone a thorough recruitment process and following their employee induction, training appropriate to the work they carried out was always available to them. Some staff were working towards a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care and the Care Certificate. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Staff members received regular supervision to help make sure they were carrying out their duties safely and effectively.

Staff spoken with confirmed they had received safeguarding and whistle blowing training, and knew who to report concerns to if they suspected or witnessed abuse or poor practice.

Care records were in place which reflected peoples identified health care and support needs. Information about people’s dietary requirements, how people wanted to be supported, when support was required and how this was to be delivered was also included in the care records we examined.

We saw written evidence that people and their relatives were involved in the decision making process at the initial assessment stage and during their care needs review. Where people who used the service did not have the capacity to make their own decisions, the service ensured that decisions taken were in line with the principles of the Mental Capacity Act.

Systems to make sure the safekeeping and administration of medicines were followed monitored were in place and reviewed annually. Medicines were stored safely and administered only by registered nurses. Any specific requirements or risks in relation to people taking particular medicines were clearly documented.

Complaints, comments and compliments were encouraged by the provider and any feedback from people using the service or their relatives were addr

Care plans were individualised and included each person's likes, dislikes and preferences. We saw, where required, best interest meetings and mental capacity assessments were included. We noted that relatives and significant others involved with the person who used the service, were documented.

We spoke with three people who used the service and comments included: "I feel happy here, the staff have really helped me gain a lot of independence", "I am included in my care plan review, I think the staff are very good in making sure, they do things to help you and do what's best for you" and "I am well supported, I feel that I have a choice and what I want is important".

Marple Dale The New Windsor had appropriate policy and procedure guidance in place which enabled staff to act apriority when any safeguarding incidents occurred. Staff had access to the local authority safeguarding team contact details.

We sampled a total of six personal files for nurses and care staff and found that each contained records of regular supervision. It was clear that roles and responsibilities had been discussed and that training undertaken or required, was well documented.

Marple Dale The New Windsor had appropriate systems in place to monitor the quality of the service provided.

"I think the care has improved in the last year: I did have some concerns in the past but I now feel that the home got better."

"The staff are very good , they always try their best."

"I do think that staffing levels have improved. I did have concerns in the past but there does seem to be a few new staff around."

“I do get my medication on time."

“The manager does take complaints seriously and I have confidence that any issue will be resolved.”

This was an unannounced inspection to this location. This inspection took place on 8 and 9 September 2015 and the first day was unannounced.

The service was previously inspected on 8 and 9 February 2014, when no breaches of legal requirements were found.

Marple Dale Hall - The New Windsor is registered to provide 24 hour nursing care for older people with a wide variety of conditions. The home also provides specialist care for younger people who are physically disabled and those with acquired brain injury or learning difficulties. The home is set in well- kept grounds situated in 34 acres of countryside. The home is located close to local amenities in the village of Marple, Stockport. There is ample space for car parking provided in the grounds of the location. The New Windsor is purpose built and there are 62 beds located over two floors, which can be accessed via staircase or passenger lift. Two of the bedrooms are shared and all rooms have an en suite toilet. A small three bed detached single storey property called Clarence House is located in the grounds of the New Windsor and provides care and accommodation to three people with acquired brain injury (ABI).

At the time of our inspection 61 people were living at the New Windsor and three people were living at Clarence House.

A registered manager was in place. 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We found gaps on some medication administration records (MAR) sheets that had not been signed to show that medicines had been given or refused. This meant that people were not fully protected against the risk associated with the lack of evidence to support that people were receiving their medicines at the prescribed times.

Not all nurses had undertaken medicines refresher training. The lack of up to date medicines training for nurses might place people at risk of medicine errors occurring.

Individual staff supervision and staff meetings were infrequent and future supervision dates had not been planned to make sure staff were regularly supported in their work.

Not all risks to people were minimised because the systems in place for monitoring staff refresher training, were not used effectively.

We recommend that consideration is given to implementing an end of life format that conforms to recent National Institute for Health and Clinical Excellence (NICE) Guidelines 2015.

People who used the service and their relatives were complimentary and positive about the attitude and support of the staff and the care they received.

A system of maintaining appropriate standards of cleanliness and hygiene was being followed regularly. The home was clean and there were no offensive odours.

The registered manager monitored staffing levels using an effective in house system.

The provider encouraged feedback from people using the service and their families. Feedback was given in the form of complaints, comments, compliments, face to face meetings with the manager, care plan reviews and an annual service user satisfaction survey.

A relative spoken with knew how to make a complaint and felt confident to approach any member of the staff team if they required. Feedback received was used to make improvements to the service.