A comprehensive inspection of Mulgrave House Nursing Home, took place on 30 October and 1 November 2018. The inspection was unannounced on day one and announced on day two. At the last inspection in March 2016, the home was rated as ‘Good’.

Mulgrave House Nursing Home is a ‘care home’. People in care homes receive 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.

Mulgrave Nursing Home is a large converted property with a modern extension. The service provides care and support for up to 35 people. The service can support older people, people who are living with dementia and people who have a physical disability. Some people are supported with intermediate care, prior to them returning home or going on to another care service. The service is close to all local amenities.

There was a registered manager in post at the time of our 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.

Medicines were not always managed safely. Stocks of medicines did not always balance with records and creams were not always applied as prescribed.

Systems and processes for monitoring the quality of the care provision required strengthening. The registered manager was in the process of introducing a new quality management tool, but it was too soon to be able to assess how effective this would be. Feedback regarding the management team was positive.

People’s care plans did not always provide accurate and up to date information about their current needs to provide effective care. Some information in the care plans was contradictory.

There were sufficient numbers of staff deployed in the home and feedback from people and staff confirmed this. Recruitment was safely managed, as relevant checks undertaken ensured staff were suitable for working with vulnerable people. Staff completed induction and there was a training programme in place. Timely staff supervisions and appraisals were carried out; staff said they felt supported by the registered manager.

Some risks to individuals were appropriately assessed, monitored and reviewed. Building maintenance and fire safety was appropriately managed as the necessary checks had been completed. People felt safe and staff knew how to recognise and respond to signs of abuse. The home was clean, tidy and odour free. There were procedures in place to reduce the risk and spread of infection. Communal areas of the home were comfortably furnished and people were familiar with the layout of the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. We found the service was working within the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, decision specific mental capacity assessments were not always in place.

People’s healthcare needs were met and they were able to access a range of healthcare professionals. People were happy with the food they received. Throughout the day, drinks and snacks were regularly provided. We observed a positive mealtime experience where people were well supported.

Staff were seen to deliver caring, kind and compassionate care. Comments from people and relatives confirmed staff provided good care. The home was warm, with a friendly atmosphere, there were good natured interactions between people and staff. People’s privacy and dignity was respected.

People received stimulation through a programme of activities with external entertainers and trips out to local

We inspected Mulgrave Nursing Home on 09 March 2016. The inspection was unannounced. We last inspected the service in October 2013 and we found the registered provider was meeting the regulations we inspected.

Mulgrave Nursing Home is a large converted property with a modern extension attached. The service provides care and support for up to 35 people and is accommodation for people who require personal care and/or nursing. The service can support older people, people who are living with dementia and people who have a physical disability. The service is close to all local amenities.

The home had a registered manager 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate systems were in place for the management of medicines so people received their medicines safely.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Staff needed to be more aware of some risk assessment documents in people’s care plans to help them complete their role.

We saw people’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate people were involved in all aspects of their care plans. Care plans and risk assessments were not always clearly cross referenced to support staff to know the hazards for each area of need.

We saw staff had received supervision on a regular basis; however, not all staff had received an annual appraisal. Staff had been trained and had the skills and knowledge to provide support to the people they cared for.

People told us and we saw there were enough staff on duty to meet people’s needs. We found safe recruitment and selection procedures were in place and appropriate checks had been made.

Staff understood how to work to the principles of providing choice and gaining consent from people they supported in line with the Mental Capacity Act (2005). However, more work was needed for staff to understand the requirements of the Deprivation of Liberty Safeguards (DoLS).

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and patient with people. Observation of the staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks. The mealtime experience was too long as people had to wait for their meal to be served. Food was of good quality and people told us they enjoyed the food. People were supported to maintain good health and had access to healthcare professionals and services.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a plentiful supply of activities. However, how the service recorded activities people took part in did not evidence whether people had enough activity to prevent social isolation.

The registered provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.