We inspected this home on 20 April 2017. Peacemills Care Home is owned and managed by My Peace Mills Limited. It is situated in the Sherwood area of Nottingham and offers accommodation for to up to 40 people who require personal care. On the day of our inspection 35 people were permanently living at the home, three people were on short-term respite stays and one person was in hospital. The home specialises in caring for people living with dementia.

The provider did not have a registered manager in charge of the day to day running of 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.

The provider had notified us in December 2016 that the registered manager was no longer in charge of the day to day running of the home and that a temporary manager would oversee the home. However the registered manager had not applied to cancel their registration with us. At the time of our inspection, the temporary manager was still in post. The provider told us that they had plans in place to recruit a new registered manager and they would ensure the current registered manager applies to cancel their registration with us.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew what action to take if people did not have the capacity to make decisions.

People were supported to maintain their nutritional intake and staff monitored and responded to people’s health conditions.

People lived in a service where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We carried out an unannounced inspection of the service on 24 March 2016.

Peacemills Care Home provides nursing and accommodation to older people. It is registered for a maximum of 40 people. There were 33 people receiving care and support at the home at the time of our visit.

On the day of our inspection there was 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.

People told us they felt safe at the home. They were supported by staff who understood how to identify and report allegations of abuse. Risk assessments were in place, but did not always identify or reduce the risk to people’s safety. Some documents were not kept secure and confidential. Sufficient staff were in place to keep people safe and medicines were stored and handled safely.

People were supported by staff who were trained and knowledgeable about people they cared for. People received effective suitable care that met their individual needs, preferences and choices.

People’s rights were protected under the Mental Capacity Act 2005. Most people received sufficient to eat and drink, but had not always had a good experience at meal times and some people were not fully supported. People had access to other healthcare professionals and received effective care that was relevant to their needs.

People were encouraged and supported to keep positive caring relationships with others. People were treated with kindness and compassion. Staff interacted with people in a friendly and caring way. People’s privacy and dignity was protected and they felt able to contribute to decisions made about their care. Arrangements were in place for people to receive support from an independent advocate if they needed one.

People’s care records focused on people’s wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

People, relatives, staff, and healthcare professionals all complimented the registered manager. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. Some documents were not kept secure or completed correctly. There were auditing processes in place that helped to identified risks to people and the service as a whole, but they were not always completed accurately or any issues were not dealt with quickly and effectively.

During the inspection we looked at evidence to answer five questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and staff told us.

If you want to see the evidence that supports our summary please read the full report.

During our visit we spoke with seven people who used the service, two relatives, and eight members of staff including the person in charge.

We found there were 25 people living in the home at the time of our inspection.

We found there was no registered manager at the time of our visit, however the person in charge told us they had submitted their application to CQC and were awaiting the application to be processed. We checked our records and found the application had been accepted by our registration team.

Is the service safe?

People who used the service were able to make their own decisions and staff supported people to be independent whenever possible.

We found one urgent Deprivation of Liberty Safeguarding (DOLs) referral had been made, but the person in charge told us the referral was not accepted as a safeguarding. The management team were aware of the new guidelines that had been put in place in March 2014 regarding Deprivation of Liberties for people who used the service.

We found where appropriate people received a Mental Capacity and Best Interest Assessment to ensure decisions were made in their best Interest.

Records showed that Disclosure and Barring Service checks had been completed prior to staff starting work.

The service involves people who used the service and their families in regular reviews and assessments of their care and treatment.

Is the service effective?

We found care plans had been reviewed on a monthly basis and changes were made accordingly. We saw on one person’s file that they had been involved with other health care professionals.

Visiting health care professionals told us they had a positive relationship with staff and their recommendations and guidance was always followed.

The service ensured staff had the right knowledge, qualifications and skills to meet people’s needs. There were systems in place to address any gaps in training needs.

We saw people’s views and choices were taken into consideration, when refurbishments took place within the home.

Is the service caring?

We found staff were attentive to people’s needs and interacted with people who used the service throughout our visit. We observed staff speaking to people in a calm and polite manner.

We spoke with two relatives and they both told us they felt their family members were well cared for. One person who used the service told us they were very well looked after.

We found the care plans were person centred and contained life histories, likes, dislikes, cultural and spiritual needs. Staff were knowledgeable about individuals and how they should meet their needs.

Is the service responsive?

People’s support plans reflected their needs and staff responded to people’s changing needs when required. We found one person’s needs had changed and they were required to be repositioned every two hours. Their care plan had been updated and we could evidence that changes had been made.

People who lacked the capacity to make certain decisions were supported by staff who understood their needs. We observed staff responding to people when they asked for assistance.

We saw relevant activities taking place during our visit. The provider employed an activities person to ensure people’s social needs were met.

People who used the service, relatives and staff were able to voice their views and opinions. We saw meetings and surveys had taken place. We saw feedback and experiences had been recorded. Where relevant the provider had responded to any issues or concerns people may have had.

We found one out of seven care files had not been up dated since the person was admitted to the home for respite. We spoke with the person in charge. They told us it was company policy to have a quick guide to care in place and care plans would be updated between six to eight weeks after a person arrived at the home for respite. We could not find any quick guide to care on the care file we looked at. The person in charge addressed this issue during our visit.

Is the service well-led?

There were systems in place to monitor the quality of the service provided. Appropriate audits and checks were in place to ensure people received care accordingly.

There were policies and procedures in place to manage risk and staff told us the policies were easily accessible if they needed to access them.

We saw staff training was up to date and staff had attended relevant training in areas such as challenging behaviour, DOLs, mental capacity and safeguarding.

Staff told us they had enough information within each person’s care plan to ensure their needs were met. Staff had good knowledge of individual's needs and how to support them.

Confidential records were kept secure and locked in the office or other designated areas. We observed staff returned the care files promptly to where they were kept once they had finished with them. This meant there were appropriate arrangements in place to ensure records were securely kept.

We spoke with one relative who told us, “Our views are respected and listened to. I think there are capacity assessments in my relative’s care plan.” One staff member told us they had completed training on the Mental Capacity Act (2005).

We looked at six people's care plans which contained information about themselves. However in four of the six care plans we looked at, information about the person had not been fully completed including their personal profiles. We found that some care plans and risk assessments had not been reviewed on a regular basis.

Relatives told us, “My relative feels safe living here,” and, “I’ve no doubt my relative is safe.” Staff members were able to tell us the procedures in place to make a safeguarding referral.

On the day of our inspection, we looked at three staff files which contained evidence of the interview process, proofs of identification and references received for staff.

One relative told us, “I had an issue which I raised with the manager and they responded appropriately and sorted the problem out.” We saw the complaints policy which provided relevant information to people using the service and their relatives if they wished to complain to the service or its regulators.

We found that some care plans did not contain Mental Capacity Act assessments and associated Best Interest Decisions for people who used the service and may lack capacity to make certain decisions for themselves.

One person who used the service said, “I’m just about getting used to it. I get enough overall support.” We spoke with a friend of a person who used the service, who said, “I don’t think the care’s good; it’s poor.”

In most care plans we looked at, information about the person had not been fully completed and individual care needs had not always been identified or assessed.

We found the service had not completed improvements in relation to people’s care and welfare nor had they been made in line with the service’s own timescales.

One relative told us, “It’s a safe environment and it’s given me peace of mind.”

We noted that there were on-going safeguarding investigations for people who used the service and the service was co-operating with the relevant local authority teams.

Effective recruitment and selection processes were not always in place.

Most staff told us they felt supported by the manager. However, one staff member said, “I don’t feel confident to speak with the manager about any issues.”

We found that not all staff had had supervision meetings or appraisals.

One person who used the service said, “It’s not terribly well run here.”

We noted that care plan audits had not always been completed in a regular or consistent manner.