This inspection took place on 31 August and 3 September 2018 and was unannounced.

Pinford End House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 40 people who require nursing and/or personal care. At the time of the inspection 32 people were living at the home.

At our last inspection in January 2016 we rated the service good. The safe section of the report was rated as ‘requires improvement.’ This was because when people were prescribed medicines on a ‘when required’ basis, for example pain relief, or when they were prescribed variable doses, for example ‘one or two tablets’, we found that staff did not always record the number of tablets administered. This meant that it was not possible to conduct an accurate stock check of medicines. At this inspection we saw action had been taken to resolve this issue.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. 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 home is run.

People were helped to take their medicines by staff who were trained and had been assessed to be competent to administer medicines.

People were supported to be kept safe because the staff continued to follow relevant policies and had appropriate training. People’s risk assessments had been written and were reviewed regularly to minimise the potential risk of harm to people during the delivery of their care.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

People were looked after by enough qualified nursing and care staff, who were trained and supervised to support them with their individual needs. Staff were supported through supervision, training and an annual appraisal. Pre-employment checks were completed on new staff before they were assessed to be suitable to look after people who used the service.

The nursing and care needs of people were assessed prior to them coming to the service and those needs were reviewed on a regular basis and more frequently should that be deemed necessary. Care plans gave staff information on how to support people with their needs.

People had access to healthcare professionals and their healthcare needs had been met. Care records seen confirmed visits to and from General Practitioners (GP's) and other healthcare professionals had been recorded.

People continue to be offered choices and were supported to eat and drink sufficient amounts of food and drink and the ttaff knew the people they supported and provided support in a caring way that promoted their dignity.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. 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 supported this practice.

People participated in a range of activities within the accommodation and also in the gardens of the service and received the support they needed to help them to do this. Peopl

This inspection took place on the 20 January 2016 and was unannounced.

At the last inspection on the 1 July 2015 we asked the provider to take action to make improvements as we found people’s safety was compromised as there were shortfalls in the management of people’s medicines. There were also insufficient systems in place to evidence and ensure appropriate clinical and professional supervision support was provided to nursing staff.

We carried out this inspection to check if improvements had been made. We found that there had been some improvement. The provider had implemented systems to regularly audit the management of people’s medicines. Staff had received up to date training in providing care for people living with dementia and updates for nursing staff employed. However, further work was needed to ensure improved monitoring of medicines stocks and balance checks of administration records.

Pinford End House Nursing Home is a registered care home with 40 beds and provides 24 hour nursing care. This nursing home specialises in the care for people with complex medical needs and end of life care. On the day of our inspection there were 35 people living at the service

There was 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.

Risks to people’s safety had been assessed as part of the care planning process. Staff had been trained in how to recognise abuse and were aware of how to report any concerns they might have.

Staff knew people well, respected their choices and understood their roles and responsibilities with regards to the Mental Capacity Act 2005.

People were involved in the planning of menus and supported to eat and drink sufficient amounts. Where people were at risk of inadequate food and fluid intake this was monitored and specialist support sought when required.

People were supported by staff with compassion and their privacy and dignity respected. People’s preferences in relation to the planning for their end of life care had been considered. People were supported with specialist palliative care when required.

People had access to a wide variety of group and individualised activities which met their personal needs. People were empowered to make decisions about how they lived their lives.

The service was well led and provided strong leadership which promoted a positive, caring culture which was focused on the needs of people who used the service.

The provider was currently working towards continuous improvement and had implemented a new system and process for the quality and safety, management monitoring of the service.

This inspection took place on 1 July 2015 and was unannounced.

Pinford End House Nursing Home is a care service registered with 40 beds and provides 24 hour nursing care. This nursing home specialises in the care for people with complex medical needs, dementia and end of life care as well as providing respite care. On the day of our inspection there were 34 people living at the service.

The service has a manager recently appointed to this post and had recently been registered with the Care Quality Commission. 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 manager was open and honest with us and had recognised the need for improved quality and safety monitoring of the service. This included improved monitoring of medication administration errors. They also identified the need for improved staff delegation of tasks including the need to implement regular, planned clinical and professional supervision support for staff and the need to provide staff with the training they needed relevant to their roles and responsibilities.

There was a lack of systems in place which would enable effective monitoring of medicine administration and audits of stock. This meant that the provider had not taken steps to identify medicines administration errors and we could not be assured that people had received their medicines as prescribed.

Everyone we spoke with told us they felt safe and the staff were caring and respectful of their choices. Staff treated people with respect, were kind and compassionate towards people.

There were systems in place which ensured the safety of people had been protected with regards to the recruitment of staff. Appropriate checks had been carried out prior to staff having been appointed to work in the service. The provider had obtained sufficient evidence to judge that staff were of good character and suitable for the role they were employed to perform.

There was sufficient staff available to meet people’s needs during the day and night. People were confident that staff would respond to their requests for support in a timely manner.

People had access to healthcare professionals when they required specialist support with complex health conditions and support in meeting their nutritional and hydration needs.

People received care that was responsive to their needs. People’s needs had been assessed before they were offered accommodation at the service. The information obtained had been used to develop detailed care plans which had information regarding people’s needs, wishes and preferences. Care was reviewed on a regular basis, care plans updated. This provided staff with up to date guidance to enable them to provide appropriate support according to people’s changing needs.

The service had an open and honest culture where people who lived at the service, their relatives and staff were listened to and the service learnt from their mistakes to improve the quality of the service that was provided.

We observed and people who used this service told us that they received a good standard of care. One person at the service said, “They try their best and they succeed. There is a happy atmosphere here.” We found that the service had assessed and were meeting people's health and care needs.

We found that the service had taken action since our last inspection in February 2013 and they provided safe management of medicines.

We found that staff were well trained to meet the needs of people who used the service.

We spoke with one relative, seven staff and twelve people that used the service. Everyone we spoke with was positive about their experience of this service. One person living at the service typically told us “It is wonderful here. This is as good as it gets”. A relative said “You cannot fault it here. The staff come straight away”.

We found that people were treated with respect and consent was obtained before care and treatment commenced.

People told us that they experienced care, treatment and support that met their needs and protected their rights. Care plans were up to date and informative for staff to follow.

Staff told us they were well trained and were happy to work at this establishment. There were enough qualified, skilled and experienced staff to meet people’s needs.

We found that people were put at potential risk because medicines were not always handled appropriately.

The people living in Pinford End House Nursing Home told us that they liked living there, that the care staff showed them respect and protected their dignity. They also told us that they were comfortable in the service. A relative told us that the care staff were very helpful, that they understood their relative’s needs and that they kept them safe.