This was an unannounced inspection carried out on 23 January 2017.

Prinsted Care Home can provide accommodation, nursing and personal care for 44 older people and people who live with dementia. There were 43 people living in the service at the time of our inspection.

The service was operated by a company that was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. People were helped to avoid preventable accidents and medicines were managed safely. There were enough staff on duty and the recruitment procedure had ensured that only suitable and trustworthy staff had been employed.

Staff had received support and guidance and they knew how to care for people in the right way. People had been helped to eat and drink enough to stay well and they enjoyed their meals. Staff had assisted people to obtain all of the healthcare assistance they needed.

The registered manager and staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people's right to privacy, and promoted their dignity. Confidential information was kept private.

People had been consulted about the help they wanted to receive and had been given all of the nursing care and practical assistance they needed. Staff promoted positive outcomes for people who lived with dementia. People’s choices were respected and they were offered the opportunity to pursue their hobbies and interests. There was a system for resolving complaints.

People had been invited to suggest improvements to their home and quality checks had been completed. The service was run in an open and inclusive way and good team work was promoted. Staff were supported to speak out if they had any concerns and people who used the service had benefited from staff acting upon good practice guidance.

We carried out this inspection as part of our routine inspection programme to answer our five questions: Is the service safe, is it effective, is it caring, is it responsive and is it well led? At our previous inspection in March 2014, we found the service was not meeting minimum standards in two areas. During this inspection we found improvements had been made in the area of obtaining consent when people did not have capacity and in the area of people’s care and welfare. The inspection was carried out by a single inspector. At the time of our inspection there were 40 people using the service. We spoke with five of them in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with the registered manager, one of the registered providers and three other members of staff.

This is a summary of what people told us and what we found.

Is the service safe?

People who used the service told us they felt safe and comfortable in the home. Risk assessments and care plans were in place to promote people’s safety and welfare.

We found the service carried out the necessary checks before staff started work and there was a robust recruitment process in place. Arrangements were in place to ensure medicines were administered and stored safely. We observed care workers helping people to move about the home safely using wheelchairs, frames and other equipment.

Is the service effective?

People told us and we observed that staff made sure people agreed to their care and support. Where people lacked the mental capacity to make certain decisions, the service carried out mental capacity assessments in accordance with the appropriate code of practice. The service was aware of the processes to follow in relation to the Deprivation of Liberty Safeguards.

People told us that they were satisfied with the care and support they received. One person said, “They look after me very well. I have a comfortable room, and the food is very good.”

We found people’s care and treatment were based on thorough assessments, and detailed and personalised support plans. Systems were in place to ensure care and treatment were delivered according to people’s plans. The service worked in cooperation with other providers to sustain people’s health and welfare.

Is the service caring?

People who used the service told us they got on well with their care workers and nurses. We observed care and support were provided in a cheerful, open atmosphere. There was appropriate joking and chatting between staff and people who used the service.

Staff we spoke with were motivated to provide high quality care. They had a thorough knowledge of people’s needs, history and how they preferred to have their care delivered. Staff showed sensitivity and concern in their interactions with people who used the service.

Is the service responsive?

The service responded to changes in people’s needs and conditions. People’s care was reviewed regularly and their care plans amended if necessary. People told us staff responded promptly when they needed assistance.

The service engaged with other healthcare providers to ensure people’s care and treatment was responsive to their changing needs.

Is the service well-led?

Systems were in place to regularly assess and monitor the quality of service provided. Complaints were followed up and responded to. The service learned lessons from incidents and accidents to improve the quality of service people received. The service listened to and acted on suggestions made by people and their relatives.

We visited this home on 26 March 2014 following some information of concern which we had received about the staffing levels available to support the care and welfare of people who lived at this home. On the day of our visit there were 33 people living at the home.

During our inspection we spoke with the new manager who was in the process of registering with the Care Quality Commission and had been in post for four weeks. We also spoke with the clinical manager, three members of staff, two people who live at the home and two visitors.

We saw that staff treated people in a kind and gentle manner respecting their dignity at all times. However, we found that there was a lack of understanding of the use of the Mental Capacity Act 2005, for people who did not have the capacity to make decisions without support.

We found that people’s needs were assessed and care and treatment was planned in line with their individual needs. However, we found that people were not always protected from the risks associated with immobility.

We saw that on the day of our visit there were enough staff to support the needs of people. We saw that the manager at the home was working to develop new ways of working to support staff with the changing dependency of people who lived at the home.

We carried out an inspection in September 2013 when we identified concerns with staffing and the assessment and monitoring of the service. We made compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and they sent us an update on their actions in October 2013.

We found that the provider had taken steps to improve processes and practice related to staffing and the assessment and monitoring of the service and were working on embedding the new systems. For example new staff had been recruited and there were reviews of care plans, medicines and dependency levels.

At this inspection we looked at staffing rotas, took a tour of the building and reviewed the systems that had been put in place to monitor the service. Following the last inspection we had also received concerns regarding staffing and infection control and cleanliness.

We spoke with three members of care staff/activity staff, two housekeepers, a nurse, a senior member of staff and the manager. We also spoke with two people who use the service.

Prinsted care home was separated into two units. The ground floor supports people with more residential needs and mild dementia and the top floor supports people with severe dementia and/or nursing needs. When we visited 19 people lived on the ground floor and 13 people lived on the top floor.

During our visit we saw positive interaction between staff and people using the service, with staff talking to people and advising them what was happening especially when they assisted them with their mobility.

Everyone we spoke with confirmed that people's privacy and dignity were maintained at all times and that people were able to make day to day decisions such as what time they got up and how and where they spent their time.

We observed people being spoken to in a kind manner and staff responding to people's needs making sure they were comfortable. We also saw that people were enjoying their lunch time meal and those able to respond told us meals were good and that alternatives were provided.

We spoke with three people using the service, five relatives and six staff. Most said that they felt that there was not enough staff available, especially during staff breaks following lunchtime and especially at weekends when sickness appeared greater.

People who lived in the home and their family members that we spoke to complimented care staff for their devotion and commitment.

People using the service spoke positively about the care provided at the home. They told us that members of staff were caring and kind. We saw positive interactions between staff and people living at the home. Staff working at the home told us they were well supported and trained to meet the needs of people. There was a training matrix at the home which told us training was available and had been delivered to staff. The staff we spoke with confirmed this. The home did not have a registered manager on the day of our inspection.

The home had recently reopened following extensive work including new bedrooms and lounge areas. On the day of our visit there were 10 people using the service. During the visit we spoke with five people who use the service and three relatives. Three of the five people we spoke with said they received good care and that staff knew how to meet their needs. People told us staff listened to their requests and provided care in the way they wanted it.

Most people told us they were able to have drinks when they wanted and said the food was generally good. People said there was a choice of meals and they were able to request something different if they wanted to. One person told us staff ensured their drink was placed in the right place to enable them to reach it and said they received the support they needed.

Relatives told us that they were happy with the staff and the care that their family member received. They said they were always informed if there were any concerns and they were able to approach any member of staff if they were worried. Examples of comments included; “Staff are always friendly and most of them are very professional”.

Whilst carrying out this scheduled inspection we looked at the progress made by Prinsted Nursing Home at meeting the compliance actions made following our last visit in February 2012. We found that the provider had reopened the home following completion of the building works, they had sent us a new statement of purpose outlining the changes and there was a new manager in post.

Although the home is registered to accommodate up to 27 people, on the day of our inspection seven people were living there. Many people had moved from the home due to major building works that were underway. As a result of these and following the findings of our inspection, we have been informed that the remaining seven people are being reviewed and plans made for being moved from the home due to risks to their care and wellbeing that the building work was posing.

The people that were living at Fraryhurst Nursing Home had varying needs and abilities. To help us to understand the experiences people had we spent time talking to people and watching what was going on in the home. Overall, we found that the management decisions along with the building works impacted on the quality of life people had. Areas affected included how people’s personal care needs were met, how much choice people had and their safety.

Overall, people who we were able to have a conversation with said they were happy with the care they received.