This inspection took place on 7 June 2018 and was unannounced. The last comprehensive inspection took place in April 2017. At that inspection, we found a breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach was in Regulation 19: Fit and proper persons.

The registered provider sent an action plan detailing how they were going to make improvements. This inspection took place to check if improvements had been made. We found that the registered had made sufficient improvements to meet the requirement of this Regulation.

Saxondale 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.

Saxondale Nursing Home is registered to provide accommodation for up to 36 older people. Accommodation is provided over two floors, accessed by a passenger lift. Communal lounges and dining areas are provided. On the day of the inspection there were 30 people living in the home.

The service had 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.

People told us they felt safe at Saxondale Nursing Home and staff told us they would report any concerns to the registered manager. Systems and processes were in place to ensure that people were protected from abuse and improper treatment.

Visitors said they were made to feel welcome at any time and were very positive about the care their relatives received.

Staff were knowledgeable about people living at the home and understood how to meet their diverse needs.

We observed warmth and affection between staff and people who used the service. People were treated with dignity and respect.

We found the home was clean and odour free. Bedrooms had been personalised and communal areas were comfortably furnished. The home was adequately maintained, and equipment had been serviced to make sure it was safe to use.

Staff recruitment procedures were robust and ensured people’s safety was promoted.

Sufficient numbers of staff were provided to meet people’s needs.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

Staff told us they felt supported by the registered manager.

People told us they and their relatives had been involved in their plan of care and had participated in regular reviews.

We found systems were in place to make sure people received their medicines safely, so their health was looked after.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences, so people’s health was promoted, and choices could be respected.

People were supported to take part in a variety of activities.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies in the service support this practice Wherever possible, people were involved in decisions about their care and were offered choices.

People and staff were happy with the service and praised the manager. There was a positive and open culture within the service. Staff said they felt able to raise concerns and were confident they would be responded to.

There was a complaints procedure in place and we saw where concerns had been raised these had been dealt with appropriately.

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified, action was taken to address

The inspection took place on 4 April 2017 and was unannounced. Our last comprehensive inspection at this service took place in November 2016 when breaches of legal requirements were identified. We asked the provider to send us an action plan outlining how they would meet these breaches. You can read the report from our last inspections, by selecting the 'all reports' link for 'Saxondale Nursing Home' on our website at www.cqc.org.uk.

Saxondale nursing home is registered to provide care for up to 34 older people with a diagnosis of dementia or mental health needs. There were 27 people living there at the time of our inspection.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 to run the service. When a service does not have a registered manager we place a limiter on the well- led domain of the report, which cannot be rated as good.

At the last inspection on November 17 2016, we asked the provider to take action to make improvements to the safe management of medicines, staff training and appraisal and the recruitment and selection of staff .The provider sent us an action plan explaining how they would address this and sent regular updates showing the progress they were making. We continued to liaise with the local authority and monitored intelligence we received about the home. At our inspection of 4 April 2017, we saw that a new management team was in place and improvements had been made.

The provider had a safe recruitment procedure in place that involved pre-employment checks being made prior to the person commencing employment. However we found there were still gaps and inconsistencies in staff personnel files.

Systems were in place to ensure people received their medications in a safe and timely way from staff who had been trained to carry out this role.

The staff we spoke with were very knowledgeable on safeguarding and whistle blowing policies and procedures.

We looked at people's records and found they identified risks associated with people's care and treatment.

People were supported to take sufficient food and drink to maintain a balanced diet and snacks were available in-between. People we spoke with who used the service told us they liked the food and were given choice.

We found there was enough staff with the right skills, knowledge and experience to meet people's needs. However, staff told us at certain times they could do with more staff to ensure people's needs were met in a timely way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

We have made a recommendation about refreshing training for staff on the Deprivation of Liberty Safeguards.

We looked at care records and found they contained a care plan entitled, 'This is my Life’ this gave staff an understanding of peoples life stories, choices and preferences and what was important to the person.

We observed staff working with people and found they were kind and caring in their nature. Staff we spoke with were knowledgeable about respecting privacy and dignity and gave examples of how they would do this.

We checked people's care records that were using the service at the time of the inspection. They told staff how to support and care for people to ensure that they received care in the way they had been assessed.

The service had an activity co-ordinator who arranged social events in the home. So people accommodated at the home had access to suitable activities.

The home ha

This inspection took place on the 17 November 2016 and was unannounced. A further two days of inspection took place on the 18 and 22 November 2016, and was announced. The service was last inspected in June 2015 and was meeting the regulations we inspected at that time.

Saxondale nursing home is registered to provide care for up to 36 older people with a diagnosis of dementia or mental health needs. There were 36 people living there at the time of our inspection.

It is a condition of registration with the Care Quality Commission that the service has 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. The registered manager had left the service and the provider had put interim management arrangements in place to support the operations and on-going improvement of the service. How?

During this inspection 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 this report.

People were not always being protected from the risks associated with medicines. We found there were shortfalls in the ordering, administration and disposal of people’s medicines that could result in mishandling or error. We found some people’s medicines were not managed safely, so they were not protected against the risks associated with the unsafe use and management of medicines.

People told us they felt safe living in the home and relatives we spoke with told us they thought their family members were safe.

People were not being protected by the home’s recruitment processes. The registered person had not ensured a robust recruitment process had been followed or recorded for all staff.

There were sufficient staff, however a significant number of staff needed to update their training to ensure they had the appropriate experience, training and skills to meet people’s needs.

People on each unit received a balanced and nutritious diet, including those people on the general nursing care unit who needed their meals pureed or softened. However, people’s dietary and fluid intake was not being monitored effectively. This left people at risk of poor nutrition or hydration.

People were not always being protected from poor quality care through the processes for audits and quality assurance. Some of the concerns we identified on this inspection had been identified in quality assessments undertaken by the provider, but actions had not been completed to rectify them. Others had not been identified. Some audit systems had been used effectively to improve people’s care, for example in reducing the risk of falls.

People told us the covering manager was accessible and approachable. Efforts were being made to increase opportunities for people to give their feedback about the home and the quality of their experience.

We found infection control was not being managed appropriately. This meant people were at increased risk of contracting an infection.

The systems for staff supervision and appraisal were not being used consistently or effectively to support staff development and to improve their skills.

People’s dietary and fluid intake was not being monitored effectively. This left people at risk of poor

nutrition or hydration.

The physical environment throughout the home did not always reflect best practice in dementia care.

The communal areas were tired and in need of decoration and throughout the inspection there was an unpleasant malodour in the communal areas.

We found care plans and risk assessments were not properly completed. People were not always supported to maintain a healthy diet. However, people identified as high risk of malnutr

We carried out an unannounced comprehensive inspection of this service on 26 and 27 January 2015 at which a breach of legal requirements was found. This was because consent for care and treatment was not always sought in accordance with legal frameworks, namely the Mental Capacity Act 2005.

After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet the requirements of the breach. We undertook a focused inspection on 4 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Saxondale Nursing Home’ on our website at www.cqc.org.uk’

Saxondale nursing home is registered to provide care for up to 36 older people who may be living with dementia or mental health needs. There were 34 people living there at the time of our inspection.

The service’s registered manager from our last inspection was still 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 and associated Regulations about how the service is run.

At our focused inspection on 4 June 2015, we found that the registered provider had followed their plan which they had told us would be completed by the 23 April 2015 and legal requirements had been met.

We saw assessments in place to show where people did not have capacity to make and consent to specific decisions themselves. Information was provided about how people were to be supported so that any care or treatment was in the person’s best interests. Care plans were reviewed to show that the support was still appropriate and make any amendments where required.

Staff utilised different methods to obtain consent from people where they were able to. Care plans we looked at were written in a person centred way and captured people’s views and preferences as to how they were to be supported. During our observations we saw staff offered choice when they supported people and supported people in line with their preferences and with their consent.

We issued a compliance action following our last inspection in January 2013. This was because we found that the suitability of the premises was not adequate. Saxondale Nursing Home submitted an action plan following our inspection. This detailed the actions they intended to take in order to achieve compliance in this area.

We visited the service on 30 May 2013 as part of our scheduled inspection programme and also to check that improvements had been made regarding suitability of premises.

People said about the home, “They (staff) respect your privacy in here.” One person said about mealtimes “We have a set menu but if you don’t like it they will sort something else out for you.”

People experienced care, treatment and support that met their needs and protected their rights. One person told us "It’s nice in here, it’s a nice home.”

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights. We spoke with a relative of someone using the service. A relative we spoke with said, “Staff are fantastic. (My relative’s) well looked after. She gets a bath or a shower and is clean. Staff know what they’re doing.”

Adequate maintenance of the premise, in respect of furnishings and fittings had not been maintained. We saw floor coverings that were stained and there were some areas where the surface of the floor underneath the floor coverings were uneven. In some people’s rooms there was no lids on toilet seats and wallpaper had not been replaced where it had been ripped from the wall. There was also an unpleasant odour that permeated the majority of the ground floor area and did not make the lounges pleasant places for people, staff and visitors to spend their time.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People’s personal records were accurate, fit for purpose and held securely. Other records to protect people’s safety and wellbeing were being maintained.

The nature of this visit was to review improvements that had been made to meet compliance actions made at our last inspection on 7 December 2010. This did not involve needing to speak with people who used the service. However, we spoke with one relative who said, “It’s fantastic. Far superior to .... Staff are interested and I’d come here myself”.

The majority of people who live at Saxondale have a diagnosis of dementia and therefore have varied methods of communication. Some people were able to express some views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat with people and observed them closely to ascertain whether their needs were met.

When we spoke to people who were able to communicate with us verbally, they told us staff treated them with dignity and respect. Their individual comments included,

“I get on well with most people. I don’t get on with staff all of the time, because I don’t want to be here”

"I keep it (dining room) nice and clean"

"(I’m) champion, can't grumble",

"I get on well with everybody",

"Meals are good",

"I like it here"

"Staff are right nice"

"(It’s) smashing here, they're great"

"They've loving ways and they're kind"

"I'd give them a good word. I always wanted to be a nurse"

We spoke to two people’s families. They told us they were involved in their relative’s care and staff kept them up to date with changes to this. They felt staff dealt with things appropriately. They said their relatives always looked well cared for when they visited.

Their individual comments include:

"Staff are brilliant"

"There’s plenty of staff"

"Nice little lasses - good and caring"

"It’s not fancy chandeliers, cups and saucers, but it's care and she's safe".

This inspection took place on 26 and 27 January 2015 and was unannounced. We last inspected this service in May 2013 and found that the service was meeting the requirements of the regulations we inspected at that time.

Saxondale nursing home is registered to provide care for up to 36 older people with a diagnosis of dementia or mental health needs. There were 32 people living there at the time of our inspection.

There was a registered manager employed at the service. 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 registered manager understood Deprivation of Liberty Safeguards (DoLS) and applied for authorisations as needed which we saw evidence of. She was in the process of making further applications. However, we found that the arrangements in place for obtaining consent for decisions did not always follow the principles of the Mental Capacity Act 2005 (MCA). For example, one person was administered medicines covertly. Although the person’s GP and a pharmacist had been consulted and deemed this to be safe, there was no assessment of capacity to show the person could not make the decision themselves to take their required medicines.

We saw clear records in place to ensure people received their medicines in a safe way and only when they needed these. Relevant staff undertook competency assessments to ensure they were safe to administer medicines and apply creams. However, issues with medicine supplies had led to some delays in people receiving prescribed medicines.

We saw that a lot of seating within the home was stained and worn and observed that the environment in communal areas was lacking in stimulation for people. The registered manager had already identified these issues and told us the provider was aware of the condition of the furniture and action was to be taken. Staffing levels were regularly assessed to ensure these met the needs of people. Although most of the time staff were visible and checked on people regularly, there were some periods where there was a lack of staff presence in communal areas.

People’s care records were reviewed regularly and in response to any change in needs. They contained current information about people’s individual support requirements and preferences and how these were to be met. Staff demonstrated knowledge of people’s personalised care preferences. Individual risk assessments were in place in order to minimise and manage risks to people. Staff knew how to identify and report abuse and unsafe practice and received annual safeguarding training.

People at the service were supported to access healthcare and received assistance and treatment for their health needs. People’s nutritional preferences were accommodated. Feedback we received from professionals was positive about how staff worked to support people, especially those with complex needs.

An effective recruitment process was in place so that people were assessed as being suitable to work at the service. We looked at three staff files and saw relevant checks had been undertaken about the staff members prior to them commencing employment. Staff told us they felt supported, had training that equipped them for their roles, and received regular supervision. There was opportunity for staff to take on further responsibilities and develop within their roles.

All people and relatives we spoke with were positive about the care they or their family member received and felt they were treated with dignity and respect. The service employed an activities co-ordinator and we saw some activities take place. However, there were periods of time where there was a lack of stimulation for people.

Feedback was sought by the registered manager by way of relatives’ meetings. Relatives told us they would feel comfortable in approaching the staff or registered manager about any issues. There was a complaints procedure in place and we saw that complaints were investigated and responded to appropriately.

Staff felt supported by the registered manager and felt part of a team. The registered manager often spent time around the home and helped to support people which staff appreciated. Good practice was highlighted and shared and regular team meetings took place. There was an open culture and all people we spoke with spoke highly of the registered manager and the staff team.

We found one breach 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.