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Inspection carried out on 20 November 2019

During a routine inspection

About the service

Puddingstone Grange provides residential and nursing care for up to 62 older people; most of whom were living with dementia and mental health needs. At the time of this inspection, 60 people were using the service. The home is purpose built and spread across four units and over two floors.

People’s experience of using this service

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about working within the principles of the Mental Capacity Act (MCA) 2005.

People were supported to participate in activities that interested them; however, there was not enough activities available throughout the day to keep people stimulated. The registered manager informed us they had identified this issue and were acting to ensure people were involved in activities that were relevant and met their needs. We will check on this at our next inspection.

People, their relatives and health care professionals were complimentary about the home. People received care and support that was personalised to their need and felt safe living at the home. People were protected from the risk of avoidable harm as potential risks to their health and wellbeing had been identified, assessed and had appropriate risk management plans in place for staff to mitigate these risks. People were supported to safely manage their medicines. There were enough staff available to ensure people’s needs were safely met; people said they did not have to wait for long to be attended to. The provider followed safe recruitment practices and ensured all staff were properly checked before they began working at the home.

Before people started using the service, their physical, mental, and social care needs were assessed, including their likes and dislikes to ensure their needs could be met. People received care and support from staff had been supported through induction, training and supervision. People were supported to eat and drink sufficient amounts for their health and wellbeing. People were living in a home which was designed and decorated and personalised to meet their needs.

People received care and support from staff that were kind, compassionate, respectful and promoted their privacy, dignity and confidentiality. Staff understood the Equality Act and supported people in a caring way and without any discrimination. People and their relatives were involved in making decisions about their care and support needs and their views were respected.

Information was presented in formats that met people’s communication needs. The service had an effective system in place to manage complaints; however, people told us they had nothing to complain about. There were appropriate plans in place to ensure people’s end of life wishes were respected and met.

The service was well led, and the management team demonstrated a commitment to provide high quality care and knew they had to be honest, transparent and open when things went wrong. The home had systems in place to assess and monitor the quality of the service and had sought feedback from people and their relatives to improve on the service delivery. The service worked in partnership with key organisations and health and social care professionals to deliver an effective service. Staff knew of their individual responsibilities, they told us they felt supported in their role and were happy working at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 23 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. I

Inspection carried out on 9 May 2017

During a routine inspection

We carried out an unannounced comprehensive inspection of this home on 09 and 10 May 2017. At our last inspection on 30 and 31 March 2016 we found the home required improvement as the provider had not always followed best practice in relation to checking on medicines storage and administering medicines covertly. Quality assurance systems were in place to monitor the quality of the service, however, medicines issues we found at inspection had not been identified during these audits.

At this inspection on 09 and 10 May 2017 we found that improvements had been made and that there was clear guidance for staff on how to manage covert medicines as prescribed by the GP. Staff followed this guidance when administering medicines. We saw that quality assurance system in place were effective in identifying shortfalls.

Puddingstone Grange provides residential and nursing care for up to 62 older people most of whom are living with dementia. At the time of our inspection there were 60 people using the service.

There was a registered manager who had been in post since March 2015. 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 that they felt safe. There were safeguarding adults’ procedures in place that were robust and staff understood how to safeguard people. There was a whistle-blowing procedure available and staff said that they would use it if they needed to. Risk assessments were carried out and reflected current risks for people and ways to try and reduce the risk from occurring. Medicines were appropriately managed and stored. There were enough staff deployed to meet people's needs. The provider had carried out appropriate pre-employment checks to ensure staff were suitable and fit to support people using the service.

Staff received adequate supervision, appraisals and training suitable to their needs and the needs of people who they supported. New staff were inducted into the service appropriately. The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and Deprivation of Liberty safeguards (DoLS). Staff asked people for their consent before they provided care. People received enough to eat and drink and had access to a range of healthcare professionals when needed.

Staff knew people well and they were treated with kindness. People's privacy and dignity was respected. People were supported to be independent as possible such as attending to some aspects of their own personal care. People's cultural needs and religious beliefs were recorded to ensure that staff met people's needs and wishes.

People and their relatives were involved in the care planning process and the care and support they received was person-centred. Care plans and risk assessments provided clear information for staff on how to support people and were reviewed on a regularly basis.

People and their relatives said they knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

Regular resident and staff meetings took place and people’s views had been sought about the service. People and staff spoke positively about the service and the registered manager who they said were supportive. Systems were in place to monitor and evaluate the quality and safety of the service and obtain feedback from people and staff.

Inspection carried out on 30 March 2016

During a routine inspection

This inspection took place on 30 and 31 March 2016 and was unannounced. At the time of our inspection the manager was in the process of registering with the Care Quality Commission (CQC). 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.

Puddingstone Grange provides residential and nurse care for up to 62 older people most of whom are living with dementia. At the time of our inspection there were 59 people using the service, with two residents currently in hospital.

At the last inspection on 15 and 16 April 2015, we found breaches of legal requirements and asked the provider to take action to make improvements to medicines storage and administration, risk assessments, mental capacity assessments and staff supervision. These actions have been completed.

At the current inspection we found that the provider had not always followed best practice in relation to checking on medicines storage and administering medicines covertly and improvements were required. However, there were regular medicine audits in place. Staff had completed medicines training and the home had a clear medicines policy in place which was accessible to staff.

The service maintained sufficient staffing levels to support people both in the home and the community. Staff received regular supervision and an annual appraisal, and the service undertook appropriate pre-employment checks on staff before they started work. Records showed that staff were also subject to regular training refresher requirements.

People were protected from the risk of abuse. Staff had access to procedures and policies relating to safeguarding people from harm. Most staff had completed training in safeguarding adults and we saw training was booked for those staff who were still due to attend. Staff we spoke with demonstrated an understanding of types of abuse that could occur and knew how to raise safeguarding concerns if needed.

Risks to people using the service were assessed, reviewed, recorded and managed appropriately. Detailed current risk assessments were in place for all people using the service which explained how to identify and manage risk and the provider was in the process of implementing a new format in order to capture appropriate reviews of need.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service. Care plans were person centred. People were treated with dignity and respect.

People’s capacity and rights to make decisions about their care and treatment where appropriate were assessed in line with the Mental Capacity Act 2005 (MCA 2005). These safeguards are there to make sure that people are receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way. The manager and staff understood the principles of Deprivation of Liberty Safeguards (DoLs) and acted according to this legislation.

People were supported to eat and drink. People were consulted about weekly menu choices and supported to prepare their own meals. People are supported to maintain good health and have access to healthcare services. Referrals are made quickly when concerns are noted as regards to people's health.

People’s concerns and complaints were investigated and responded to in a timely and appropriate manner. We saw that the provider carried out compliance audits. However, issues in relation to medicines management were not always identified and actioned promptly. The registered manager and

Inspection carried out on 15 & 16 April 2015

During a routine inspection

The inspection took place on the 15 & 16 April 2015 and was unannounced. At the time of our inspection there was a new 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 and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Puddingstone Grange provides residential and nursing care for up to 62 older people most of whom are living with dementia. At the time of our inspection there were 50 people using the service.

During our inspection we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medicines, risk assessments, staff supervision and appraisals, consent, care planning and assessing need and maintaining and keeping accurate and appropriate records. You can see what action we have told the provider to take at the back of the full version of this report.

Medicines were not always stored and managed appropriately within the home. Staff medicine competency supervision records were not always kept up to date. Consideration was not always given to meeting people’s individual needs when medicines were administered. The need for covert administration of medicines was not always assessed in line with the Mental Capacity Act 2005.

Risks to people using the service were not always assessed, reviewed, recorded or managed appropriately. People’s capacity and rights to make decisions about their care and treatment where appropriate were not always assessed in line with Mental Capacity Act 2005 (MCA 2005).

Staff supervision and appraisals were not conducted in line with the provider’s policy. Staff files did not evidence that supervision and appraisals were conducted on a regular basis.

Care plans did not always accurately reflect people’s individual care needs and preferences and assessments were not always conducted in line with the provider’s policy.

The new manager had identified issues with inaccurate records and was addressing this issue however at the time of inspection a number of inaccurate records were identified.

Appropriate safeguarding adults from abuse policies and procedures were in place. Staff had good knowledge of the provider’s policies regarding safeguarding and whistle blowing. There were safe staff recruitment practices in place and there were sufficient numbers of staff available to meet people’s needs appropriately. People were supported appropriately to eat and drink sufficient quantities to maintain a balanced diet.

People were supported by staff that had the necessary skills and experience to meet their needs and staff were provided with an induction to the service prior to starting work. There were appropriate procedures in place to deal with foreseeable emergencies.

People were treated with dignity and respect and their wishes with regards to their care and support were acted upon by staff. Interactions between staff and residents was displayed by kindness and facilitation. The home provided a range of activities and outings that people could choose to engage in and people told us they enjoyed the activities on offer at the home.

People’s concerns and complaints were investigated and responded to in a timely and appropriate manner. People and their relatives told us they knew how to make a complaint. People using the service and their relatives were asked for their views about the service and resident meetings were held on a frequent basis providing a forum for feedback.