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Archived: Bentley Lodge Care & Nursing Home Requires improvement

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Reports


Inspection carried out on 6 October 2016

During an inspection to make sure that the improvements required had been made

The inspection took place on 6 and 7 October 2016 and was unannounced. Quinta Nursing Home is registered to provide accommodation and support to 41 people. At the time of the inspection there were 25 people living there.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 May 2016. Breaches of legal requirements were found in relation to safeguarding, clinical governance, safe care and treatment, consent, and requirements relating to workers. The provider was served with two warning notices requiring them to meet the safeguarding regulation by 4 July 2016 and the clinical governance regulation by 12 September 2016. Following the comprehensive inspection, the provider wrote to us to say when they would meet the legal requirements in relation to safe care and treatment, consent and requirements relating to workers.

We undertook this focused inspection to check that they had met the requirements of the two warning notices and followed their action plan in relation to the breaches of the other three regulations. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Quinta Nursing Home on our website at www.cqc.org.uk.

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. Staff were provided with relevant information to enable them to safeguard people and understood their role. Where incidents had occurred staff had completed an incident form and a body map where required. The registered manager took appropriate actions and reported potential safeguarding incidents to Social Services as the lead agency as required.

People told us the service was clean. Staff were provided with appropriate infection control guidance which they followed they also used the personal protective equipment provided. Previously damaged and worn furniture and equipment such as bed sides and commodes had now been replaced to ensure they could be cleaned thoroughly. Cleaning of the service was completed in accordance with the cleaning schedule and checks were made upon the quality of the cleaning of the service for people.

Processes were in place to ensure potential staff had a sufficient grasp of English for their role. Staff’s suitability for their role had been assessed by the provider however, not all staff had provided a full employment history dating from when they left full-time education. The registered manager took prompt action during the inspection to ensure the required evidence in relation to employment history was obtained for all staff.

People’s written consent to the content of their care plan had been sought and where people lacked the capacity to consent to their care legal requirements had been met.

A range of audits had been completed and were being used to drive improvements for people. Audits were being used to enable the registered manager to identify any trends in incidents and falls both across the course of particular months and across time. People’s views were being sought by the registered manager to enable them to identify areas for improvement.

There was written guidance about people’s diabetes care on their records for staff’s reference. People’s re-positioning and mattress records were complete. People’s fluid charts had been completed by care staff and totalled. The clinical lead took action during the inspection to ensure people had a target fluid intake. The registered manager took action during the inspection to ensure a staff member was delegated to print off photographs of people’s wounds and place them in their

Inspection carried out on 16 May 2016

During a routine inspection

The inspection took place on 16 and 17 May 2016 and was unannounced. Quinta Nursing Home is registered to provide accommodation and support to 41 people. At the time of the inspection there were 27 people accommodated.

We carried out an unannounced comprehensive inspection of this service on 7, 8 and 9 December 2015. Breaches of legal requirements were found in relation to safe care and treatment, staffing, consent, people’s dignity and governance. Following the last comprehensive inspection this service was placed into special measures by the Care Quality Commission (CQC). We imposed a condition on the provider’s registration that they must not admit any new service users to Quinta Nursing Home for the purposes of this regulated activity without the prior written consent of the CQC. At this inspection we found that overall the service was improving and action was being taken to address the areas that still required action. Therefore the service has now been removed from special measures.

The service does not have a registered manager, although since the last inspection a new manager has been appointed and they are in the process of registering with the 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 the service is run.

Following the last inspection the provider submitted their action plan informing us about how they would address the areas which required improvement. At this inspection we found the provider had made the required improvements to address two of the five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 found at the last inspection. At this inspection we found them to be in breach of a further two regulations in addition to the three continuing breaches of regulations.

Risks to people had been assessed and managed, safety checks had been completed. The provider had undertaken work to improve infection control processes and the cleanliness of the service. However, we found not all staff consistently followed the guidance provided and not all aspects of the service were clean, so there was a still a risk to people of acquiring an infection.

Some people said Quinta Nursing Home was a safe place to live, whilst others told us that they were not safe and alleged they had experienced physical abuse. Although the manager had taken the correct actions to safeguard people when safeguarding concerns came to their attention, there were not robust recording and reporting processes to protect people from the risk of abuse. Staff had not always documented unexplained bruising to people or completed an incident form to ensure any required action was taken in order to protect people from the potential risk of abuse.

The provider had completed staff recruitment checks; however, these were not always robust. The provider had not ensured that they had thoroughly assessed the English language skills of staff . It could not be established whether all staff possessed the required level of competency to be able to communicate effectively with people.

Staff had ensured that Deprivation of Liberty safeguards applications had been submitted for people as required. However, there was a lack of evidence to demonstrate that people’s written consent had always been obtained, or that where they lacked the capacity to make a decision, legal processes had always been followed to ensure their human rights were upheld.

The manager had taken action to implement audits of the quality of the service provided; however, they were not all fully effective in identifying issues. Incidents were not reviewed as part of a monthly audit to identify any potential trends which could indicate people were not safe. Improvements had been made to the standard of reco

Inspection carried out on 7,8,9 December 2015

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 14 and 15 April 2015 2015. Breaches of legal requirements were found in relation to staffing and records. Following the inspection, the provider wrote to us to say what they would do to meet these legal requirements. The provider informed us the final date by which they would have fully completed their action plan to ensure they met regulatory requirements was 18 October 2015.

In November 2015 the Care Quality Commission received information of concern about the effectiveness of infection control processes at the service. We undertook an unannounced comprehensive inspection of the service on 7, 8 and 9 December 2015. As part of the inspection we included infection control and checked to see if the provider had completed their action plan in relation to the previously identified breaches of regulatory requirements.

Quinta Nursing Home is registered to provide nursing care for up to 41 older people some of whom are living with dementia. At the time of the inspection there were 37 people living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The service did not have a registered manager in post as required for this location; the provider had informed us on 7 September 2015 that the service was being run by the deputy manager. The provider intended that the deputy manager would become the manager of the location and submit an application to become the 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. We have asked the provider to ensure the previous registered manager submits an application to de-register as the registered manager of Quinta Nursing Home as required.

Most people told us staffing levels were still not sufficient to meet their needs. There had been a small increase in the number of care staff for people on each staff shift but there was still no system in place to demonstrate the adequacy of the staffing levels provided. There was a lack of sufficient staff to provide people’s care at the times it was needed for example, in the morning or at lunchtime. As a result records demonstrated some people were awoken at 05:30 and people who required support to eat their meal at lunchtime did not always receive timely support. There was a high use of agency staff and a high staff turnover which resulted in people receiving inconsistency in their care. Agency nurses were regularly in charge of the service at night, this meant the service at night was not always being run by nurses who were sufficiently familiar with the service and people’s needs. There was an insufficient level of management currently provided to ensure the service was well managed to ensure peoples’ safely.

Staff were receiving supervisions and staff appraisals had commenced. However, the provider was unable to demonstrate that all staff had completed the care industry standard induction requirements. Staff had still not all completed ongoing training to ensure they kept their knowledge and skills up to date. Staff still did not receive robust moving and handling training with an assessed practical element to ensure they could move people safely. The competency of nurses to carry out their role effectively had not been assessed. People were cared for by staff who had received insufficient training and induction into their role.

People’s records still did not always contain all of the required information to enable staff to provide people’s care safely and effectively.

The provider had not ensured people were protected from the risk of acquiring an infection. They had not ensured preventative measures were in place and robustly implemented, such as; thorough monitoring of staff practices to ensure they had followed infection control guidance. Regular and thorough cleaning of the service or the analysis of two incidents where people had acquired an infection were not in place to prevent a reoccurrence or spread of the infection.

Environmental risks to people had not been managed safely. Required checks in relation to water safety had not always been completed and where defects had been found they had not always been acted upon promptly to ensure people’s safety.

Staff had not ensured people could always reach their call bell or that they had a drink within reach. Staff had not always ensured people could access assistance as required for their safety and comfort. This meant people were at risk of not being able to access staff as required.

Most people told us the staff were good. Many staff were observed to interact positively with people; however, there was inconsistency in staff practice. People did not all experience positive relationships with staff. People were not all supported to make choices and not everyone had their privacy and dignity upheld. Not all staff knocked on people’s bedroom doors before entering. Not all staff ensured conversations with people about personal care were held in private. Staff did not always protect people’s dignity and privacy when providing their personal care. Staff did not consistently respect the fact they were working in peoples’ home and refrain from the use of mobile phones at work. Not all staff treated people with compassion.

Staff had not all received training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLs). As a result not all staff understood their role or responsibilities. There was a lack of evidence to demonstrate that where people lacked the capacity to make a decision an MCA assessment had been undertaken and a best interest decision made on their behalf. DoLs applications had been made for three people but there was no associated MCA assessment to demonstrate how the decision to make each application had been reached. The building was not secure for people who were subject to DoLs and mobile to ensure their safety. There were no door codes on the inside of the front door, so if people were mobile and wished to leave the building they could do so, which could place them at risk.

Since the last inspection only three areas of the service had been audited, in relation to infection control, medicine administration records and staff files. These audits had not identified all of the issues we found at this inspection which required action or improvement. Following completion of the audits there was a lack of resulting robust action plans to ensure improvements were made to the service for people and to ensure their safety.

The provider had not ensured that all of the required information was available for each member of staff in relation to their safe recruitment. The interim manager had completed an audit on 3 December 2015 and was aware of these discrepancies. However, there was no action plan in place yet to ensure to ensure this was addressed for people in order to demonstrate the suitability of staff for their role.

People and staff were generally supportive of the interim manager. People did not consistently provide positive feedback about the provider. Since the provider had terminated the registered manager’s contract in August 2015 there had been a lack of sufficient management for the service. The interim manager lacked the support of a deputy manager to enable them to carry out their role effectively.

Staff spoken with were not aware that the provider had a set of values. We requested a copy of the provider’s values but these were not provided. Staff behaviour was not always consistent with their duty of care towards people. Staff had taken unauthorised leave which resulted in some shifts not being adequately staffed. The staff rota was not managed at a local level to ensure an effective organisation of staff shifts so that the staff roster was operated smoothly and efficiently for people.

People’s relatives had been encouraged to participate in reviews of their care. However, their involvement was not always evident from people’s care records. Some people’s care records had not been reviewed as regularly as required by the provider. Staff received a verbal handover between shifts and a written handover sheet. However, this did not contain all of the information staff needed in order to provide people’s care safely and effectively.

Staff were focused on the practical delivery of people’s care. There were a range of activities available to people, however, these were not based on people’s assessed needs and interests.

People received their medicines safely. Medicines had been stored safely. People’s medicines were administered to them by staff who sought their consent prior to administration.

People told us they felt safe. Most staff had completed safeguarding training and understood their role and responsibilities. Safeguarding alerts had been made to the relevant agency as required. Staff had access to relevant safeguarding guidance.

People told us they were satisfied with the food available, which looked and smelt appetising. Staff knew who had specific dietary requirements and these were met. The risks to people from weight loss had been assessed. People were supported to access health care services in response to their assessed needs.

There was a complaints process and people’s complaints had been responded to.

We found two continuing and three new 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 the report.

Inspection carried out on 14 and 15 April 2015

During a routine inspection

The inspection took place on 14 and 15 April 2015 and was unannounced.

Quinta Nursing Home is registered to provide nursing care for up to 41 older people. At the time of the inspection there were 40 people accommodated.

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 2014 and associated Regulations about how the service is run.

The service was inspected in August 2014 and was found to be non-compliant in relation to suitability of the premises, cleanliness and infection control and the service lacked an effective health and safety system to assess risks to people. Following the August 2014 inspection the provider sent us an action plan to tell us they would make the required improvements in relation to cleanliness and assessing the safety of the premises by 31 October 2014. The service was last inspected on 27 October 2014 to follow up on a warning notice served on the provider in relation to the safety and the suitability of the premises. We found improvements had been made in relation to the premises but further improvements were required to fully achieve compliance. Following the 27 October 2014 inspection the provider sent us an action plan to tell us they would become compliant with the suitability of the premises by 31 January 2015. During this inspection we looked to see if all of the required actions had been completed and we found that they had.

Staff had undergone relevant pre-employment checks as part of their recruitment to their role. This ensured people were cared for by staff whose suitability to work with vulnerable people had been checked by the provider. However, there were insufficient care staff to ensure people’s call bells were answered in a timely manner. There was a reliance on agency care and nursing staff. The registered manager had been providing nursing care and therefore could not ensure management tasks had been completed effectively. Although the cleaning of the service was adequate there were insufficient cleaning hours for staff to clean to a good standard.

There was a lack of evidence to demonstrate all staff had undergone the care industry standard induction requirements. Staff had not all completed ongoing training to ensure they kept their knowledge and skills up to date. Distance learning did not meet the needs of staff in relation to moving and handling, as they were unable to see a practical demonstration of techniques to move people safely. Not all staff had received training in the Mental Capacity Act 2005. The training of agency care staff had not been robust. Staff had not received an appraisal of their work and care staff had not received regular supervision. People were cared for by staff who had not received adequate training or support to undertake their role effectively.

People’s records did not always contain all of the required information to enable staff to provide their care safely and effectively. Records were not always easy to locate.

Risks to people had been assessed and actions taken to manage any identified risks to them. When incidents occurred these were recorded and reviewed by the manager to ensure learning took place. People’s medicines were stored and administered safely. People were safe as potential safeguarding incidents had been reported to the registered manager by staff.

People’s consent had been sought in accordance with legal requirements. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had received training in the Mental Capacity Act (MCA) 2005 but was unaware of a Supreme Court judgement which widened and clarified the definition of deprivation of liberty. They may not have understood when an application should now be made for people. We have made a recommendation that the registered manager access further information on the judgement in relation to DoLs.

People had received appropriate support to ensure they received adequate nutrition. Staff knew who required a specific diet. People were supported to have their healthcare needs met by a range of professionals as required.

People provided positive feedback about staff and told us they were caring and kind towards to them. One person’s relative told us “Staff are caring and patient.” Although staff were very busy they did not rush people when they provided their care. People were treated with dignity and respect by staff. Staff consulted people about decisions relating to the provision of their care. People’s care plans identified their communication needs.

People’s needs had been assessed prior to them being accommodated but records of their needs prior to being offered a service could have been completed more comprehensively to ensure their needs were accurately documented. People had care plans in place to meet their assessed needs. Staff understood people’s care needs, but had limited time to spend with people when not providing their care. People’s care plans were regularly reviewed by staff but there was a lack of written evidence to show people’s involvement. Activities were organised but records did not demonstrate people’s participation and how the activities had met their needs.

People and staff told us the registered manager was respected and good at their role. A relative and three professionals told us the service had improved under their leadership. The registered manager ensured aspects of the service were audited and action plans produced to address issues identified.

Information about how to complain was made available to people. Where complaints had been made appropriate action and learning had taken place. The registered manager had sought people’s views on the service through the annual survey and resident’s /relatives meetings. The registered manager had used this feedback to discuss with staff how the service could be improved for people. The provider however, had not created a positive culture within the service where they listened to the views of relatives and staff.

There was a lack of a clear vision and set of values for the service embedded within the staff induction and supervision processes.

The provider had taken responsibility for staff recruitment and staff rosters from the registered manager and allocated these tasks to their head office staff. This had made it difficult for the registered manager to carry out their role effectively, as they could not determine if potential staff were suitable or if the staffing roster met people’s needs. The provider had recently taken action to introduce clearer lines of accountability between the registered manager and themselves.

We found a number breaches of the Health and Social Care Act 2014 (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.

Inspection carried out on 27 October 2014

During an inspection to make sure that the improvements required had been made

An adult social care inspector carried out this inspection. At the previous inspection on 29 August 2014 the service was found to be non-compliant with outcome 10 safety and suitability of premises. A warning notice was issued which required the provider to take urgent action to ensure compliance with this outcome by 24 October 2014. The purpose of this inspection was to follow up on the actions taken to check the required improvements had been made.

At the previous inspection we had also identified concerns in relation to cleanliness and infection control practices and effective systems for assessing and monitoring the quality of service provision. The service was requested to send us a report identifying actions that would be taken to make the necessary improvements to address these concerns. This will be followed up at a later date when the provider has completed the actions required in accordance with the timescales identified in their report.

The registered manager was not available during this inspection. We were assisted by staff from the provider�s head office. We also spoke with the maintenance person and a contractor who was completing related work at the service. We visually inspected the service to check if works had been completed and reviewed records relating to the premises. Following the inspection we spoke with the fire service and the provider�s appointed health and safety person. The provider submitted further evidence to demonstrate the work they had completed following the previous report and further work planned to ensure compliance with this regulation.

Below is a summary of what we found.

Some of the required actions had been completed. People had personal emergency evacuation plans in place in the event of fire. The safety of the gas and electrical installations in the building had been tested, which had identified further work required in relation to the electrics. Arrangements have been made to complete these works. The legionella assessment had been completed and arrangements made for ongoing testing in relation to legionella. A competent person had been appointed to provide guidance in relation to health and safety matters, including completion of required risk assessments. Window restrictors were in place, apart from one which was being installed. The service no longer admitted people who were identified as at risk when walking up and down the accessible stairwells to reduce the risk of people falling down the stairs. This ensured that the level of risks to people associated with the premises had reduced.

Work had taken place in relation to fire safety and further work was due to take place. During the inspection we identified a further issue in relation to the safety of the hot water temperature from the taps; this meant that people were potentially at risk of scalding. Following the inspection we were provided with evidence that the provider was taking action to address this issue. Arrangements had been made to ensure the required works were completed. The level of risk to people had been reduced, but further actions were required to promote their safety.

Inspection carried out on 29 August 2014

During a routine inspection

The inspection team who carried out this inspection consisted of an adult social care inspector and an expert by experience. This is a person who has personal experience of using or caring for someone who uses this type of care service. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

On the day of the inspection there were 40 people using the service. As part of this inspection we spoke with 15 people, eight people�s relatives, the registered manager and nine staff. We also reviewed records relating to the management of the home which included, four care plans, daily care records and records which related to the maintenance and safety of the building.

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

Is the service safe?

The service was not always safe. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that one application been submitted. This meant that the service had identified that they were depriving a person of their liberty in order to keep them safe and had made an application to the relevant body to authorise this. The registered manager had not received training in DoLs; however, they understood when an application should be made, and how to submit one.

The building was clean overall. However, some areas required attention to ensure that the risk of infection was effectively managed. The provider was unable to demonstrate to us that they were operating effective processes in relation to the cleaning of commode pans in order to prevent the risk of cross infection. Staff had not all received infection control training. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control.

We found that the provider had not undertaken the required measures to ensure people�s safety within the building. Two other agencies had informed us prior to our inspection that they had identified a range of breaches of health and safety and fire legislation which indicated that people�s safety was at risk. The service had been required by these agencies to address these breaches.

The provider had taken some limited actions to address these breaches. However, there was still a considerable amount of work that had yet to be undertaken to ensure that people were safe. We have taken action to ensure that the provider becomes compliant in relation to the safety and suitability of the premises.

We included staffing as an additional outcome as we were concerned about the risks to people of staff working long hours to cover staffing vacancies internally. However, people did not tell us that this had impacted negatively upon their care. All of the people we spoke with stated that they felt safe, and relatives we spoke with all supported that view. Staff were working long hours but told us that they did not mind being asked to work additional shifts.

Is the service effective?

The service was effective at meeting people�s care needs. People told us they had faith in the abilities of the staff. One person told us �This is a very nice place; everybody�s very nice, and the food is good. I can go to the dining room when I want to, but they don�t make me if I�m not in the mood.�

Pre-assessments had been completed prior to people being offered a service to help ensure that their needs could be met before moving to the service. Individual risks to people had been identified and they had care plans in place that gave guidance about how their care was to be provided and risks to them managed.

People received the care they needed and were supported to access external professionals as required.

There were sufficient supplies of equipment to meet people�s needs, such as hoists and stand aids. Arrangements had been made to ensure that equipment was examined regularly by an external contractor for any defaults.

Is the service caring?

Staff at the service were caring. People and their relatives told us that they were kindly treated and that the staff were �Lovely�, �Very kind�, �Really patient.� Relatives were unanimous in their praise and �Relief� that their relatives were happy and comfortable. One typical quote from a relative was: �Mum is happy, and that�s all we really want.�

We observed throughout the inspection that staff were kindly in their interactions with people and appeared to know individuals very well. Although staff worked long hours to cover the shifts they remained caring in their attitude towards people. The registered manager was often working as a nurse on the floors to cover staff shortages covering the floors. We saw that care was the priority. The staff were visibly responsive and caring. We observed staff interacted with people politely and respectfully.

Is the service responsive?

The service was responsive to people�s comments. People we spoke with told us that they would not hesitate to approach the registered manager with any complaints or concerns they had, at any time, because �It�s always dealt with.� There was evidence that residents� meetings had been held and actions taken in response to issues raised.

Is the service well-led?

The service was well led by the registered manager. However, there were constraints upon the time that she was able to spend leading the service.

The service had not been sufficiently responsive to the fire and health and safety risks that had been identified. The provider had taken responsibility for addressing the issues in relation to the fire risk and health and safety. This meant that the registered manager was not fully aware of the provider�s plans to address these areas.

There was a lack of on overall action plan to demonstrate that the fire and health and safety risk issues had been prioritised and who was responsible for addressing them and by when.

Although we saw evidence that audits of the service had been completed there was a lack of action plans as a result.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

Inspection carried out on 2 September 2013

During an inspection to make sure that the improvements required had been made

This was a follow-up inspection to review the actions that the provider had taken to address issues identified at the previous inspection on 16 April 2013.

On the day of the inspection there were 30 permanent people who used the service and one person who was staying for a weeks respite care.

We spoke with two people who used the service and two people�s relatives. Overall people were positive about the service. One person told us �I am well looked after� and another said �Staff understand my care needs.� A person�s relative commented �We are very satisfied.�

We found that action had been taken in relation to the pre-assessment forms and care plans. Documentation had been revised and action had been taken to ensure that peoples� care plans and risk assessments had been completed and reviewed regularly.

Staff had been provided with appropriate safeguarding training and were able to demonstrate their understanding.

Staff had been required to complete a health declaration in relation to their fitness to undertake their role.

We found that on the day of the inspection there was an adequate number of staff to meet the needs and welfare of the people accommodated.

Inspection carried out on 16 April 2013

During a routine inspection

We spoke with people and their relatives who were positive overall about the care provided. People told us �It�s very good living here� and �They look after us well�. We were also told however that on occasions it took staff a long time to answer people�s call bells. One person�s relative told us �There can be alarms going off and they can take a long time to answer them�.

We found there was insufficient recording of people�s initial assessments and inconsistency with people�s care plans and risk assessments.

We saw evidence that staff at the home co-operated with other providers and worked with professionals.

Staff were aware of their roles and responsibilities in relation to safeguarding. We were not assured however that staff had completed or updated their safeguarding training as there was no written evidence we could review.

Medicines were managed appropriately within the home.

We found that the premises were safe and suitable for the provision of people�s care.

We found that not all the required checks had been completed prior to staff commencing work at the home.

There was not a sufficient number of staff to provide the care that people required safely and effectively. There was insufficent management cover for the home and there were no administrative staff.

Records were stored centrally and were accessible to staff.

During a check to make sure that the improvements required had been made

As this was a desk top review we did not speak to people who use the service on this occasion.

We reviewed the documentary evidence that the provider produced in line with their action plan following the last inspection. We found that the manager had taken measures to ensure that their monitoring of the quality of the service included audits of different aspects of the service provided.

Inspection carried out on 10 April 2012

During an inspection to make sure that the improvements required had been made

Many of the people at Quinta Nursing Home had dementia and therefore not everyone was able to tell us about their experiences.

People who could express a view told us they liked living at the home. They said that the staff were good, and they were encouraged and supported to do things for themselves.

They said they were encouraged to express their views and make or participate in making decisions related to their care and treatment.

Relatives informed us that they were consulted about their relative�s care needs, as and when appropriate. They told us they felt able to raise any complaints and they were confident that there concerns would be responded to and dealt with quickly.

One relative told us their relative had only been in the home a short time, but that staff had built up a good rapport with them and had a good understanding of their needs.

People told us they knew the manager well and that she was always around to speak with.

Inspection carried out on 5 January 2012

During an inspection to make sure that the improvements required had been made

A number of the residents who live at Quinta Nursing Home have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences of people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Residents who could express a view told us they were very happy at the home. They said that the staff were "kind" and " helpful".

They told us their bedrooms were kept clean and tidy and that they were pleased with the new flooring throughout the home.

Relatives told us that they were happy with the care provided at the home. They told us the staff kept them informed about their relatives care, and they believed their relatives were safe living at the home.

Two relatives told us that staff were very polite and courteous, and despite their relative being very poorly and not able to understand what was being said to them, the staff always explained to their relative what they were going to do before they attended to their relatives care.

Relatives told us they felt able to raise any complaints and that they would be responded to and dealt with. They said that since the new manager started at the home things were much better.

Inspection carried out on 27 April 2011

During an inspection in response to concerns

Residents were positive about the staff and the way they spoke to them. We were told that residents� meetings were held but people had not always seen the owner at these meetings. Meetings took place every few months. One person said they had never seen the provider.

A resident said they received the care they needed and a relative told us staff kept them informed when their relative had been unwell. Residents and relatives were happy with the food provided. People were happy at the home and told us they had no concerns and that they felt secure and safe at the home.

Relatives told us that they were always made welcome and that the premises were always clean and tidy. People told us that they were happy with the equipment provided to support them and they told us that if they pressed their call point in their room staff responded quickly.

During our first visit, two relatives told us that staffing levels could be a problem at weekends. During our second visit to the home, a resident told us they received the care they needed from staff and that they came when they rang the call bell. Residents and relatives told us they would feel able to raise any complaints.

Residents were positive about the staff and the way they spoke to them. We were told that residents� meetings were held but people had not always seen the owner at these meetings. Meetings took place every few months. One person said they had never seen the provider.

A resident said they received the care they needed and a relative told us staff kept them informed when their relative had been unwell. Residents and relatives were happy with the food provided. People were happy at the home and told us they had no concerns and that they felt secure and safe at the home.

Relatives told us that they were always made welcome and that the premises were always clean and tidy. People told us that they were happy with the equipment provided to support them and they told us that if they pressed their call point in their room staff responded quickly.

During our first visit, two relatives told us that staffing levels could be a problem at weekends. During our second visit to the home, a resident told us they received the care they needed from staff and that they came when they rang the call bell. Residents and relatives told us they would feel able to raise any complaints.

Residents were positive about the staff and the way they spoke to them. We were told that residents� meetings were held but people had not always seen the owner at these meetings. Meetings took place every few months. One person said they had never seen the provider.

A resident said they received the care they needed and a relative told us staff kept them informed when their relative had been unwell. Residents and relatives were happy with the food provided. People were happy at the home and told us they had no concerns and that they felt secure and safe at the home.

Relatives told us that they were always made welcome and that the premises were always clean and tidy. People told us that they were happy with the equipment provided to support them and they told us that if they pressed their call point in their room staff responded quickly.

During our first visit, two relatives told us that staffing levels could be a problem at weekends. During our second visit to the home, a resident told us they received the care they needed from staff and that they came when they rang the call bell. Residents and relatives told us they would feel able to raise any complaints.

Reports under our old system of regulation (including those from before CQC was created)