This inspection took place on 19 April 2017 and was unannounced.

Ardenlea Grove nursing home provides nursing and residential care to a maximum of 60 people. On the day of our visit 50 people lived at the home. The home had three floors. The Emerald Unit (ground floor) provided care to people who lived with dementia. The Pearl Unit (first floor) which had provided temporary care to people discharged from hospital. The Ruby unit (first floor) provided care to people with nursing and palliative care needs; and the Sapphire unit (second floor) provided care to people with physical nursing needs.

The home 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 felt safe living at Ardenlea Grove and thought staff were kind, considerate and caring. Staff told us they enjoyed working with people who lived at the home. They understood people’s needs, wants and preferences, and treated people with dignity and respect.

There were enough staff on duty to keep people safe. The provider’s recruitment practice reduced the risks of the home employing staff who were unsuitable to provide care. Staff understood how to safeguard people from harm.

People's risks were considered, managed and reviewed to keep people safe.

People thought staff had the experience and training to support them. Staff had received training to support them meet people’s health and safety needs, but more specialised dementia training had still not been provided since our last visit.

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

People were offered a choice of meals and drinks throughout the day. Specific dietary needs were catered for, and appropriate support given to people who needed extra help with their eating and drinking.

Individual and group activities were provided to people who lived at Ardenlea Grove. There had been improvements since our last visit, although the activity worker acknowledged further improvements were needed. Visitors were welcomed at the home, and there were no restrictions on the length of time visitors could stay.

Medicines were managed safely and people received their medicines at the expected time. People were referred to other health and social care professionals when necessary and in a timely way.

There were systems to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to ensure people were kept safe.

People, relatives and staff thought the culture of management was open and transparent. The atmosphere in the home was happy and relaxed.

This inspection took place on 24 February 2016. It was unannounced. At our previous inspection on 6 November 2014, there was a breach in one of the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve their care planning and record keeping. We found during this inspection that improvements had been made.

Ardenlea Grove nursing home provides nursing and residential care to a maximum of 60 people. On the day of our visit 52 people lived at the home. The home has three floors. The Emerald Unit (ground floor) provides care to people who live with dementia. The Pearl Unit (first floor) provides care to people who have been discharged from hospital and whose needs were being assessed to determine what their next steps would be. The Ruby unit (first floor) provides care to people with nursing and palliative care needs; and the Sapphire unit (second floor) provides care to people with physical nursing needs.

The home has 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 that staff were not always available at the times they needed them. We were concerned that staffing levels during the evening and night time meant some people’s care needs were not responded to quickly. Some people told us their care needs were not always met in a timely way at busy times of the day. The recruitment process checked that staff were suitable to work in a care service.

Suitable arrangements were in place for ordering, storing and returning medicines. Medicines were mostly managed safely and securely.

Risks related to people’s care were mostly managed appropriately. Staff mostly had a good understanding of how to manage risks related to people’s health and welfare. The registered manager and staff understood the principles of the Mental Capacity Act and the registered manager had applied for Deprivation of Liberty safeguards for people whose freedoms were restricted.

People told us they felt safe at the home, and staff understood policies and procedures designed to protect people from the risk of abuse.

People received food and drink which met their nutritional needs. There were mixed opinions about the quality of the meals, and the meal time experience did not cater sufficiently to meet the needs of people who lived with dementia.

Staff sought the advice and guidance of other healthcare professionals to support people’s healthcare needs. These included the GP, dietician, tissue viability nurses and speech and language therapists.

Most people felt cared for by staff. Some people felt that staff did not spend enough time talking with them and engaging with them, and we observed this during our visit. Staff had received sufficient training and support to meet people’s care and nursing needs, but had not received training to provide a ‘specialist’ dementia care service.

Some organised activities and individual activities were available to people who lived at Ardenlea Grove. People enjoyed the activities but did not think there were sufficient to keep them occupied. The registered manager had recruited a new activity worker who would provide a further 20 hours of activity work per week. People who lived with dementia had very little stimulation or activities available to them.

There were systems in place to capture feedback from people and relatives who used the service. This included a formal complaints policy and procedure, customer feedback boxes, relatives meetings, and quality assurance questionnaires. Friends and relatives were able to visit the home when they wished.

People and their relatives felt the home was m

We inspected Ardenlea Grove on 6 November 2014 as an unannounced inspection. At the last inspection on 13 September 2013 we found there were no breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008.

Ardenlea Grove is registered to accommodate a maximum of 60 people. It provides nursing care to older people and people living with dementia. On the day of our inspection there were 54 people living at the home.

A requirement of the service’s registration is that they have 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. At the time of our inspection there was a registered manager working at the service.

There were enough suitably qualified, skilled and experience staff to meet people’s needs. Staff had the training and support they required to keep their skills up to date.

Suitable arrangements were in place for storing medicines. Medicines were managed safely in accordance with the provider’s policies and procedures.

There were suitable policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. We saw that where there were concerns about people’s capacity to make decisions, appropriate assessments had been made.

Staff treated people with dignity and respected their choices about how they wanted to spend their time. People had privacy when they needed it, and could have their relatives visit them when they wished.

People had access to advocacy services when they needed to. An advocate is a designated person who works as an independent advisor in another’s best interest.

Staff were not always responsive to people’s preferences. There was a lack of information in care records detailing people’s preferences for care, which meant their preferences were not always met.

People were supported to take part in interests and hobbies that met their needs.

People were supported to maintain their health and wellbeing through access to healthcare professionals.

Care records were not always up to date. This meant people were not fully protected against the risks of receiving care or treatment that was inappropriate or unsafe.

The provider obtained feedback from people and their relatives about the service to identify where improvements were needed to the quality of service provision.

People were able to make complaints or raise concerns with the provider which were investigated and responded to in a timely way.

Where investigations had been required, for example in response to accidents, incidents or safeguarding alerts, the provider learned from those investigations to minimise the chance of them happening again.

You can see what action we told the provider to take at the back of the report.

We visited Ardenlea Grove to follow up on concerns we raised at our last inspection about unclear care instructions in relation to people who were at risk of developing pressure ulcers. During this visit we found this had been rectified and instructions were clear to staff.

At our last inspection we were concerned about people who were unable to eat food or take liquid via their mouth. These people needed to use a tube inserted into their stomach for nutrition (percutaneous endoscopic gastrostomy) and were not receiving appropriate mouth care to stop the mouth area from becoming dry and cracked. On this visit we noted systems had been put in place to ensure the mouth area was kept moist.

At our last inspection we noted the service was not sending the CQC notifications of people who had developed pressure ulcers classified as a grade three or above after admittance to Ardenlea Grove (grade one is the lowest severity of injury to skin and underlying tissue and grade four is the highest). Since our visit, the service has sent us notifications.

We visited Ardenlea Grove unannounced on Wednesday 3 July 2013. We spoke with nine people living at Ardenlea Grove, six staff, and seven relatives visiting the home. People told us:

“Staff are kind”,

“The staff are very respectful”,

“It’s different here but very nice, everyone is very helpful to you”.

We observed staff being kind and caring to people living at Ardenlea Grove.

We looked at whether people had adequate nutrition and hydration. We were satisfied people enjoyed a good menu which was adapted to suit individual needs.

We looked at how staff at Ardenlea Grove co-operated with other services. We saw there were good links with other services to promote the well-being of people living in the home.

We checked the safety, availability and suitability of equipment used at Ardenlea Grove. We were satisfied that there was sufficient equipment to meet the needs of people living at the home.

We looked at staffing levels and the skills and qualifications of staff working in the home. We were satisfied there were sufficient staff to support people living at Ardenlea Grove. Staff had appropriate training and qualifications to meet people's needs.

We looked at care and care records. We were satisfied that the majority of people living at Ardenlea Grove were receiving good care and treatment. We had concerns about some aspects of care and the recording of that care. These are detailed in the body of the report.

We spoke with 10 people who used the Ardenlea Grove service. All were very happy with the care and treatment they had received. They told us they felt their privacy and dignity was respected.

We saw good care and treatment provided to people living in the home. We were told by people “I’ve been better since I’ve been here”, “the food here is good, it’s too good for me because I eat it all”, “the staff are lovely, so nice and friendly…and we have entertainment”.

We spoke with one visiting relative who told us their loved one received “excellent care” and the “staff are lovely”

We looked at how the service managed medication. We were satisfied it was managed competently and people were safe. We noted some inconsistencies with the amount of stock in relation to the medication records of two people, however these did not put people at risk.

We saw good recruitment systems in place to ensure staff are safe to work with people. Staff told us it was a stable staff team with many having worked at Ardenlea Grove for a number of years. We noted some gaps in staff files of information required by Schedule 3 of the Health and Social Care 2008.

We looked at how the service responded to any formal and informal complaints and were satisfied that complaints were taken seriously and responded to in a timely way.

People living at the home told us they were very happy there. They said that staff cared for them very well and they were content.

Comments included: "They always ask me what I would prefer" "They are very kind and helpful" "It is lovely here" "The staff look after me very well" "They know what I like"". "They are so kind to me" "Nothing is too much trouble for them" "I have no complaints".

They told us the food was very good. They said: "The food is very nice" "We always have a choice, its very good" "I like the food, its always very tasty".

They told us they felt safe there. They said: "It’s very secure here, I feel safe" "I know the staff look after me well" "I could talk to any of them if I had a problem".