Bakewell Cottage Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide care for 38 people, at the time of our inspection there were 36 people living there. People were accommodated in single rooms across three floors within the building. There were two lifts within the building.

There was a registered manager in post at the time of our inspection. 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 inspection visit took place on 18 and 23 April 2018; the first day was unannounced. The timing of the second visit was agreed with the registered manager in advance. The service was last inspected in 2016, when it was rated good. At this inspection the service was rated overall as Requires Improvement; however it was rated good in caring and responsive as an acknowledgement of the caring nature of the staff. This is the first time the service has been rated Requires Improvement.

We identified three breaches of regulation at this inspection. You can see what action we told the provider to take at the back of the full version of this report.

The service was not always safe. Risk assessments were not always in place or were not always followed consistently. Information regarding known risks to people was not always shared with relevant people or agencies and we found a safeguarding referral had not been made when required. Some people were at risk of receiving ineffective medicines or not receiving ‘as required’ medicine to treat occasional symptoms, due to poor management of medicines.

Staff were skilled and knowledgeable about people’s care needs. People generally received effective care that met their individual needs. People received a varied and nutritionally balanced diet and independent eating was supported wherever possible. People had access to specialist and local healthcare services to support them to live healthier lives. Specialist aids were available to promote peoples independence and safe mobility. However, the registered manager did not always follow the principles of the Mental Capacity Act and could not always assure us that restrictive care was provided in people’s best interest or the least restrictive option.

People and their relatives were overwhelmingly positive about the kindness and compassion of the staff. Relatives said their loved ones were well cared for and staff treated them with respect and dignity. Choice and independence were promoted and people were involved in making decisions about their daily activities and their care.

Staff were responsive and had a good understanding of people’s needs, preferences and interests. We saw people engaged in activities of their choosing and spending time with their visitors in the privacy of their room or in the communal areas and garden. There was a complaints policy in place and relatives told us they would not hesitate to use it. There had only been two complaints recorded in the last 12 months. Staff supported people and their families with dignity and sensitivity at the end of their life and assured us their wishes and preferences were considered.

The registered manager was respected by people, relatives, health professionals and staff. People described the registered manager as firm but fair and always having the interests of people at the centre of what they did. There was a clear vision and focus on dignity, independence and personalised care and this was supported by the staff team. There were strong productive links with local serv

Bakewell Cottage Nursing Home is located in the Peak District in the village of Bakewell. It is registered to provide personal care for up to 36 older adults, which may include some people living with dementia. This inspection was unannounced and took place on 23 February 2016. At the time of our inspection there were 32 people living at the service.

There was a registered manager at this 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.

During our inspection we observed that the home had a calm atmosphere and staff were friendly and approachable. We observed staff delivering care which met people’s individual needs and supported them in a respectful and appropriate way.

People were involved in choices about their care. Staff were supportive and compassionate and took time to communicate with people in a friendly and reassuring manner. Staff had a good understanding of people’s needs and people’s privacy was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. Staff had access to additional training specific to the needs of people using the service. People were encouraged to access and maintain links with external health and community services, making effective use of the good relationships the registered manager had developed in the local community and with visiting healthcare professionals.

People, relatives, staff and visiting professionals spoke very highly of the registered manager and felt the service was well-led.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time and offered refreshments or meals if visiting over a meal time. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual and group preferences. Activities included one-to-one time on outings or in pursuit of personal hobbies or interests; as well as group activities which enabled people to meet up and were a social occasion.

Staff were aware of their roles and responsibilities for people’s care. People said that staff were approachable and felt there was an open and honest culture within the home, which encouraged people to raise any issues or concerns they might have.