This inspection was unannounced and took place on 7 August 2017; at the time of our inspection 63 people were living at the home. The provider is registered to accommodate and deliver nursing and personal care to up to 63 people. People who lived there may have needs associated with old age and/or dementia.

At our last comprehensive inspection in April 2015 the provider whilst meeting the law in relation to the regulations, they did need to make improvements in the key question of Safe. This related to some concerns and issues found regarding the provider’s medicines management and staffing levels. During this inspection we found that the necessary improvements had been made.

There were two registered managers 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 2008 and associated Regulations about how the service is run.

Staff demonstrated a good awareness of their role and responsibilities regarding protecting people and were confident a member of the management team would deal with any concerns reported. Sufficient staff were on duty to meet people's needs. Staff were employed through safe recruitment practices. Medicines were safely administered and stored.

Staff were well supported though supervision, the availability and variety of training and the quality of the induction provided to them. Systems in place ensured people were not deprived of their liberty unlawfully. People were supported to provide consent for the care they received. People were supported to maintain healthy nutrition and their food preferences were known and catered for. People were supported to access a range of healthcare services.

People were supported by staff that were caring and respected their right to privacy. Staff treated people with dignity and respect. People wherever possible were involved in planning and making decisions about their care. Information was available for people about how to access and receive support from an independent advocate.

People’s individual preferences, were reflected in the personalised care and support they received. People were actively encouraged to take part in activities. The provider ensured people’s diverse needs, including identifying their needs relating to their sexuality, were known, understood and wherever possible supported. Staff had a good understanding of people's identified care and support needs. A complaints procedure was in place and people and their relatives felt confident any concerns or issues raised would be addressed.

People were positive about their experiences of living at the home. People were actively encouraged to provide suggestions and opinions about the service in regular meetings that were held and surveys supplied to them for their completion. Staff could make suggestions and give their opinions openly to the registered manager or provider. The registered managers understood their responsibilities for reporting certain incidents and events to us and to other external agencies. Quality monitoring systems were in place and the appropriate action was taken when areas requiring improvement were identified.

The provider is registered to accommodate and deliver nursing and personal care to 63 people. People who lived there were elderly and some lived with needs associated with dementia. On the day of our inspection 62 people lived there.

In August 2015 we received information from an anonymous person. They alleged that incidents had been occurring in the home that could constitute abuse. They did not highlight any names of people who lived there who may have been affected, or give us any detail into their concerns. In response to this information we made the local authority safeguarding and contracts staff aware and carried out this focussed inspection.

The inspection was unannounced and took place on 1 September 2015. We did not identify evidence of abuse or abusive practice during our inspection.

At our last full inspection in April 2015 the provider was meeting all of the regulations that we assessed. However, some improvement was needed in the safe domain.

Staff knew what to do to ensure the risk of harm and abuse to people was prevented.

Staff had mixed views about staffing levels. They told us that there was a staff shortage when staff phoned in sick.

This report only covers our findings in relation to the information of concern that we received. The rating shown on this report is the one awarded following our April 2015 inspection. As we did not inspect in full we did not give the service a new rating. You can read the report from our last comprehensive inspection by selecting the all reports link for Bearwood Nursing Home on our website at www.cqc.org.uk.

The provider is registered to accommodate and deliver nursing and personal care to 63 people. People who lived there are elderly and some may have needs associated with dementia.

Our inspection was unannounced and took place on 27 April 2015. At the time of our inspection 57 lived there.

At our last inspection in 2014 the provider was not meeting one the regulations that we assessed which related to the recruitment of staff. During this inspection we found that changes had been made to recruitment processes and the regulation was met.

A manager was registered with us as is required by law. 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.

Systems in place did not always promote safe medicine management to prevent people being placed at risk of possible ill health.

People and their relatives had mixed views about staffing levels. The provider agreed to review staffing levels to ensure people’s needs would be consistently met.

Staff knew what to do to ensure the risk of harm to people was prevented and that people received care and support in a safe way.

We found that staff were trained to support the people who lived there effectively and safely. Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

Staff supported people with their nutrition and health care needs. We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered.

Systems were in place for people and their relatives to raise their concerns or complaints.

Although people were encouraged to engage in recreational activities some relatives told us that more should be offered.

Staff supported people to keep in contact with their family as this was important to them.

People were encouraged and supported by staff to be independent and attend to their own personal hygiene needs when they could.

All people received assessment and treatment when needed from a range of health care professionals including their GP, specialist consultants and nurses which helped to promote their health and well-being.

People we spoke with communicated to us that the quality of service was good. This was confirmed by the majority of relatives we spoke with. The management of the service was stable, with processes in place to monitor the quality of the service.

We carried out this inspection in response to information that had we received about staff from overseas who were on a nurse adaptation course. The information highlighted that those staff were undertaking nursing duties before they had been formally registered to practice with the Nursing and Midwifery Council (NMC) which is a requirement in law.

On the day of our inspection 43 people lived at the home. During our inspection we spoke with nine people, ten members of staff (which included nurses, care staff and staff who were on a nurse adaptation course) and the registered provider. We looked at seven staff files to see the standard of recruitment and looked at staffing levels.

People we spoke with told us that they were well cared for. One person said, “The staff are good”.

We carried out this inspection so that we could answer our five questions;

Is the service safe?

We found that checks of the barring system had been undertaken to ensure that staff being employed had not previously harmed or abused people so protected the vulnerable people who lived there.

People who lived there told us that they felt safe. One person said, “The staff are all very kind and look after me well”.

We found that the recruitment of staff was not undertaken in a way that prevented unsuitable staff being employed and therefore did not reduce the risk of harm and abuse to the people who lived there.

Is the service effective?

We found that the provider had not always ensured that gaps in prospective staff member’s employment history had been explored to determine past performance and suitability.

We found that where health conditions had been declared by prospective staff these had not been risk assessed to give assurance that the staff were physically and/or mentally fit to undertake their job role.

We found that greater diligence was needed regarding the auditing of recruitment documents to ensure that all of the required information had been received.

Is the service caring?

We observed staff caring for people in a kind considerate manner. All of the people we spoke with told us that the staff were kind. All staff we spoke with told us that they felt that people were well cared for and were safe.

Is the service responsive?

The provider told us that they were aware that there were not enough nurses on night duty. To address this, in the short term they had secured agency nurses. This showed that the provider had been responsive to ensure that there were enough nurses on night duty to provide the nursing care that people required.

Is the service well-led?

The provider told us that they had given the responsibility of the management of recruitment documents to three staff. However, we found that the three staff had not followed processes correctly. This did not confirm that those staff were well led.

All staff we spoke with told us that on a day to day basis they felt supported by senior care staff, the nurses and the management. This showed that systems were in place to support staff to provide care safely.

There were 52 people living at the home on the day of our inspection. As our inspection was unannounced no one knew we would be visiting. We spoke with seven people who lived at the home, one relative, and ten staff. Some people were unable to verbally share with us their views about their care so we used different ways to evidence their experiences such as looking at their care records and observing the care provided.

People we spoke with were happy with the care and service provided. One person told us "It is very nice here". Another person said “I am very happy”. A relative said “It is good here".

We found that people were treated politely and that their privacy and dignity was maintained.

We saw that people's needs had been assessed by a range of health professionals including specialist doctors and nurses. This meant that staff had taken action so that people's health and care needs would be monitored and met.

Adequate processes were in place to prevent malnutrition and dehydration.

Generally we found that staff had the knowledge and skills and were given adequate support to enable them to provide care that was safe and could meet people’s needs.

Records that we looked at confirmed that some systems had been used to monitor how the home had been run and to make sure that the service was being operated in the best interests of those who used it.

There were 58 people living at the home on the day of our inspection. As our inspection was unannounced no one knew we would be visiting. We spoke with six people who lived at the home, three relatives and eight staff.

People we spoke with told us positive things about the home. One person told us "It is a very good home". Another person said “It is alright here, I like it”. Relatives we spoke with complimented the home. One relative said “It seems good". Another relative said "Our family is happy with the home and the way they are looked after. We have no complaints or concerns".

People's needs had been assessed by a range of health professionals including specialist doctors and nurses. This meant that staff had taken action so that people's health and care needs had been met.

We found that the premises were adequately clean and processes had been implemented to improve infection prevention procedures.

We found that recruitment checks had been carried out which prevent unsuitable staff working at the home and the risk of harm to people.

Records that we looked at confirmed that systems had been used to monitor how the home had been run.

We did speak to one person about their care, but because of people’s general frailty it was difficult to get information so we spoke to two relatives as well.

A relative of one person said; “I had problems here last year and was going to take her out of the home. I spoke with the owner and things have improved. Things are not too bad with the care now. I’ve got no worries or concerns”.

The daughter of another person said; “We have no worries or concerns. She is well looked after. The food is very good and she eats well. Her bedroom is lovely. She has been in two homes before and this is the best yet, she is really happy and settled”. This person also said; “Her bedroom is lovely and clean”.

The person herself said smiling; “I do like it here. The girls are so kind. It is the best yet”.