This inspection was carried out on 6 and 13 July 2017and was unannounced. Collingwood Grange Care Home is a care home with nursing operated by BUPA. Service provision is for up to 75 people of either gender, also people with dementia and adults with physical disabilities. At the time of our inspection 73 people were living at the service.

There was a registered manager in post who supported us on both days of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection in September 2016, the service was rated ‘Good.’ However there were breaches in regulation around the lack of mental capacity assessments for people and people were at risk of having decisions made for them without their consent. We also made recommendations in relation to staff supervisions and the choices for people at meal time. On this inspection we initially planned to review just these areas, however as we identified a concern with staffing levels on day one we returned for a second day to complete a comprehensive inspection to review all aspects of care. At this inspection we found the service remained ‘Good’, the breach had been met and our concerns with the staffing levels had been addressed.

People told us they were safe at the service. Staff understood what constituted abuse and what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm.

There was sufficient numbers of care staff deployed at the service to meet people's needs. The registered manager had increased staffing numbers as a result of our concerns being raised. Assessments were undertaken to identify risks to people to keep them safe and staff understood what the risks to people were.

Incidents and accidents were recorded, analysed and used to reduce the risk of them re-occurring. Recruitment practices were robust and ensured that only suitable staff were employed at the service.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business continuity plan that identified how the service would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them, there was evidence that these were done in their best interests. Mental capacity assessments were completed in relation to specific decisions.

Staff were having group and one to one support with their manager that promoted their development. We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing.

People had sufficient amounts to eat and drink and there were appropriate arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to health care services.

Staff treated people with compassion, kindness, dignity and respect. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.

People had access to activities that were important and relevant to them. People were protected from social isolation.

People's needs were assessed when they entered the service and on a continuous basis to reflect changes in their needs. Staff understood the care th

This inspection was carried out on the 16 September 2016. Collingwood Grange provides residential, nursing and respite care for older people who are physically frail. The service is separated over three floors, one floor is dedicated to care for people living with dementia. It is registered to accommodate up to 90 people. At the time of our inspection 69 people were living at the service.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

There was a lack of MCA assessments in relation to specific decisions and people’s ‘Do not Resuscitate’ forms were not always appropriate. Where people had restrictions placed on them there was not always evidence that this was done in their best interests. However, staff were up to date with current guidance to support people to make decisions.

There was sufficient numbers of care staff at the service to meet people's needs, however we asked the manager to address the deployment of staff during meal times to ensure that people were not kept waiting for support with their meals. Risks assessments were in place for people and staff understood and acted upon the guidance provided. Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a business contingency plan that identified how the service would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

Medicines were managed, stored and disposed of safely. Any changes to people's medicines were

prescribed by the person's GP and administered appropriately. People understood the medicines they were receiving and where appropriate relatives were kept informed of people’s medicines.

People told us they were safe at the service and relatives felt their family members were safe. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm. Recruitment practices were safe and relevant checks had been completed before staff started work.

We found the staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing. However, staff had not always received appropriate supervision.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. We asked the registered manager to ensure that people were being supported with meals when they needed and that people were always offered meal choices.

People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with care, kindness, dignity and respect. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.

People's needs were assessed when they entered the service and on a continuous basis to reflect changes in their needs. There were some care plans that required updated information which the registered manager confirmed that they were addressing. People's care and welfare was monitored regularly to ensure their needs were met.

People were supported to voice their concerns or complaints about the service. Concerns and complaints were used as an opportunity to learn and improve th

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to people’s consent to care and treatment, staff not being appropriately supported, staffing levels, care and welfare of people, respecting and involving people, meeting people’s nutritional needs and records.

We undertook this focused inspection to check that they had followed their plan and to confirm that they have now met legal requirements. This report 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 Collingwood Grange Care Centre on our website at www.cqc.org.uk.

There was a registered manager at the service however they were on leave on the day of our visit. 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.

Although there was a programme of activities people did not always enjoy what was being provided. There was a lack of activities specific to people’s individual needs and wants.

Records of people’s care were not always up to date and accurate. They did not always reflect the care that had been provided.

There were sufficient numbers of staff deployed around the service to meet people’s needs. We saw that people received care in a timely way from staff.

Staff had the most up to date guidance in relation to their role. The required mandatory training had been completed by all of the staff and nurses were up to date with their clinical knowledge.

Staff had knowledge of their responsibilities under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people lacked capacity and their liberties were restricted in their best interests applications had been made to the local authority in relation to the liberty being deprived.

Staff gave examples of where they would ask people for consent in relation to providing personal care. We saw several instances of this happening during the day.

People and relatives felt that staff were kind and considerate. People were treated with kindness and compassion by staff throughout the inspection. However we did see a few examples of care which did not demonstrate dignity for the individuals concerned. Staff acknowledged people warmly and sat talking with people where possible.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

We carried out an unannounced comprehensive inspection of this service on 19 January 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to cleanliness and infection control.

We undertook this focused inspection on the 2 April 2015 to check that the provider had followed their plan and to confirm they have now met legal requirements. 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 Collingwood Grange Care Centre on our website at www.cqc.org.uk.

The service was clean and the risks of cross infection had been reduced. People’s rooms and all of the communal areas were clean and tidy. Staff had received refresher training in infection control and we saw staff using gloves and aprons where necessary. Additional staff had been recruited to keep the service clean.

This was an unannounced inspection, which took place on the 19 January 2015. Collingwood Grange Care Centre is a care home with nursing provided by BUPA. Collingwood Grange Care Centre provides care for up 90 people on a short- and long-term basis. The care provided includes nursing, care for people living with dementia and care for people with Huntington disease.

At the time of inspection there was 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 and associated Regulations about how the service is run.

People and their relatives said they felt they were safe with the staff. One person said “I feel safe and happy here; I would tell the manager if I had safety concerns but there's been no need”. Another said “You can be vulnerable somewhere like this but I feel safe”. Not all staff had received updated safeguarding adults training but had knowledge of the safeguarding procedures and what to do if they suspected abuse.

There were not always enough staff to safely meet people’s needs. This meant that sometimes people did not receive care in a timely way. Staff felt that care was rushed as a result of there not being enough staff. One person said ”The staff look after you well but sometimes I have to wait a bit when I press the buzzer, they're probably too busy to come right away.”

Risk assessments for people were undertaken and measures put in place to reduce the risk of them coming to harm. Staff were aware of people’s risks and what to do to minimise them.

Medicine was administered safely and disposed of in a safe way. People’s medicine charts were completed correctly and a nurse signed to say that people’s medicines had been given. There was guidance for staff on when to give people their PRN (as needed) medicines.

Pre-employment checks for staff were completed. For example in relation to their full employment history and reasons why they had left previous employment. This meant that only suitable staff were employed.

One relative told us “We’re happy with the nurses and carers here. They seem efficient. If my husband is unwell and I'm not here, the staff always notify me including letting me know if the doctor's been to see him. I don't have to wait long”. Health care professionals said that staff had the support and skills to deal with some people’s complex conditions.

Staff were not up to date with the service mandatory training and others had not had any training in some areas. This included first aid, fire training and infection control. This meant that staff would not have the most up to date guidance. Not at all staff had received a one to one supervision or appraisal with their manager.

People said staff asked them for consent before they gave care. One said “The staff look after me well and ask for my consent to care.” Staff knew about the Mental Capacity Act 2005 and mental capacity assessments had taken place for most people. However where people’s freedom was restricted by keypad doors and the provider had not completed the appropriate forms to the Local Authority.

People thought the food was good and felt that their nutritional needs were catered for. People were encouraged to make their own decisions about the food they wanted. There was a wide variety of fresh food and drinks available for people. However those people who needed additional support to eat were not always given that.

People had access to a range of health care professionals, such as chiropodist, community matron and a GP. GPs visited regularly and people were referred when there were concerns with their health.

People thought that the staff were caring and that they were treated with dignity and respect. People also felt that if they needed privacy then this would be given. We saw instances where staff were not always caring. These related to people who needed additional support and were living with dementia.

Some people felt there was enough to do. One told us “I can do what I want - go out in the summertime, phone my family, watch television and I decide when to go to bed.”

There were not enough activities provided for people specific to their needs. This was more specific to the needs of people living with dementia. Some people said that they didn’t like group activities but preferred to sit with one person to do something meaningful to them. They felt that this was not always offered to them.

People and relatives said they understood how to make a complaint and felt comfortable to do so. There was a copy of the complaints procedure for everyone to see in the reception area. All of the complaints were logged and there was evidence that the provider learned from these complaints.

People, relatives and staff were asked for their opinion and feedback on what they thought of the service. The Manager was unable to show us the analysis of the 2013 Survey and was waiting for the analysis of the 2014 Survey. Regular residents and relatives meeting had taken place and suggestions and issues were used to improve the service.

People and staff felt that the service was well managed. However not all of the audits that took place were effective and improvements had not always been made as a result of the audits. For example in relation to cleanliness and staff being caring.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

We last inspected this service on the 8 May 2013 and found the provider was not meeting the essential standards of quality and safety for cleanliness and infection control, safeguarding people from abuse, supporting workers, assessing and monitoring the quality of service provision and records.

The provider sent us their action plan which addressed how and by when they would become compliant with the required standards.

Staff understood the signs of abuse and told us they would raise any concerns with managers and were confident that their concerns would be dealt with in a timely manner. People spoken with told us they felt safe living at the home. One person told us “If I was worried about anything or if I heard or saw anything that I though should not be happening then I would tell the managers.”

Improvements had been made in infection control practices and the home was clean and hygienic. People spoken with displayed a high level of satisfaction with the cleaning at the home. One person said “It’s always spotless.” A second person told us “They try so hard to keep my room up to scratch, I think they do a good job.”

Staff informed us improvements had been made in the level of support and supervision they received from managers.

The arrangements in place to monitor the quality of the service had improved and people’s confidential records had been stored appropriately and securely.

There has been no registered manager at this service since January 2013.

Prior to our visit we received information from health professionals who had recently visited the home. They had raised a number of concerns with regards to the care and welfare of people who lived at the home. Many of the people at Collingwood Grange Care Centre were unable to tell us about their experiences in a meaningful way. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. "SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

People had been treated respectfully and their views had been taken in to account by staff. Risks to people's health and welfare had been assessed and care was planned and delivered according to people's needs.

Some staff did not understand the signs of abuse and what constituted abuse. Nor did managers respond in a timely manner to concerns raised. Some infection control practices at the home were poor.

People's health and welfare needs were met by sufficient numbers of appropriate staff. However staff had not received appropriate supervision and support.

The arrangements in place to monitor the quality of the service were ineffective. People's confidential records had not been stored securely.

You can see our judgements on the front page of this report.

A number of the people at Collingwood Grange were unable to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of

support they got and whether they had positive experiences. We spent a considerable amount of time observing care and found that on the whole people had positive experiences.

People using the service 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.

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

During our visit we spoke with three people's representatives who were visiting the home, and following the visit we also spoke with five representatives on the telephone. Most of the representatives told us they were happy with the care provided at the home. Others told us that there was not enough staff on duty at weekends and that this had a negative impact on their relative.

People's representatives 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 their concerns would be responded to and dealt with quickly.

People who use the service told us that all staff respect their privacy and dignity, and their views are listened to. They told us that they attend the residents meetings where they put forward suggestions and ideas.

They make decisions about themselves, and they can talk to staff and the manager if they were not happy with how they are being looked after.

People who use the service told us that they are looked after well by all the staff. They told us that they were aware of their care plans, and had been included in producing them, but their families are more involved with these. They stated that they could not remember all the information in their care plans. Some of the people using the service informed us that they visited the service before making a decision about moving in, and that an assessment of their needs was undertaken at this time, which was then repeated when they moved into the home. The other people told us they went to the service from hospital, and an assessment was undertaken at that time.

They agreed that the food at the service is very good, and there is always a choice. They told us that they can have a drink and snack at any time, and can choose to have their meals in their bedrooms.

We were told by people who use the service that they felt safe and well looked after by the staff at the service. They told us that staff look after them in a respectful manner, and always respect their privacy and dignity. They stated that staff always listen and act on what they say.

During discussion in regard to medication, people who use the service told us that they always receive their medication on time, and they know what the medicines are for. We were told that the GP visits them at the service and they are seen in the privacy of their bedrooms. They can go to the surgeries if they wish to.

People who use the service agreed that there is enough staff on duty to help them when they need support. Staff always talk to them in a nice and respectful manner, are always available, and they look after them well.