The inspection took place on 08 March 2017 and was unannounced.

Conewood Manor Nursing Home accommodates up to 42 older people, some of whom live with dementia. At the time of our inspection 38 people lived at the home.

The home had a registered manager. 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.

When we last inspected the service on 12 July 2016 we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to identify, effectively manage and monitor shortfalls by means of the audit process. For example, shortfalls were identified at the inspection in areas including health and safety matters within the environment, record keeping with regards to medicines, staff recruitment and care plans, communication skills of the staff team and people told us that they did not always receive their care in a timely manner. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements.

At this inspection we found that the provider had made the necessary improvements to help ensure that people received a safe and well managed service.

People felt safe living at Conewood Manor Nursing Home. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management team and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

This inspection was carried out on 12 July 2016 and was unannounced. We previously carried out an unannounced comprehensive inspection of Conewood Manor Nursing Home on 05 May 2015 at which we found there were insufficient numbers of suitably qualified, competent, skilled and experienced staff available to meet the needs of the people who used the service. We undertook a focused inspection on the 15 October 2015 to check that the provider and management team had followed their plan and we found that the legal requirements had been met. There were sufficient suitably qualified, competent, skilled and experienced staff members available to meet the needs of the people who used the service.

Conewood Manor Nursing Home accommodates up to 42 older people, some of whom live with dementia. At the time of our inspection 40 people lived at the home.

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 and associated Regulations about how the service is run.

We found a shortfall in the medicine management systems however, while this had potential for risk there had not been a negative impact on the care and welfare of people who used the service. Staff were trained in how to safeguard people from avoidable harm and were knowledgeable about the potential risks and signs of abuse. However, some staff were not all able to communicate their understanding effectively.

Many areas of the home had been refurbished since our previous inspection visit and refurbishment work was still on-going in some areas. It was acknowledged that the building is listed and consequently the possible alterations are limited. However, there were potential risks to the safety of people who used the service, visitors and staff due to steep and in some cases, uneven ramps. Newly recruited staff described a clear recruitment process however, we found that the provider’s recruitment policy did not ensure that satisfactory evidence of conduct in previous employment concerned with the provision of services relating to health and social care was obtained.

The registered manager was responsive to the issues we raised at the inspection and undertook immediate action to help mitigate risks. However, these areas of shortfall and potential risk to people’s health, safety and wellbeing had not been identified by the managements internal audit systems.

People’s relatives told us they felt that there were enough staff available to meet people’s needs however, people who used the service and staff did not always agree. The deployment of staff was not always effective in meeting people’s needs due to the complex layout of the home.

Potential risks to people’s health, well-being or safety had been identified, and were reviewed regularly to take account of people’s changing needs and circumstances.

People’s health needs were well catered for. People received care and support from a staff team who were supervised and had the knowledge and skills necessary to provide safe and effective care. People were supported to make choices about food and were assisted to eat in a calm and unhurried manner. However, we noted that staff missed opportunities for interacting with people and that clothing protectors were placed on people without any consultation. We have made a recommendation about staff training on the subject of promoting people’s dignity.

People’s relatives were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual’s needs and preferences and people were involved in the planning of their care where they were able. Visitors were encouraged at any time of the day and people’s privacy was promoted.

There was a programme of activity and stimulation in plac

We carried out an unannounced comprehensive inspection of Conewood Manor Nursing Home on 05 May 2015 at which a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found. This was because there were insufficient numbers of suitably qualified, competent, skilled and experienced staff available to meet the needs of the people who used the service.

Following the comprehensive inspection, the provider wrote to us on 30 June 2015 to tell us how they would make the required improvements to meet the legal requirements. We undertook a focused inspection on the 15 October 2015 to check that they had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to this regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Conewood Manor Nursing Home on our website at www.cqc.org.uk

Conewood Manor Nursing Home accommodates up to 42 older people, some of whom live with dementia. At the time of our inspection 39 people lived at the home.

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 and associated Regulations about how the service is run.

At our focused inspection on 15 October 2015, we found that the provider had followed their action plan which they had told us would be completed by 30 September 2015 and the legal requirement had been met. There were sufficient suitably qualified, competent, skilled and experienced staff members available to meet the needs of the people who used the service.

The inspection took place on 05 May 2015 and was unannounced. This was the first inspection since new providers had taken over the service in September 2014.

Conewood Manor Nursing Home accommodates up to 42 older people, some of whom live with dementia. There were 37 people using the service when we inspected.

The home had a registered manager. 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Conewood Manor Nursing Home and were pending an outcome.

People who used the service, their relatives and staff members expressed concerns about the numbers of staff available to meet people’s needs according to their personal preferences. Staff recruitment processes were safe and a range of training was provided to staff to give them the skills and knowledge required to undertake their roles.

People told us that the staff team were kind and caring. Care and support was delivered in a way that protected people’s privacy and promoted their dignity. Activities were provided for people but had not been tailored to meet people’s specific interests. The provider had arrangements in place to support people and their relatives to raise complaints or issues of concern and provide feedback about their experiences.

We received positive comments about the management team from people who used the service, their relatives and the staff team. People were encouraged and supported to raise concerns and the manager closely monitored and sought feedback about the services provided to identify areas for improvement and drive forward improvements in the home.

We found that the provider was in breach 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.