This inspection took place on 11 October 2018 and was unannounced. This means no-one connected to the home knew we were visiting that day.

When we completed our previous inspection in September 2017 we found the system used to monitor how the home operated was not always effective in highlighting areas needing attention, especially around records. We also highlighted shortfalls in the documentation of end of life care. At that time this topic area was included under the key question of ‘Caring.’ We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is now included under the key question of ‘Responsive.’ Therefore, for this inspection, we have inspected this key question and also the previous key question of ‘Caring’ to make sure all areas are inspected to validate the ratings.

In September 2017 we judged the overall rating of the service to be 'Requires Improvement’ and asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did. Due to our concerns we also imposed conditions onto the provider's registration. These required them to submit evidence to us monthly on the areas of concern. The provider complied with all our requirements, and this helped evidence they were meeting the Regulations.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Darnall Grange’ on our website at www.cqc.org.uk.

At this inspection we found improvements had been made and the breach of Regulation found at the last inspection had been addressed. A more robust system had been implemented to assess if the home was operating as planned. This meant areas needing improvement had been identified and action taken in a timely manner to address them. We also found care plans and risk assessments provided better information, including about end of life care arrangements, and improvements had been made to medication records.

Darnall Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Darnall Grange provides accommodation for up to 60 older people who require nursing and/or personal care, including people living with dementia. Accommodation is provided over two floors, accessed by a lift. The home is close to local transport and amenities. At the time of our inspection 47 people were living at the home.

The service had 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.

Care and support was planned and delivered in a way that ensured people were safe. People were protected, as any risks associated with their care were identified and appropriately managed. Systems were also in place to safeguard people from abuse.

The recruitment policy had been reviewed and amended to make sure essential checks were made on potential staff's suitability to work with vulnerable people. Staff were trained and supported to develop their skills and provide people with the standard of care they required.

There was enough staff employed to meet the needs of the people living at the home at the time of our inspection.

Medication was managed safely and administered by staff who had completed appropriate training.

People were supported to have maximum choice and control of their lives and staff supported the

Darnall Grange is a care home which is registered to provide nursing and personal care for up to 60 older people, some of whom are living with dementia. The home is purpose built and provides accommodation over two floors. On the day of our inspection there were 58 people living in the home.

The inspection took place on 25 and 28 September 2017 and was unannounced. This meant no-one was aware we were inspecting the service on that day.

The home was last inspected on 1 March 2017 at which time the service was rated overall as requires improvement and was not meeting the requirements of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued two warning notices and six requirement notices to the registered provider. At this inspection we checked and found the necessary improvements had not been made to comply with one of the breaches of regulation identified at the last inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to the reports after any representations and appeals have been concluded.

There was a manager at the service who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living at Darnall Grange and spoke very positively about the staff. This was also reflected in the feedback received from people’s relatives.

Staff, people and relatives said the registered manager and providers were approachable and communication was good within the service. Comments included, "The improvements are obvious - I feel so much more confident in the managers" and “[Manager] is very nice, very approachable, very attentive and interested in what’s going on. He’s hard working.”

Additional staff were in the process of being employed to take account of the increase in care needs, including anxieties of some people living with dementia, during the late afternoon and early evening.

The registered provider’s recruitment policy required reviewing to make sure it contained all the information required about staff before they commenced employment, and in turn that all recruitment information was available for all staff when they commenced employment.

Staff told us they received an induction and shadowed experienced staff prior to commencing work. They also told us they received regular updates to their training and were provided with relevant supervision and appraisal so they had the skills and support they needed to undertake their role. The documentation we look at did not support these views and required improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, but further improvement was required in the submission and recording of applications and authorisations to restrict people's choice and control.

A varied diet was provided to people which took into account their dietary needs and preferences so their health was promoted and choices could be respected. However, we saw some people’s nutritional intake monitoring records required improvement to include further information to aid analysis and early intervention when people did not eat and drink enough.

We found the home was clean and well maintained. However, further improvement was required so that the environment met best practice guidelines particularly around prevention of cross contamination to minimise the spread of infection among people and staff and better meet the needs of people living with dementia.

People told us they were respected and their privacy and dignity upheld. However, we saw areas where this required imp

The inspection took place 1 March 2017 and was unannounced. The home was last inspected in September 2015 at which time it was rated as requires improvement, with ratings of good in safe, caring and well-led. We found the required improvements had not been made since our last inspection.

Darnall Grange offers residential and nursing care for up to 60 older people, some of whom have a diagnosis of dementia. The home offers accommodation over two floors.

There was no registered manager at the time of the inspection; however there was a manager in post who was in the process of registering with the Care Quality Commission. 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 had undertaken safeguarding training, however not all staff had received up to date training. There had been incidents which had not been recognised as safeguarding and had not been reported to the relevant bodies as a result.

Risk assessments did not identify individual risk and did not explain to staff the measures which needed to be in place to keep people safe.

There was a recruitment process in place which was being followed; this included carrying out all necessary pre-employment checks including disclosure and barring service (DBS) checks and references from previous employers. However we found there was no process to carry out checks on people’s DBS status to ensure people remained suitable to work with vulnerable adults.

There were sufficient staff on duty, however due to the design of the building there were periods where people were left unsupervised in communal areas.

Medicines were not always managed or recorded safely.

Staff had undertaken some training, however there were gaps in the training and support of staff which meant they may not have the skills and knowledge required to carry out their roles.

The home was not always working within the Mental Capacity Act 2005, and had not carried our best interest decisions or applied for Deprivation of Liberty Safeguards for all the people that required them.

There were some issues with weight loss and there was little evidence the home was taking adequate action where people had lost weight.

Staff were kind, caring, considerate and sympathetic. However whilst staff knocked on doors and waited for response which protected people’s dignity, we also found people without shoes and glasses and people who were wearing food stained clothing.

Care plans were not person-centred and did not always reflect the current needs of people who lived at the home. The care plans were reviewed each month, however the reviews did not add current information into people’s care plans to ensure they were current.

There were a variety of activities taking place in the home. People and their relatives enjoyed the activities which were on offer.

There was clear leadership and management in the home.

Processes to monitor the safety and quality of the home were not effective and had not identified some of the issues we found during the inspection; this meant the registered provider did not have oversight of the performance of the home.

The registered provider had not ensured they notified us of all events which affected the running of the home or the people who lived there.

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced and was undertaken on 16 July 2014.

Hazeldene EMI Nursing Home provides care for up to 60 older people who are living with dementia. 53 people were living at Hazeldene EMI Nursing Home on the day of our inspection. Accommodation is provided over two floors, accessed by a lift. All bedrooms are single and have ensuite toilets. Each floor has a separate dining area. There are lounges throughout the home.

A registered manager was not in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does S & S Healthcare, the provider. On 25 February 2014 we served a fixed penalty notice to S & S HealthCare for failing to have a registered manager in place at Hazeldene EMI Nursing Home. A fine of £4000 was paid. A manager was later received and approved.

Hazeldene EMI Nursing Home was last inspected in February 2014. During this inspection we found that the home was not meeting the requirements of the regulations pertaining to records and care and welfare of people who use services. Following our previous inspection, the provider sent us an action plan to inform us of the changes they were going to make. During this inspection we noted that improvements had been made with regard to the areas we previously had concerns about. Records about people’s weight and nutrition were up to date and the care plans for people who had behaviours which may challenge now included clear plans and risk assessments to support staff to identify and appropriately respond to these behaviours.

We found that there were systems in place to make sure people were protected from the risk of harm. Staff knew about safeguarding adults and we saw that any concerns had been reported and appropriately dealt with.

People were not appropriately supported to make decisions in accordance with the Mental Capacity Act, 2005 (MCA). Whilst the manager had an understanding of the MCA and Deprivation of Liberty Safeguards (DoLS); care staff could not consistently demonstrate an understanding of these pieces of legislation and how they applied in practice.

We identified some unsafe medication practices which meant people were not being protected from the risks associated with unsafe medicines management. The practice we observed in relation to ‘homely remedies’ did not match the homely remedy policy document. A homely remedy is a medication which is used to treat minor ailments and which can be purchased without a prescription. We identified some recording errors within Medication Administration Records (MARs) and found that protocols were not in place to identify when people may need as and when required (prn) medicines.

There were sufficient care staff to meet people’s needs. Care staff spent time sitting and talking with people and there were sufficient staff to support people at meal times. Staff were aware of people’s nutritional needs and food preferences. Our observations of mealtimes and our review of nutritional records evidenced that people received a choice of suitable healthy food and drink.

Some areas of the home were in need of re-decoration. The provider was aware of the need to make the environment more ‘dementia friendly’ and had begun to make some changes to support this.

Staff undertook an induction programme which included shadowing an experienced member of staff. Mandatory and further training was available to support staff to meet the specific needs of people living at the home. Staff received supervision and appraisals to support them to meet people’s needs.

We saw that staff knew people well, were respectful and made sure people’s privacy and dignity were maintained.

Health professionals we spoke with prior to our inspection said that the manager and staff sought their advice and involvement when needed. People’s care plans were centred on people’s individual needs and contained information about their preferences and backgrounds.

Complaints were managed appropriately and people, relatives and staff told us that the manager was approachable. People and their relatives told us that they felt able to raise any concerns with care staff and/or the manager.

There were systems in place to assess and monitor the quality of care provided and to gain the views of people and their relatives.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of the report.

We used informal observation throughout our inspection. This was because many of the people living at Hazeldene had dementia and were not able to tell us about their experience of living at the home. Our observations enabled us to see how staff interacted with people and see how care was provided. We also spoke with one person, three relatives, five members of staff and the manager of the home. We reviewed the care plans of seven people and other associated documents.

The direct care observed during our inspection was appropriate. We noted that the staff were attentive and focussed on the needs of people living at Hazeldene. We saw that group and individual activities were provided for people. The person spoken with during our inspection stated, “I can get up when I want and go to bed when I want,” and was generally positive about the staff and the manager of the home. Relatives spoken with on the day of our inspection were similarly positive about the staff and care at Hazeldene. One relative said, “I’ve no qualms at all. It’s 100% this place. I think the carers are excellent.”

We identified some issues relating to the care records at Hazeldene. Key information about people’s needs was absent from some of the care plans reviewed. We also found that some people’s weight had not been recorded monthly, as stipulated in their care plan. We were concerned that these issues could result in people not receiving appropriate care and treatment.

We used both formal and informal observation throughout our inspection. This was because people living at Hazeldene had dementia and were not able to tell us about their experience of living at the home. Our observations enabled us to see how staff interacted with people and see how care was provided. We also reviewed a range of records and spoke with six members of staff and the acting manager of the home.

Our review of records evidenced that people and /or their relatives and representatives had consented and been involved in decisions about their care and treatment.

We saw that the direct care provided at Hazeldene was safe, appropriate and took people’s individual needs into account. We also found that people benefited from equipment that was used safely and met their needs.

Our conversations with staff and our check of records identified that they received supervision, an annual appraisal and a range of training courses.

We found that a system was in place to gather, record and evaluate information about the quality and safety of care provided at Hazeldene.

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time.

People who lived at Hazeldene had a range of needs. Some people were not able to tell us their experience of living at Hazeldene so we used a variety of formal and informal observation methods across both floors of the home in order to see how people and staff interacted, and see how care was provided.

Our observations showed us that people received a good level of support with their personal care needs. Throughout our inspection we saw that staff interacted positively with people. We saw that staff at the home spoke to people in a kind and respectful way and had a clear knowledge of people’s individual likes and preferences.

We spoke with three relatives during our inspection all of whom were positive, about both the care their family member received and staff within the home. Comments included, "the staff are really caring, they know people as individuals" and, "I can't speak highly enough of the carers."

We observed lunchtime within the home. We saw that people were offered a range of meal choices and were supported appropriately. One carer described the quality of food within the home as , "excellent," and said, "if carer's see people, 'picking,' at their food they always offer other options." We saw evidence of this during our visit.We also saw that people were offered a range of drinks and snacks throughout the day.

Relatives were also positive about the two recently appointed activity coordinators within the home, one of whom was present at the time of our inspection. One relative said that this person had, "made a real difference to the atmosphere within the home." We observed a number of activities during our inspection and saw that these were positive experiences for people who used the service. We also saw that picture and crafts from these activities were displayed around the home.

People living in the home have a variety of dementia and associated cognitive impairments. Due to their communication needs, we used informal methods of observation during our visit. We did not get the direct views from people that used the service for this outcome, but observed staff providing support and assistance as required. Relatives indicated they were satisfied with the service provided.

Our inspection of Hazeldene EMI Nursing Home was undertaken on 10 and 14 September 2015. The first day of our inspection was unannounced.

The last comprehensive inspection of Hazeldene EMI Nursing Home by the Care Quality Commission (CQC) took place in July 2014. Two breaches of regulations were identified during this inspection. Following the inspection, the provider completed an action plan to say what they would do to meet the legal requirements in relation to the two breaches. Our September 2015 inspection included checks to ensure that the home had followed their plan and to confirm that they now met legal requirements

Hazeldene EMI Nursing Home provides care for up to 60 older people, most of whom are living with dementia. The home was fully occupied at the time of our inspection. Accommodation is provided over two floors, accessed by a lift. All bedrooms are single and have en-suite toilets. Each floor has a separate dining area. There are lounges throughout the home.

The manager in post at the time of our inspection was not the registered manager of Hazeldene EMI Nursing Home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does S & S Healthcare, the provider.

They manager had been at the home for six weeks and was in the process of obtaining the necessary checks in order to then submit their application to become the registered manager of the home. The deputy manager was an established member of staff and had provided management cover pending the recruitment of the new home manager.

People told us that they felt safe living at Hazeldene EMI Nursing Home. Conversations with staff and the manager demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse.

We found that there were sufficient staff to meet people’s needs and keep them safe. We noted that there was a high use of agency staff and nurses on both days of our inspection and also received comments from staff and relatives about this. Particularly because the agency staff were often unfamiliar with people’s needs. The manager was aware of this and was in the process of recruiting to all vacant posts within the home.

Improvements had been made to medication practices within the home. Our observation of a medication round on each floor of the home together with our review of records provided evidence that medicines were safely administered, recorded and stored. We noted some shortfalls in relation to the recording of as and when required, (PRN) medications. We were reassured that these issues would be addressed as part of the improvements the manager was in the process of making to this area of practice.

We found that improvements had been made to records documenting people’s capacity to make decisions. Capacity assessments and best interest decisions were clearly recorded and in line with the Mental Capacity Act Code of Practice. Clear records about the Deprivation of Liberty Safeguards (DoLS) were also maintained.

Staff were provided with an induction and a range of training to help them carry out their roles. Nursing and senior carer had received a recent supervision session and an annual appraisal. However, other members of care and ancillary staff had not received an annual appraisal or a supervision within the providers recommended timescale. The new manager was aware of this and showed us a folder they had prepared to plan supervisions and appraisals for all staff.

People’s physical health needs were monitored and clearly documented. Referrals were made when needed to health professionals.

We received mixed feedback about the food at Hazeldene EMI Nursing Home. We observed the lunchtime meal in both of the dining rooms and noted that the mealtime was well organised. The meals looked appetising and were well presented and there were sufficient staff to ensure people were supported to eat at the same time.

We noted that meals were served on bare tables in both dining rooms, some of which were scuffed and worn. There were also few examples of staff interacting with people during our observation of lunchtime in the first floor dining room. We fed back our observations to the manager and were reassured that they had identified the need for meal times to be improved, and how they proposed to do this within a recent action plan.

The manager’s action plan also reflected our observations that the environment was not always dementia friendly. It stated, “We need to create an enabling environment of care that enhances the resident’s orientation,” and again listed ways of achieving this.

Our observations together with conversations with people and relatives provided evidence that the service was caring. We saw that staff across the home spent time sitting and talking with people. Members of staff spoken with on the day of our inspection had a good understanding of people’s individual needs and preferences and knew how to respect people’s privacy and dignity.

Relatives and members of care staff felt that activities within the home could be improved. Our observations confirmed this. The manager of the home agreed with our findings and said that they had identified activities as an area for development. We noted that this had also been documented within their recent action plan.

People’s needs were assessed and reviewed and care plans were amended in response to any changes in need. However, one of the six care plans reviewed during our inspection did not contain the required records to document an injury we observed and heard a member of care staff discuss during the course of our inspection.

Relatives and staff were positive about the deputy manager and the newly appointed manager and the way in which they led the service. They told us that both individuals were visible and were approachable. Staff told us that the new manager had clearly communicated the improvements they wished to make. One member of staff commented, “I agree with what the things the deputy and manager are changing and how they’re doing it. They’re there for the residents and that’s what we’ve needed.”

A system was in place to continually audit the quality of care provided at the home. We saw that this incorporated a range of weekly and monthly audits relating to differing areas of the service.