We undertook an unannounced inspection on 27 and 29 June 2017. At our previous inspection in May 2016 the service was rated as Requires Improvement and had four breaches of regulations relating to keeping people safe from risk and abuse, poor administration of medicines, insufficient monitoring of the service and lack of support to staff. We inspected against these breaches of regulation in January 2017 and the provider was meeting the regulations inspected. We carried out this inspection to see if the provider had continued to make sustained progress against the breaches we had previously found. At this inspection we found the provider was delivering a good service

Galsworthy House Nursing Home is registered to provide accommodation, care and support for up to 72 older people, some of whom have dementia. The service is split across three floors. The ground floor provides a service for people who need personal care, the first floor provides nursing care and the second floor supports people living with dementia. At the time of our inspection 53 people were using the service. The service was still undergoing a comprehensive refurbishment programme and the manager had purposefully left some rooms empty to provide additional space whilst the upgrade to the environment took place.

The home had a newly appointed manager at the time of the inspection, who was in the process of registering with the CQC. 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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the manager or deputy at any time.

Staff were familiar with risks people faced and knew how to manage these. We saw that regular checks of maintenance and service records were conducted to make sure these were up to date.

There were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider's staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people's needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people's rooms. People were supported at the end of their lives and had t

We carried out an unannounced comprehensive inspection of this service on 24 and 25 May 2016 at which breaches of legal requirements were found. We found that safe medicines management processes were not followed and people did not receive the support they required with the prevention and management of pressure ulcers. We also identified improvements were required around the effectiveness and management of the home. We found staff did not always receive the training and support they required to undertake their role, safeguarding procedures were not consistently followed and actions were not always taken when improvements were identified as required through the provider’s quality assurance processes. The service was rated ‘requires improvement’ overall and in all five key questions. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. They said they would make the necessary improvements by December 2016.

We undertook an unannounced focused inspection on the 12 January 2017 to check they were meeting legal requirements relating to safe care and treatment, safeguarding, staffing and good governance. This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Galsworthy Nursing Home’ on our website at www.cqc.org.uk.

Galsworthy Nursing Home provides accommodation and nursing care to up to 72 older people. The service is split across three floors. The ground floor provides a service for people who need personal care, the first floor provides nursing care and the second floor supports people living with dementia. At the time of our inspection 57 people were using the service.

A new manager was in post and 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.

The provider had made improvements and was now meeting the regulations relating to safe care and treatment in regards to medicines management and wound care, safeguarding people from abuse, supporting staff and good governance. Staff had worked with the local authority’s contracts and safeguarding teams, as well as the community tissue viability nurse to improve their practice and the care provided to people.

Staff were reporting signs of possible abuse to the management team who, in liaison with the local authority’s safeguarding team, investigated the concerns to ensure any areas requiring improvement were learnt from and people were protected from further harm.

Staff undertook preventative measures to protect people from developing pressure ulcers and from falling. They provided appropriate wound care and changed people’s dressings frequently in line with advice from the tissue viability nurse. Medicines management processes had improved and people received their medicines as prescribed, including controlled medicines, pain relief patches, topical creams and medicines to be taken ‘when required’.

Staff training and supervision processes had improved. An ‘in-house’ trainer had been appointed who provided additional support to staff when completing their induction and mandatory training. Protected time had been allocated to ensure staff had the time to comply with their training requirements.

The management team regularly reviewed and monitored the quality of service provision. Where areas were identified as requiring improvement action was taken promptly to address the concerns. The manager reviewed key service data to identify any trends and learning to minimise the risk to people.

We undertook an unannounced inspection on 24 and 25 May 2016. At our previous inspection on 21 January and 4 February 2014 the service was meeting the regulations inspected.

Galsworthy House Nursing Home is registered to provide accommodation, care and support for up to 72 older people, some of whom have dementia. At the time of our inspection 68 people were using the service. The service was currently undergoing a refurbishment programme and the manager had purposefully left some rooms empty to provide additional space whilst the upgrade to the environment took place.

At the time of our inspection the service did not have a registered manager. The new manager had applied and was in the process of becoming the 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 2008 and associated Regulations about how the service is run.

Staff were aware of the signs of possible abuse. However, we found that processes were not followed in regards to reporting possible abuse to the local authority safeguarding team. This meant appropriate investigations could not take place to identify whether abuse had occurred and to protect people from harm.

Staff assessed and identified the risks to people’s health and safety. We saw that the majority of these risks were managed appropriately. However, sufficient action was not taken to protect people from the development and deterioration of pressure ulcers. Staff did not follow guidance in people’s care plans in regards to frequency of repositioning, which could put people at further risk of breakdown in their skin integrity.

Safe medicines management processes were not consistently followed. We identified stock discrepancies and people were not always receiving their medicines as prescribed.

Care plans were developed outlining people’s initial support needs. This included their capacity to make decisions. The majority of care plans contained detailed information about people’s support needs. However, we found that care plans were not always updated as people’s needs and capacity changed.

A full training programme was in place to enable staff to update their knowledge and skills. However, we found that staff were not up to date with this programme and had not completed the necessary training for their role. A system was in place to supervise and support staff. However, this was not being adhered to and staff were not receiving the support they required to undertake their duties.

Systems were in place to monitor and review the quality of service delivery. We saw that these reviewed all aspects of service delivery and had identified the concerns we found during this inspection. However, they were not that effective as they had not ensured that standards of service were consistently maintained and sufficient action had not been taken to address these areas requiring improvement.

Staff engaged people in activities. There was a programme of activities delivered at the service, and we saw for people with dementia this included sensory stimulation. However, the range of outings for people was limited and there was a reliance on people’s friends and family members to take people out in the community and to access local amenities.

Staff had built caring working relationships with people. Staff were knowledgeable about the people using the service, including the support they required, their preferences and their interests. We saw that people were supported in line with their preferences and staff offered people choices about aspects of their daily lives.

Staff adhered to the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards. Staff were aware of who needed to be deprived of their liberty in order to keep them safe, and had applied to t

We saw that the top floor of the home focused primarily on care for people living with dementia. People on the other floors were seen to have varying needs including dementia. We spoke with ten people using the service, seven relatives or friends of people using the service, eight staff members and two managers during our two visits to Galsworthy House Nursing Home. Comment cards were received from seven relatives or friends following the inspection.

People using the service told us that “Everybody is kind”, “I can’t ask for more attention”, “I can’t look after myself and they are very good” and “I like it here – it suits me”. Individuals spoken to told us that they were treated with dignity and respect by care staff.

Feedback included from relatives or friends included “People with dementia are treated with compassion, respect and dignity at all times”, “My relatives condition has improved with the care and attention they have been shown”, “Fantastic” and “Caring and supportive”. One relative or friend told us “Any concerns are immediately addressed and all staff are approachable”.