Herncliffe Care home is a ‘nursing home’. People in nursing homes receive accommodation and nursing care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides nursing and personal care for up to 129 older people, some of who are living with dementia. There were 119 people using the service when we inspected. The home has six separate wings; Garden wing provides nursing care for up to 24 people living with dementia; Margaret wing provides nursing care for up to 23 older people; Terraces provides nursing care for up to 26 older people; Constance wing provides nursing care for up to 24 older people living with dementia; Alexandra wing provides personal care for up to 17 older people living with dementia and Victoria wing provides personal care for up to 14 older people. Each wing has its own communal areas including lounge and dining space.

The inspection took place on 9 and 15 October and was unannounced. At the last inspection in June 2017 we rated the service Requires Improvement. We found breaches of regulation relating to person centred care, safeguarding service users from abuse, staffing and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Is the service Safe?, Is the service Effective?, and Is the service Well Led? to at least good.” At this inspection we found improvements had been made and the service was no longer in breach of any regulations.

A registered manager was in place. 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.

Overall we found the service provided high quality care and support. People who used the service, relatives, healthcare professionals and staff provided good feedback about the home and said people’s care needs were met. Some further improvements were needed to the safety of the service, namely ensuring there were consistently enough staff on duty throughout the home and ensuring the administration of topical medicines such as creams was done in a consistent way. These issues had already been identified by the management team and plans were in place to address them.

People were safeguarded from abuse and improper treatment. Well understood policies were in place to protect people from harm. People said they felt safe and secure living at the home. Overall, risks to people’s health and safety were well managed. Risk assessment documents were in place to guide staff. Staff we spoke with knew people well and the risks they were exposed to.

Most medicines were safely managed and given as prescribed. Better systems were needed to ensure the administration of topical medicines were recorded in a consistent way.

The premises were suitable for their purpose and had been adapted to meet people’s individual needs. The home was clean and odour free.

Staffing levels were sufficient in most areas of the home, although they required review in Margaret wing and at mealtimes. Staff were recruited safely. Staff received a range of training and developmental opportunities and told us they felt well supported.

The service had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards and acted within the legal framework. People were involved in decision making to the maximum extent possible.

People’s nutritional needs were met by the service. People had access to a suitable range of food. On the first day of the inspection we found some aspects of the mealtime experience needed improving. This had been rectified by the second day of our visit.

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The inspection took place on 20 and 21 June 2017 and was unannounced on the first day.

The home provides nursing and personal care for up to 129 older people, some of who are living with dementia. There were 124 people using the service when we inspected. The home has six separate units; Garden wing provides nursing care for up to 24 people living with dementia; Margaret wing provides nursing care for up to 23 older people; Terraces provides nursing care for up to 26 older people; Constance wing provides nursing care for up to 24 older people living with dementia; Alexandra wing provides personal care for up to 17 older people living with dementia and Victoria wing provides personal care for up to 14 older people. Each wing has its own communal areas including lounge and dining space as well as bathrooms and toilet facilities. The majority of bedrooms are single occupancy although there are 14 double bedrooms for people who wish to share. There are well maintained gardens and patio areas around the home, including a secure outdoor space which can be accessed from the Garden wing.

The home has 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 2008 and associated Regulations about how the service is run.

At the last inspection in May 2016 we identified three breaches of regulations, Regulation 9 (person centred care), Regulation 12 (safe care and treatment) and Regulation 13 (safeguarding service users from abuse and improper treatment). The overall rating for the home was ‘requires improvement’. During this inspection we checked to see if the required improvements had been made. We found that although improvements had been made the issues raised at the last inspection had not been fully addressed and there were continued breaches of two regulations.

People and relatives told us they felt the home was a safe place to live. We found improvements had been made to the way safeguarding concerns were identified and reported. Staff knew how to keep people safe and report any concerns about people’s safety and welfare. Risks to people’s health and wellbeing were managed effectively.

The management team decided on the staff numbers and skill mix for each unit. However, we found there were sometimes less staff on duty that were required. This meant there was a risk people, particularly those people living with dementia, would not have their needs met in a timely way.

There were robust recruitment procedures in place to protect people from the risk of receiving care and treatment from staff unsuitable to work in a care setting. References were obtained and criminal records checks were carried out but we found the records did not always show that gaps in people’s employment history had been explored at interview. Staff were trained and supported to carry out their roles and responsibilities.

We found overall people’s medicines were managed safely and people received their medicines as prescribed.

The home was clean and fresh and generally well maintained and secure. However, the provider did not have an electrical wiring certificate to confirm the safety of fixed electrical installations.

People’s capacity to make decisions about their care and treatment was assessed and where appropriate applications for Deprivation of Liberty Safeguards authorisations had been made. However, we found while staff were aware of who had DoLS in place they were not always aware of the attached conditions. This created a risk that people’s rights were not protected.

The majority of people were satisfied with the food and we saw staff were patient and sensitive when supporting and prompting people to eat. People were offered a choice of food but people living with dementia were not offered a visual choi

This inspection took place on 4 and 5 May 2016. The first day of the inspection was unannounced and at the feedback session at the end of the day we told the provider we would return the following day to complete the inspection. At the last inspection on 26 and 27 June 2014 we found the service was meeting all the regulations we looked at.

Herncliffe Care Home provides nursing and personal care for up to 129 older people, some of who are living with dementia. There were 121 people using the service when we inspected. The home has six separate units – Garden wing provides nursing care for up to 24 people living with dementia; Margaret wing provides nursing care for up to 23 older people; Terraces provides nursing care for up to 26 older people; Constance wing provides nursing care for up to 24 older people living with dementia; Alexandra wing provides personal care for up to 18 older people living with dementia and Victoria wing provides personal care for up to 14 older people. Each wing has its own communal areas including lounge and dining space as well as bathrooms and toilet facilities. The majority of bedrooms are single occupancy although there are 14 double bedrooms for people who wish to share. There are well maintained gardens and patio areas around the home, including a secure outdoor space which can be accessed from the Garden wing.

The home has a registered manager who commenced in post in November 2015. 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.

People told us they felt safe in the home. On the majority of units we found there were sufficient staff to meet people’s needs, however our observations on the first day of the inspection showed there were insufficient staff on Terraces. When we returned on the second day the registered manager told us about the action they had been taken to address this.

Safeguarding procedures were in place and staff knew the action to take to protect people from abuse. Records showed appropriate action had been taken in response to some safeguarding incidents. However, we saw reports of incidents where there had been physical altercations between people who lived in the home and these had not been identified as safeguarding or reported appropriately. The registered manager acknowledged these should have been reported and assured this would addressed.

People told us they received their medicines when they needed them, however we found medicines management systems were not always safe. This meant some people did not receive their medicines as prescribed. We saw medicine audits which showed some of these issues had been identified by the registered manager and were being addressed.

Risks to people were not always well managed. For example, risk assessments lacked detail and were not always up to date or reflective of what was happening in practice. This put people at risk of receiving inconsistent care.

Deprivation of Liberty Safeguards (DoLS) were in place for some people and applications had been made for others. However, records showed the legal requirements of the Mental Capacity Act (MCA) were not always being met.

Safe staff recruitment procedures were in place and people were cared for by staff who received the induction, training and support they needed to fulfil their roles and provide appropriate care and support. Staff knew people well and had a good understanding of their needs and the care and support they required.

The home was clean, well maintained and a rolling redecoration an refurbishment programme which ensured the décor and furnishings were maintained to a good standard.

People gave mixed feedback about the food. We found variations in how mealtimes were organised

During the inspection we had the opportunity to speak with people who used the service, relatives, registered nurses, maintenance leads and other staff members.

The people who used the service and their relative told us they were looked after well and felt safe with the care and treatment provided. Their comments included: “Staff are really nice”, “They are friendly” and “Staff are very nice and look after me”.

We found that the service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We spent time observing the lounges and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people. The interactions we saw between staff and people who used the service and visitors were respectful. We saw some people engaged in activities with members of staff such as watching TV.

The home had recently had an external audit by the local pharmacy and it was noted that where issues had been raised actions had been taken.

The service obtained five stars from the local authority inspection team for the kitchen in summer 2013.

During the inspection we observed good security practices. We saw the external doors had access control in place. The manager told us each room had a call bell that was serviced on a regular basis.

People told us that they were "well looked after" and the home was a "pleasant place to live." We found that people were treated with dignity and respect and involved in making decisions about their care. We found appropriate risk assessments were conducted for people living at the home and care plans provided adequate information. We found some care plans were too generic and on occasion lacked detail but this did not affect the provision of care. We found staff were clear about safeguarding processes and were appropriately trained and supported in order to carry out their work effectively. We also found the home had an effective complaints procedure and this was well managed.

During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

Is the service effective?

People's health and care needs were assessed with them or their relative. People were responded to as part of the care planning process.

Is the service caring?

Care staff were attentive and spent time talking to people and making sure their needs were being met. People commented, “I like it here the staff are really good I get really good care.” A relative told us they visited their family member at any time without notice. They were confident their relative was well cared for and said staff discussed care with them and were always available.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service, their relatives and other professionals involved with the service had completed provider satisfaction surveys. Feedback was very positive and comments included, “Staff are always very welcoming, friendly and informative.”

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. This enabled the provider to focus on improvement.