The inspection took place on the 25 and 31 October 2018 and was unannounced.

This was the first inspection of High Peak Residential and Nursing Home following a change of service provider.

High Peak Residential and Nursing Home is a ‘care home’ run by Sanctuary Care (UK Limited). 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.

The care home provides accommodation, personal and nursing care for up to 41 people in one adapted building. The majority of double rooms are used as single rooms with a maximum of 34 places provided. Most of the rooms have en-suite toilet facilities and communal bathing and toilet facilities are located throughout the care home. At the time of our inspection, the care home was accommodating 29 people.

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

The registered manager was present during the two days of our inspection and was supported by their regional manager and deputy manager. The management team were open and transparent throughout the inspection process and demonstrated a commitment to the ongoing development of the service.

The care home provided a warm and caring environment for people to live in. Overall, we observed that staff were responsive to the needs of people living in the care home and that people were treated with dignity and respect. We observed two occasions when the lounge area was not supervised by staff and saw people calling for help. We raised this feedback with the management team who arranged to review the staff deployment system and amend the staffing levels in the home to ensure the same number of staff were on duty throughout the day.

We found that information on people's assessed needs and the support they required from staff had been recorded within care plans. This included risk assessments and other supporting documentation. The care planning system was in the process of being updated at the time of our inspection to ensure the registered provider’s current documentation was utilised. This work is due to be completed by December 2018. Nevertheless, care plans viewed had been kept under monthly review to ensure the information recorded was up-to-date and accurate.

Policies and procedures had been developed to ensure staff were aware of their roles and responsibilities for ordering, storing and administering medication and to ensure safe systems and practice.

People were offered a choice of nutritious and wholesome meals. People were able to socialise and eat their meals at their preferred pace and support was available when required.

A programme of activities was in place. The activities coordinator was absent during the period of our inspection so alternative arrangements were put in place to ensure people continued to benefit from social and recreational stimulation.

Systems had been established to ensure that staff working in the care home had been appropriately recruited and to safeguard people from abuse or harm.

A complaints policy and procedure had been developed and people's views, concerns and complaints were listened to and acted upon.

People were supported to attend healthcare appointments and staff liaised with people's GPs and other healthcare professionals as necessary to maintain people's health or support them at the end of life. We observed that a GP visited the care home on a regular basis to ensure the healthcare needs of people were monitored and reviewed.

Staff had access to regular supervision and completed induction, mandatory and

This inspection was unannounced and took place on the 01 February 2016.

High Peak Nursing Home was previously inspected in June 2013. Three breaches of legal requirements relating to the care and welfare of people using the service, staffing and assessing and monitoring the quality of service provision were identified. We undertook a follow-up inspection in November 2013 and found that improvements had been made to address the breaches.

The home provides accommodation, personal and nursing care for up to 41 older people; however the majority of double rooms are used as single rooms with a maximum of 34 places provided, The registered provider is Embrace (UK) Limited. At the time of our inspection the service was accommodating 27 people.

The home is an adapted three storey country house located in a rural part of Warrington. It has a two storey purpose built extension and is set in its own grounds. Most of the rooms have en-suite toilet facilities. There is a car park provided for visitors.

At the time of the inspection there was a registered manager at High Peak Nursing Home. 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 manager was off duty on the day we inspected High Peak Nursing Home. The Regional Manager made arrangements to attend the inspection in order to provide help and assistance to staff and the inspection team and was joined later in the day by the home’s deputy manager.

During the inspection we found High Peak Nursing Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content with the standard of care provided.

Staffing levels varied throughout the day and were structured to meet the needs of the people who used the service and to reflect the design of the building. Overall, staff spoken with reported that they felt the staffing levels were generally adequate to meet the needs of the people using the service but reported it was difficult to meet people’s needs, particularly at mealtimes.

We raised this feedback with the registered manager following our inspection who assured us that she would explore the deployment of staff in the afternoons and how the service could utilise staff more efficiently and effectively at mealtimes.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training and supervision to develop the necessary skills and competence for their roles.

People had a choice of meals and drinks at lunchtime, breakfast and supper. Special dietary needs were met, such as soft and pureed meals for people with swallowing difficulties.

Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a range of individualised and group activities and a choice of wholesome and nutritious meals. Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff understood their duty of care in relation to this protective legislation.

Systems were in place to safeguard people from abuse and to respond to complaints.

At our previous visit we identified there had been limited support planned and offered on a regular basis to meet people’s social needs and requests. We noted some improvements to try and meet people’s social needs at this follow up inspection. The manager had since employed an activities organiser for 27.5 hours per week.

We met most people living at the service. They were able to tell us that they were happy with the service. They made various positive comments such as:

"Its ok here, I have no complaints" ;"They work very hard, not sure how I would cope without them" ;"activities are champion" and "the activities are fine, not sure what's planned for Christmas."

The manager has introduced a 'staffing tool' to help her calculate how many staff she needed to have in place to meet the assessed dependency levels of the people living at the service. This tool had been regulalry reviewed by the manager to help to show how staffing levels were being reviewed and monitored. The manager had also arranged to display the staffing levels on duty on one of the notice boards so that anyone at the service could visually see how many staff were on duty.

We acknowledged the improvements made into the management of staffing levels and the employment of an activities organiser following our previous inspection. However we noted the lack of evidence to include people's opinions at the service regarding staffing levels.

We spoke with six people who were living at the service during our visit.

Their comments overall were very positive.

They all agreed that they liked living at the service and used word to describe it such as; “We have everything we need”; “it’s a good service”; “we don’t have any problems here.” and “We have everything expected.”

Two people seemed unsure about using their nurse call buzzer at night and felt they shouldn’t use it for general things as it was there for an emergency. This needed clarifying with people at the service to ensure they knew they could ask for assistance at anytime.

People who were living at the service collectively told us they were happy with their home and they liked their bedrooms. One person showed us their room which they really liked. They told us they had everything they needed and liked to go to their room each day.

One person told us their room was due for an update and had been promised in the past it would be done but they didn’t know when it would be redecorated.

Two people told us they would like to go to their room in the day but had been told they couldn’t use the lift without staff assistance. They were unclear as to whether this meant they could or couldn’t go to their room when they wanted. This needed clarifying with people at the service to ensure they had access to their rooms whenever they wanted to go to them.

When we visited High Peak nursing home we had the opportunity to observe the care that was being given to people living at the service. This was called a “short observational study, a SOFI ”. SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.”

We saw many examples of good communication and patience by care staff who interacted with people in a positive manner. For example staff spoke quietly and lowered down to eye level to talk to people they were supporting. We noted staff quietly asking people if they would like to go the toilet before settling into their armchair after lunch. Staff were friendly and respectful to the people they were supporting.

We had also contacted the local authority contracts and monitoring team for Warrington Social services before we visited the service.

Relatives told us they had been involved in discussions about care and support and confirmed that this was an ongoing process. One person advised: “I have been included in their care plan and I’ve completed a questionnaire about the service."

We looked at a selection of in house audits carried out by the manager in which she carried out inspection's/assessments of the service. However we noted various areas within the service that showed signs of wear and tear and were in need of deep cleaning and maintenance. The manager advised they had previously been awarded money by the company to help refurbish the service and that they were still in the process of taking quotes for this work. There seems to have been considerable delays and lack of consultation and evidence of when this work would actually be carried out.

During our inspection we noted that staff appeared busy and we did not observe staff being able to sit and chat to people during our visit. At times there were no staff in the communal areas as they were busy supporting people with personal care needs. We saw no evidence of any monitoring of the standards of care and support provided by staff. The manager advised she would review all areas identified during this inspection.