This inspection took place on 3 and 7 August 2018.It was an unannounced visit to the service.

We previously inspected the service on the 21 February 2017. That was a focused inspection to follow up on a previous breach of the regulations. We found the service had met the breach of the regulation, however, we found a further breach of another regulation as the service was not ensuring all the required pre-employment checks were carried out prior to new staff commencing work. At this inspection we found significant improvements had been made.

Mandeville 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. The care home is a mixture of a traditional Victorian build and new build. Accommodation is located over two floors. People had access to several seating areas on the ground floor and were able to enjoy spending time in a well-established and maintained garden area.

The service is registered to provide accommodation up to 31 people. At the time of our inspection 23 people were living at the home.

The service had a registered manager in post. 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.

We received positive feedback from people, their relatives and staff on how the service was led. Comments included “I certainly wouldn’t criticise them, especially the manager, she is excellent, salt of the earth” and “This place is very well run.”

People were supported by staff who knew how to protect them from abuse. The likelihood of harm to people was reduced as potential risks were assessed and reduced.

People told us the environment replicated a traditional family home and was well maintained. People and their relatives told us Mandeville Grange was a “Home away from home” and “I see this as my home, I have freedom to move about and I can make choices.”

People told us they really enjoyed the food. There was a selection of meal options available to people.

People were cared for by staff who demonstrated compassion and kindness. People told us they liked living at the home and felt the staff provided a good service. Comments from people included “I couldn’t think of anywhere else to live,” “There is not a better place to live,” “Everyone is kind, when I mean that I mean compassionate, from the cleaner right up to the top.”

People were supported to engage in meaningful activities and keep in contact with family and friends. A wide range of activities were available to people, both in a group an individual basis.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

This inspection took place on 21 February 2017. It was an unannounced visit to the service.

We previously inspected the service on 17 and 22 December 2015. It was given an overall rating of good at the time. However we found the service did not ensure people were protected from potential abuse of medicine which needed additional storage. We gave the provider a requirement to improve. The provider sent us an action plan which told us how they intended to make improvements to medicine safety. This inspection was a focused visit to check what improvements had been made. We only looked at evidence to ask if the service was safe.

Mandeville Grange Nursing Home is a care home for older adults, some of whom may be living with chronic illness or dementia. It is registered to provide accommodation for 31 people. At the time of our inspection 25 people lived at Mandeville Grange Nursing Home.

The service had a registered manager in post. 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.

We found improvements had been made to the storage and management of medicines that required additional controls due to their potential for abuse. We were satisfied the requirement to improve had been met. There were good systems in place to ensure people received their prescribed medicines when required. This was confirmed by what people told us.

People were protected from avoidable harm as staff had received training and were able to recognise signs of abuse. Staff knew what actions they would take if a safeguarding concern was raised. People told us they had confidence in the staff to support them, however if they were concerned they told us they would tell the senior staff.

People told us and we could see there were enough staff on duty to respond to people’s needs. We observed call bells were answered in a timely way One person told us “There are enough staff here, they [staff] always come, they come when I want, I just buzz them.”

Risks posed to people as a result of their physical or mental health were identified and measures were in place to minimise those risks. For instance, we found assessments were in place for risk of falling, pressure damage and risk of malnutrition. Staff had a good understanding of the risk assessment and how to minimise risk to people.

Environmental risks had been assessed. For instance, a fire risk assessment had been undertaken on 26 July 2016. We noted the service undertook fire drills and was until very recently recording weekly fire alarm tests. The last recorded test was in September 2016. However the registered manager and staff informed us tests were undertaken. Records relating to health and safety of the building in relation to water were not always updated. We have made a recommendation about this in the report.

Incident and accidents were recorded and the registered manager monitored these to look for patterns or ways of preventing future events.

We found some of the required pre-employment checks were not always carried out prior to the staff member commencing employment. The registered manager told us that new staff were subject to an induction period which did not allow them to work alone. However some staff had been in employment for over two months prior to a criminal record check being undertaken. After the inspection the registered manager sent us an action plan on how they intended to rectify this in the future.

We found a breach of the Regulations 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 this report.

This inspection took place on 17 and 22 December 2015. It was an unannounced visit to the service.

Mandeville Grange Nursing Home is a care home for older adults, some of whom may be living with chronic illness or dementia. It is registered to provide accommodation for 31 people. At the time of our inspection 25 people lived at Mandeville Grange Nursing Home.

We previously inspected the service on 21 August 2013.The service was meeting the requirements of the regulations at that time.

The service had a registered manager in post. 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.

Mandeville Grange Nursing Home is located within a converted Georgian family home. It had a home from home atmosphere. Rooms were personalised and people had access to a wide range of activities.

There was a potential for people to receive incorrect doses of medicine. Medicines were not always managed in line with best practice. We found the service lacked space to store medicine safely and more medicine was stored than was required.

People were protected from avoidable harm as staff had received training and were able to recognise signs of abuse. Staff knew what actions they would take if a safeguarding concern was raised.

Risk assessments were undertaken and staff were aware of how to minimise risk to people.

Staff were aware of people’s needs; they had knowledge of people’s lives prior to moving into the home. Staff spoke with people in a dignified manner, and sought consent from individuals prior to care provided.

People were supported by staff who had awareness of the Mental Capacity Act 2005 and Deprivation of Liberty (DoLS). Where needed appropriate referrals were made the Local Authority to authorise a DoLS.

The provider and registered manager were clear about their vision to provide person centred care to people. They invested in staff members’ education to enable them to perform a quality service. Staff felt supported by management and told us they were confident to address any issues with them.

We found a breach of the Regulations 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 this report.

We spoke with people who lived in the home, who told us they were happy living there. One person who lived with their partner in the home told us “I don’t think we would be happier anywhere else.” Another person told us “It is nice here. We are well looked after, the staff are nice and helpful.” We observed how staff interacted with people in a positive manner. We read how people’s care was assessed, planned and monitored. We saw how staff members cared for people in line with the person’s care plan.

We looked at the documentation related to storage, administration and disposal of medication. We found it was in line with the provider’s policy. We observed how a nurse administered medication safely and appropriately to people. We saw the medicines being stored for disposal were accessible to people. The manager made immediate arrangements to make the medicines secure.

We examined documentation related to complaints. We saw how complaints were handled and responded to appropriately and in a timely way. A relative who had made a complaint told us how the situation had been investigated and resolved satisfactorily. We heard how people were dissatisfied with the limited food choices at supper time. The manager told us they were aware of the comments and had acted upon them. However, we were told people were still not satisfied with the outcome. The manager assured us they would investigate further to ensure people’s choice of food was made available where possible.

We spoke with six people who used the service and three relatives who were visiting family members on the day of our visit. People spoken with said they were very happy with the care and support they were receiving. A person using the service said, “The care was excellent. Staff provide care in a professional manner. I feel I am being looked after in a home and not an institution.” A second person said, “Staff do a good job caring for us. They totally respect our privacy and dignity. They called me by my preferred name.” “I am given choices for example, I don’t like meat and custard and I am provided with alternatives such as fish and ice cream.”

People told us they felt safe and comfortable with staff providing them with care and support. They said staff provided care in an unhurried manner. People described the way staff spoke to them as “calm, polite and respectful.”

People said they received their medication at the appropriate time. One person said, “Staff make sure I receive my pain killers regularly to keep me pain free.”

Relatives described the care their family members were receiving as “very good.” One person said, “My mother has been living here for a short period of time. She has settled in very well.”

We found people were not protected against the risks associated with medicines because the arrangements in place to manage medicines were not being followed.

People told us that the home was clean and tidy. They said that their bedrooms were cleaned daily and the laundry facilities were good. They told us that all areas of the home had been repainted including their bedrooms. The premises were well maintained and comfortable. They were able to meet visitors in the privacy of their bedrooms if they wished to, and had access to all the communal areas.

People said that staff were aware of their needs and looked after them very well. They said staff were kind, polite and addressed them by their preferred names.