This inspection took place on 3 December 2018 and was unannounced. Our last inspection was on 20 September 2017. At that time, we found concerns with how the provider was meeting the regulations we looked at; people felt there was not enough staff and where people needed support to make decisions, it was not clear how decisions about people’s capacity had been reached. New care plans had not always been completed to record how to provide safe care for them. Quality assurance systems were in place but these were not always effective and prompt action was not always taken to resolve identified issues. We gave an overall rating of Requires Improvement. On this inspection we found improvements had been made but further improvements were still required and the service remains as Requires Improvement.

Nether Hall provides residential and nursing care for up to 50 older people who may be living with dementia. At the time of our inspection there were 31 people who used the service.

There was not a registered manager in post however, a new manager had been recruited to the service and they were submitting an application to register with us. 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 were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. This was because when people lacked capacity to make decisions for themselves, capacity assessments had been completed, however, these were not always specific to the decision being made. Further work was needed when decisions were made in people’s best interests. There were systems in place to monitor the quality of the service and improvements had been made, although further improvements were needed to ensure people were moved safely and received dignified, caring interactions at all times.

People felt safe and there was enough staff, who had been suitably recruited, available to support people when they wanted and needed this. Risks to individuals were assessed and information was available for how to mitigate these risks. Medicines were managed to ensure people were safe from the risks associated to them and infection control standards were in place. The provider reviewed incidents to ensure lessons were learnt.

Staff received training that helped them provide support to people. Staff knew people well and the staff worked in partnership with health care professionals to ensure their needs were met. People enjoyed the food available and were offered a choice. People could choose how to receive care at the end of their life.

People’s privacy was upheld. People were encouraged to be independent and make choices how to spend their day. Relatives felt updated by the home and people felt involved with their care. People were given the opportunity to participate in activities they enjoyed.

Staff felt listened to and had the opportunity to raise concerns. The manager understood their responsibilities around registration with us and notified us of significant events that occurred within the home. People and relatives had the opportunity to raise concerns and suggested improvements, we saw these were considered.

We found breaches 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 the report.

This inspection took place on 20 September 2017. The inspection was unannounced. Our last inspection took place in 18 November 2015 and at that time we found the provider was meeting the regulations we looked at and we gave an overall rating of Good.

Nether Hall provides residential and nursing care for up to 50 older people who may be living with dementia. At the time of our inspection there were 31 people who used the service.

There was 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.

People felt there was not enough staff to meet their needs. People would not always able to engage with activities that interested them or have prompt care when this was needed. Where people needed support to make decisions, it was not clear how decisions about people’s capacity had been reached. New care plans had not always been completed to record how to provide safe care for them. Quality assurance systems were in place but these were not always effective and prompt action was not always taken to resolve identified issues.

Staff developed caring relationships with the people they supported which were respectful. Dignity and privacy was maintained at all times. Staff knew people well and understood how to provide the support people needed.

People received the medicines they were prescribed and there were systems in place to reduce the risks associated with them. They were supported to maintain good health and had regular access to healthcare professionals. Mealtimes were not rushed and food and drink was regularly provided; records were maintained for people who were nutritionally at risk.

People were kept safe by staff who could identify signs of abuse and knew where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills.

Complaints were managed within the provider’s procedure and any concerns were resolved. Visitors were welcomed at any time and they were encouraged to provide feedback through meetings and surveys.

We found breaches 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 the report.

This inspection took place on 18 November 2015. The inspection was unannounced. Our last inspection took place in August 2013 and at that time we found the provider was meeting the regulations we looked at.

Netherhall provides residential and nursing care for up to 50 older people who may be living with dementia.

There was 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.

People were confident that staff supported them in a manner which protected their welfare and they told us they felt safe. Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

People’s care needs were planned and reviewed regularly to ensure their care continued to meet their needs. There were sufficient staff to meet people’s needs and people were confident that the staff had received the training they need to provide support to them.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had been assessed and applications made to appropriate authorities to ensure any restriction was lawful.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed support, this was done in a caring and supportive way.

People were treated with kindness and compassion by staff who knew them well. People were given time and explanations to help them make choices. We saw that people’s privacy and dignity was respected and people were called by their preferred name. People were confident that staff supported them in the way they wanted. Staff knew people’s likes and dislikes and care records reflected how people wanted to be supported and how care was provided.

People knew how to make complaints. They were confident that the staff and registered manager would respond to any concern and they could approach them at any time. Complaints were managed in line with the provider’s complaints procedure and people were informed of any investigation and actions.

Staff felt supported by the registered manager and provider. Systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement. People and staff were involved in developing the service and there was strong leadership which promoted an open culture and which put people at the heart of the service.

We spoke with five people who told us care workers treated them well by providing for their care needs. They sometimes found staff did not always carry out their wishes and did not do all the things they needed doing at the time. They told us they were able to change their mind about things. People’s family representatives said they were included in care planning and in important decisions about their relatives care.

During the inspection we asked four visitors if they found the home to be generally clean and tidy. They told us they had no concerns about the cleanliness of the home. We asked three people using the service if they thought the public places such as the dining room and bathrooms were kept clean. They told us they were. They also added that their bedrooms were cleaned each day.

We asked one person at the service if care workers knew how to care for them. They said, “I think all the staff are helpful. The care workers seem to understand what they need to do to care for me”.

One of the new care workers who spoke with us said “I feel that my training has been good here and it has helped me to care for people in a better way”.

We asked people if they knew that records were kept about them. One person said “yes I know records are here about me and it is fine”. Another person told us “the records are kept to help care for me”.

We observed staff attending to people’s needs. We heard staff asking people if they needed help to use the facilities provided. We also saw that staff would sometimes forget to do this.

People told us they were treated well by staff and that staff would listen to them before providing a care to them.

A visitor explained how the staff had supported their relative when they were dying and had been very supportive to the family afterwards.

We saw the meals being served and although there were times when people had to wait for their meal the process was orderly and everyone was provided with their meal.

We asked one person about their meal and they told us the food was very good. People we spoke to told us they could have extra portions of food if they wanted this and told us they could have snacks in between.

During the lunch time meal we saw people received their medications . The staff member was patient as they encouraged people to take their medications. We saw people were not rushed during this process.

Two people told us, “staff are wonderful and they treat us well”.

A relative told us, “my relative is very happy here and well cared for”.

We observed people at the home who responded well to all the staff that provided care to them. We saw people who sat and talked together during the day. Staff created a comfortable environment for people to live in.