About the service:

Nightingale Group Ltd, Trentham Care Centre is a residential care home that was providing personal and nursing care to 148 people at the time of the inspection. People who used the service had physical disabilities, sensory needs and mental health needs; such as dementia.

People’s experience of using this service:

Improvements were needed to ensure there were systems in place to monitor all areas of people’s care needs and to ensure the improvements were consistently implemented across the service. Records were in the process of being updated to ensure they reflected people’s up to date needs and preferences in the way they wished their care to be provided.

People were supported by safely recruited staff who had the skills and knowledge to provide safe and effective support. People were supported by staff that understood their responsibilities to safeguard people from the risk of harm. There were systems in place to ensure lessons were learnt when things went wrong.

People were supported by caring and compassionate staff that supported people with patience. People’s choices were respected in line with their individual communication needs to promote informed decision making. People’s right to privacy was up held and their independence was promoted.

People had the opportunity to be involved in interests and hobbies and for social interaction. Complaints were listened to and improvements were made as a result of feedback. People’s end of life wishes were gained, which ensured their preferences were taken into account at this time of their lives.

There was an open culture within the service where feedback was gained from people, relatives and staff, which was used to make improvements to people’s care. The provider had recognised that improvements were needed at the service and had started to implement changes to the way the service was managed. The provider had a clear vision for the future of the service.

Rating at last inspection:

Requires Improvement (report published 26 April 2018).

Why we inspected:

This inspection was carried out to check the provider had made improvements to the service since the last inspection. We found improvements had been made and the overall rating had improved to good.

Follow up:

We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 7 and 8 March 2018 and was unannounced. At the last inspection completed on 14 and 15 November 2016 we found the service was rated Requires Improvement and the provider was not meeting the regulations for safe care and treatment, consent, person centred care and governance. At this inspection we found the service had made improvements and were meeting the regulations but further improvements were needed.

Nightingale Group ltd. Trentham Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal 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.

Nightingale Group ltd. Trentham Care Centre accommodates 155 people in three adapted buildings, with five units within these buildings. At the time of our inspection there were 136 people living at the home.

There was a registered manager in post at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Peoples risk assessments were not consistently followed by staff. Guidance for administering some medicines lacked detail for staff to follow. Checks required on controlled drugs were not always carried out. People did not consistently receive personalised care and were not consistently able to access social stimulation. The governance arrangements were not consistently being followed by staff.

People were supported by staff that could recognise abuse and understood how to safeguard them. People were supported by sufficient suitably recruited staff. People received their prescribed medicines. People were protected from the risk of infection. Incidents were reviewed to ensure learning when things went wrong.

People’s individual needs were assessed and care plans were in place to meet their needs. Staff were trained and demonstrated a knowledge of how to support people and provided consistent care. People were supported to have enough to eat and drink and could make choices about their meals. People had equipment and adaptations to enable staff to support them effectively. People were supported to access health professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and the policies and systems in the service supported this practice.

People received support from caring staff that knew them well. People were able to make informed choices and had their individual communication needs met. People were supported in a way that maintained their dignity and staff were respectful and ensured they had their privacy protected.

People’s preferences were understood by staff when they provided support. People were supported to maintain their religious beliefs. People understood how to complain and the registered manager ensured all complaints were responded to. People were supported with dignity at the end of their lives.

The registered manager was accessible and people and their relatives were able to share their views about the service. There were quality audits in place which enabled the registered manager to check people had received the care and support they needed. Lessons were learned when things went wrong and people and their relatives felt involved in the service.

This unannounced inspection took place on 14 and 15 November 2016. At our previous inspection we found the provider was in breach of six Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the service was not safe, effective, caring, responsive or well led. We had issued the provider with two warning notices and asked them to improve. At this inspection we found that although some improvements had been made further improvements were required. You can see what action we have asked the provider to take at the end of the report.

The service is registered to provide accommodation and personal care for up to 143 people. People who use the service have complex physical health and/or mental health needs, such as dementia, acquired brain injury and behaviours that challenge. At the time of our inspection 125 people were using the service.

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

Risks of harm to some people were not being minimised as safe infection control procedures were not being followed in relation to their specific conditions and some staff did not know how to keep these people safe. Medicines were not managed safely and put people at risk of not having their prescribed medicines at the times they required them.

The principles of the MCA 2005 were not being consistently followed as some people were not consenting to or being supported to consent to their care. People did not always have their choices and individual preferences met and there were limited opportunities for people to participate in hobbies and interests of their choice.

Systems the provider had in place to monitor and improve the service had not been fully effective in ensuring improvements in people's quality of care were made.

There were sufficient suitably trained staff to meet the needs of most people who used the service in a timely manner, however some specialist training was required to meet all people's needs safely. New staff were employed following safe recruitment procedures and agency staff were checked for their suitability to work with people who used the service.

People were safeguarded from the risk of harm and abuse as staff and the management knew what to do if they suspected someone had been abused. The local safeguarding procedures were being followed.

Staff who cared for people felt supported and received regular supervision and on going training. People felt the staff were competent and effective in their roles.

People received health-care support from other professionals when their needs changed or they became unwell. People were supported to maintain a healthy diet and support was sought if people experienced difficulty in eating and drinking.

People told us and we saw that staff treated them with dignity and respect. People's right to privacy was upheld and they were encouraged to have a say in how the service was run. People and their relatives were involved in their care planning and kept informed of any changes.

The provider had a complaints procedure and people and their relatives felt their complaints were taken seriously and acted upon. Changes to the management structure had created opportunities for staff to develop and had played a part in the improvements made since our last inspection.

We inspected this service on 9 and 10 May 2016. This was an unannounced inspection. Our last inspection took place in August/September 2015 where we identified improvements were needed to ensure the service was; safe, effective, caring, responsive and well-led.

The service is registered to provide accommodation and personal care for up to 143 people. People who use the service have complex physical health and/or mental health needs, such as dementia, acquired brain injury and behaviours that challenge. At the time of our inspection 122 people were using the service.

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

At this inspection, we identified a number of Regulatory Breaches. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely and people were not always protected from the risk of abuse. This meant people’s safety, health and wellbeing was not consistently promoted.

There were not enough suitably skilled staff available to meet people’s individual care needs and preferences in a timely manner and people did not always receive the right care at the right time. Gaps in staff training meant people could not always be assured that they consistently received their care in a safe and effective manner.

Effective systems were not in place to consistently assess, monitor and improve the quality of care. This meant that improvements to the quality of care were not always made in a prompt manner and any improvements to the quality of care were not always sustained.

The legal requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not consistently met. This meant people could not be assured that decisions were made in their best interests when they were unable to do this for themselves.

People were not always treated with dignity and their privacy was not always promoted.

Safe recruitment systems were in place to ensure people employed by the provider were of suitable character. However, improvements were needed to ensure temporary agency staff employed by external providers were also of good character.

People were supported to access suitable amounts of food and drink of their choice and their health and wellbeing needs were monitored. Advice from health and social care professionals was sought and followed when required.

When people were able to make choices about their care, the choices they made were respected by the staff.

People and their relatives were involved in the planning of their care and their feedback about the quality of care was sought and acted upon to make improvements.

People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manger informed us of notifiable safety incidents in accordance with the requirements of their registration.

The inspection took place on 23 and 24 October 2014 and was unannounced.

At the last inspection of June 2014 we asked the provider to take action to make improvements to the way they planned and provided care to people, to the staffing numbers and the accuracy of records. We found at this inspection there had been some improvements in all of the non-compliant areas. However there remained concerns about staffing levels on two of the units we inspected against and aspects of the care delivery for some people.

Guardian Care Centre provides nursing and personal care for up to 143 people. The service is divided into three separate buildings and five distinct units. Providing support for older people living with dementia, older people who have nursing care needs. Younger adults with physical disabilities, with complex care needs and who may have suffered brain trauma or injury, and people who have genetic conditions such as Huntington’s Disease.

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 protected from the risk of harm, because staff we spoke with knew how to recognise and report suspected abuse. The provider reported any alleged abuse to the local authority appropriately. At the time of the inspection there were on-going investigations of alleged abuse. These investigations were being conducted under large scale investigation procedures.

Risk assessments were in place which supported people to remain safe. Reviews of areas of risk had been undertaken, meaning they were up to date.

Recruitment processes were robust and ensured that prospective staff were fit to work.

Medicines were usually stored safely when not in use, but there were concerns about administration practice, storage of temperature sensitive medicines and disposal procedures. There were examples where it was not evident that people had received their medication as prescribed and concerns that people were having medication administered covertly without best interest agreements.

The principles of the Mental Capacity Act 2005 were not always followed. This meant some important decisions made on behalf of people had been made without their consultation.

Staffing levels had improved since our last inspection and on most units we noted that staffing levels met people’s needs, but on Garden Walk and Garden View we observed people not receiving the support they needed. We observed people being left for long periods of time without attention or supervision.

We found improvements had been made to the records management and recording of people’s care but we also saw some important documents were not complete and did not reflect people’s needs.

Staff had received training and supervision to ensure they were effective in their roles. Although some up-dates to training had not been provided, the provider had a plan in place.

People had a choice of food. Most people we spoke with told us they were happy with the food choices available to them. When people required more support to meet their nutritional needs, plans were put in place to monitor and ensure that people received adequate food and fluids. We observed people had mixed experiences at mealtimes, with some people receiving good levels of support but others left for long periods of time without assistance.

People’s health care needs were met. Records showed that people were supported to see a health care professional when they became unwell or their needs changed, but this wasn’t consistently applied which meant there were examples where people’s health care needs had not been dealt with promptly.

From our observations and talking to people who used the service, people were usually treated with dignity and respect, but we observed examples where people’s dignity had been compromised.

There was a complaints procedure for people who used the service and their families and friends to access. Most people we spoke with told us they knew how to complain and who to go to. Some people commented that they hadn’t always felt listened to when they had raised concerns in the past.

The registered manager and the management consultancy team were auditing the quality of the service to find where improvements were needed to be made. They demonstrated a good understanding of the improvements needed.

Where breaches in regulation have been identified you can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to check on the care and welfare of people who used the service as part of our planned schedule of inspections. The inspection was unannounced which meant the provider and the staff did not know we were going to visit.

At the time of the inspection Guardian Care Centre was providing accommodation and support for up to 143 people. Some people using the service had dementia related conditions and we used our SOFI tool to help us see what people's experiences were like. The SOFI tool allowed us to spend time watching what was going on in a service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We saw that people were included in making decisions and their consent to care and treatment was sought and recorded. Where people's capacity to consent was limited best interest decisions had been made on their behalf.

We saw the care records included all information about how people needed to be supported and how risks had been assessed.

Staff understood their responsibilities to recognise and protect people from the risk of potential abuse.

Essential training was provided and staff confirmed that they felt supported by the management of the home.

We saw that the service was monitored and audited to ensure that quality standards were maintained.

People told us that they were generally satisfied with the care and support their relatives were receiving from the service. People referred to this as "basic but adequate". People thought that there had been some improvements made to the meals served in the home but they were not sure whether people had a choice about meals. They said that the staff on the dementia care unit were "very good". People had confidence in the staff to look after their relatives.

Due to the nature of people’s illness we were not able to engage them in a conversation about their experiences of living in the home.

We visited Garden View unit and spoke to three sets of relatives.

They were all were satisfied with the care provided on the unit. One person described the care as ‘basic’ but added that when issues were raised these were addressed by staff. One person told us their relative is taken out regularly and that they enjoy this experience.

We saw that some people were left for long periods of time in the same place with little to occupy them. For example one person was seen sat in a chair in the same position all day.

We saw that activities were provided for some people in the lounge and dining areas. Several people who use the service were engaged in these activities during the day.

We found that people were not given a choice of main meal during the lunch time period. We noted that they were not asked what they would like to drink during the day but given either tea or coffee. Staff told us they knew what people liked/disliked and therefore did not need to ask.

Meals were provided in two sittings. Staff told us that people who require assistance and others who become agitated and want their meals early were accommodated in the first sitting. The people who did not mind waiting were placed on the second sitting. This did not take into account the time people got up in a morning and whether they had an early or late breakfast.

We inspected this service on 20, 25, 26 August and 2 September 2015. Our inspection was unannounced.

When we inspected the service in October 2014, we identified a number of breaches of the Health and Social Care Act 2008 )Regulated Activities) Regulations 2010. We told the provider that improvements were required to ensure people received care that was; safe, effective, caring, responsive and well-led. At this inspection we found that some required improvements had been made, but further improvements were needed.

Guardian Care Centre provides accommodation with nursing and personal care for up to 143 people. The service is divided into three separate buildings and five distinct units. Providing support for older people living with dementia, older people who have nursing care needs. Younger adults with physical disabilities, with complex care needs and who may have suffered brain trauma or injury, and people who have genetic conditions such as Huntington’s Disease.

The provider had appointed a manager, who had applied to be registered with us. Registration had been agreed at the time of the inspection. 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 protected against the risk of abuse. Staff had received training in how to recognise and report abuse and knew how to blow the whistle.

Risk assessments were completed for individuals and had been reviewed regularly, but some risks had not been responded to promptly.

Appropriate recruitment checks were carried out to ensure new staff were suitable.

Prior to and during the inspection we received concerns about staffing levels from people who used the service, staff and relatives. We observed that call bells were answered promptly and people’s needs were being met but we also observed delays in people receiving essential care, because of how staff were organised and deployed.

We found concerns about medicines management, administration and stock control. We saw examples of staff signing medicines records incorrectly and people not receiving medicines they were prescribed.

Arrangements were in place to induct and train staff. Most staff were able explain the training they had received and we observed staff using appropriate techniques for example manual handling.

Staff told us they received supervision and appraisal of their practice.

The principles underpinning the Mental Capacity Act 2005 and associated Deprivation of Liberty safeguards were understood by nurses and senior care staff, but more training was required for junior staff. We observed staff seeking peoples consent in provide care and support. We also found examples were restrictions hadn’t been recognised or obtained consent for.

Referrals to the GP and other health professionals was evident. We received positive feedback from two health professionals.

The dining experience of some people was poor and food choices were not always promoted.

We observed some occasions where people were referred to in language that was not respectful. For example we overhead people being referred to as, ‘feeders’ and described as ‘kicking off’ in their presence.

We observed caring interactions and people being treated with respect. We also observed some examples where dignity was not always promoted for example. We overhead and read people using the service being referred to as ‘feeders’, ‘walkers’ and described as ‘kicking off’, in their presence.

Care plans had been personalised and subject to review, but there was limited evidence of people’s involvement. We found that incidents had not always been responded to and observed that staff did not always respond to people’s needs promptly. We found that care plans were not always followed.

We observed mixed interactions from staff providing support, where some staff were engaging but others were not. We saw that activity coordinators had been recruited to improve the social and recreational opportunities of people, but found that further work was needed. People told us there was often too little to occupy their time.

People who used the service and their relatives knew how to make a complaint and some people told us their concerns had been responded to. Relative and service user meeting were being organised.

Staff told us their managers were supportive and things were improving on some units. Staff meetings were held.

We found examples where records were not up to date or were inaccurate.

We observed that some audits of the service were not effective.

Surveys on the quality of the service had been circulated to people who used the service and their supporters and analysed. Action plans resulting for the surveys had not yet been developed.