This inspection took place on 14 March 2017 and was unannounced.

Partridge House Nursing and Residential Care Home is purpose built, and was taken over in 2014 by Tradstir Limited. The service provides nursing and residential care, across three units, for up to 38 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care was provided. There were 36 people resident at the time of the inspection.

There was a registered manager for the service. 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 of the service on 3 November 2015 the service was rated as requires improvement. This was because training records had not been kept up-to-date and it was not possible to fully evidence staff had completed essential training. Training opportunities for nursing staff to update their clinical skills was in the process of being sought. Not all the staff had received regular supervision. Auditing and monitoring processes were not fully in place and embedded in practice. There was no evidence of analysis of the information received and how this had been used to influence and improve the service delivery. At this inspection we found work had been undertaken to rectify this and address the issues highlighted. However, we found although the range of activities people could join in continued to be developed and were provided every day, there were significant numbers of people not engaged in meaningful activities. This is an area in need of improvement.

People lived in a safe and secure environment. We observed staff speaking with people in a kind and respectful manner and saw many examples of good natured but professional interaction. Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity.

Medicines were stored correctly and there were systems to manage medicine safely. Regular audits and stock checks were completed to ensure people received their medicines as prescribed.

Senior staff monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. They told us there had been good access to training to ensure they had the skills to meet people’s care needs. The registered nurses could attend the essential training provided, and were being supported with training updates to ensure their clinical skills were kept up-to-date. Staff told us they felt well supported and had received regular supervision and support.

Safe recruitment policies and procedures were followed in the recruitment of new staff to work in the service.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff were aware of the appropriate action to arrange meetings to make a decision within their best interests.

People told us they had felt involved in making decisions about their care and treatment and felt listened to. People's individual care and support needs were assessed before they moved into the service. An electronic care planning system had been embedded into the service. There were good examples of personalised care plans, and these included detailed information about people’s personal histories and preferences, includi

This inspection took place on 3 November 2015 and was unannounced.

Partridge House Nursing and Residential Care Home is purpose built, and was taken over in 2014 by Tradstir Limited. This is the second inspection since the new provider took over the service.The service provides nursing and residential care, across three units, for up to 38 older people with increasing physical frailty, many living with dementia or other mental health needs. Long term care and respite care was provided. There were 36 people resident at the time of the inspection.

There was a registered manager for the service. 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.

This inspection was undertaken following the last inspection of the service in November 2014 which identified a number of breaches in regulations. The provider subsequently provided an action plan as to how these breaches in the regulations would be rectified. The focus of this inspection was to ensure improvements had been made. Although we could see significant improvements had been made, there were still areas in need of improvement, and further embedding into the service.

At this inspection we found there was evidence of some regular auditing by senior staff in the service. In addition an external group had been called in twice during 2015 to audit and give feedback to the senior staff. Quality assurance surveys had been sent out to staff and people’s relatives and representatives. The information received had been collated. However, it could not be clearly identified how the provider addressed, monitored or analysed the information received to look for any emerging trends or make improvements to the service provided. Quality assurance processes had not always identified areas in need of improvement. This is an area in need of improvement.

Safe recruitment policies and procedures were followed in the recruitment of new staff to work in the service. Senior staff monitored peoples dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. They told us there had been good access to training to ensure they had the skills to meet people’s care needs. However, training records were not fully up-to-date so it was not possible to fully evidence this. This is an area in need of improvement. The registered nurses could attend the essential training provided, but training updates for their clinical skills was being sought but not fully in place. This is an area in need of improvement.

Staff told us they felt well supported and had received regular supervision and support. One member of staff told us they received supervision, “Every couple of months, and we are listened to.” However, supervision records showed us that not all the staff had received regular individual supervision. This is an area in need of improvement.

The experiences of people in the service and their relatives were positive overall. People and their relatives told us they felt safe living in the service, staff were kind and compassionate and the care they received was good. One relative told us, “Take it from me, it’s lovely here, we don’t have any issues or concerns about mum’s care.”

People lived in a safe and secure environment. Medicines were stored correctly and there were systems to manage medicine safely regular audits and stock checks were completed to ensure people received their medicines as prescribed. We observed staff speaking with people in a kind and respectful manner and saw many examples of good natured but professional interaction. Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had a good understanding of the Mental Capacity Act 2005 (MCA) and associated legislation, which they put into practice. Where people were unable to make decisions for themselves staff were aware of the appropriate action to arrange meetings to make a decision within their best interests. People told us they had felt involved in making decisions about their care and treatment and felt listened to.

People's individual care and support needs were assessed before they moved into the service. A new electronic care planning system had been introduced into the service. There were good examples of personalised care plans, and these included detailed information about people’s personal histories and preferences, including details about their previous occupation, family, pets, hobbies, interests and food likes and dislikes. Staff spoke well of the new system as there were access point in the service which care staff could use to update the records and they told us this had led to the care plans being more up-to-date and accessible.Supporting risk assessments were in place to protect people.Where people had been assessed at risk for developing pressure sores, or from falling out of bed, the equipment identified to be used had been regularly checked to ensure it remained suitable for individual peoples use.

People were able to join in a range of meaningful activities. Staff told us there were now two part-time activities co-ordinators who were trying out new ideas for activities and were receiving support and guidance on providing activities for people living with dementia. Where possible care staff also joined in the activities with people, particularly during the afternoons. One member of staff told us, “The activity workers are really good. They find out what people like and try to find something for everyone. If they need help they ask us. Things are pretty good with them.” They saw activities as improving all the time. “The present two activities staff are a team. They try new things. Their weekly activity plan is good for showing what we should do.”

People’s nutritional needs were assessed and recorded. People told us they enjoyed the food provided. Where people were being supported to ensure they had adequate nutrition and fluids, records had been fully completed.

Procedures were in place for people and their relatives/representatives to raise any concerns.No one we spoke with had raised any concerns, but they felt it was an environment where they could raise issues and they would be listened to.

We inspected Partridge House Nursing and Residential Care Home on 14 November 2014. This was an unannounced inspection.

Partridge House is purpose built, recently taken over and now owned and maintained by Tradstir Limited. The service provides nursing care, across three units, for 38 older people with increasing physical frailty, many living with dementia or other mental health needs.

The registered manager was present throughout 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.

The experiences of people at the home were positive overall. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good.

We found systems and processes to maintain an effective service required improvement. Individual care plans did not consistently reflect people’s capacity to make specific decisions, or record whether such capacity had been appropriately assessed and managed. Capacity issues were recorded in a generic way and there was little evidence of people’s consent to care and treatment being obtained. This did not demonstrate a good understanding of capacity and consent issues.

There was little evidence of any social stimulation, across all three units, in the form of any organised activities. During our inspection we observed people sitting in communal areas or in their room, for long periods of time with very little interaction, either with staff or each other.

Care plans were disorganised, cumbersome and poorly maintained, with information often difficult to track and not always current or accurate. There was also little documentary evidence that plans were consistently reviewed and updated to reflect any changes to risk or the care and treatment being provided. These Issues related to capacity, consent, personalised care planning and activities that reflected shortfalls in the auditing systems and overall management of the service.

We found that Partridge House was a safe and secure environment. We observed staff speaking with people in a kind and respectful manner and saw many examples of good natured and professional interaction. Staff were aware of the values of the service and understood the importance of respecting people’s privacy and dignity.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Medicines were effectively managed and were administered safely to people.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.