This inspection took place on 12 November 2018 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Pexton Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Pexton Grange is a nursing home that provides care for up to 57 people. It is a purpose built care service. At the time of our inspection 42 people were living at the service. Twenty two of those people were using the intermediate care service provided on behalf of the NHS. Those people have experienced a period of ill health or have been in hospital and are unable to manage at home. They therefore require rehabilitation and support for a short period of time to help them regain their independence. Therapy support for those people was provided at the service by the NHS Sheffield Teaching Hospitals, Community Services.

Our last inspection at Pexton Grange took place on 17 October 2017. The service was rated requires improvement overall. We found the service was in breach regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014, staffing.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was a manager at the service who was registered with the CQC. A registered manager is a person who has registered with the CQC 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.

People said they felt safe living at Pexton Grange and we found there were systems and processes in place for people's needs to be safely met. Staffing levels were supportive of people's individual care needs. The recruitment procedures in operation promoted people’s safety.

People received their medicines on time and staff understood each person's abilities and health needs.

People were supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice and staff understood legislation around people's mental capacity.

Staff were provided with relevant training, supervision and appraisal so they had the skills they needed to undertake their role.

Staff had a kind and caring approach and showed respect when interacting with people and good regard for people's privacy and dignity.

People enjoyed meaningful activities and there were appropriate opportunities to engage with the activities coordinator in groups or on a one to one basis.

People’s care plans contained relevant information and had been reviewed to ensure they were up to date.

People were confident in reporting concerns to the registered manager and staff felt they would be listened to.

There were quality assurance and audit processes in place to make sure the service was running well.

Pexton Grange is a nursing home that provides care for up to 57 people. It is a purpose built care service. At the time of our inspection 51 people were living at the service. Thirty three of those people were using the intermediate care service provided on behalf of the NHS. Those people have experienced a period of ill health or have been in hospital and are unable to manage at home. They therefore require rehabilitation and support for a short period of time to help them regain their independence. Therapy support for those people was provided at the service by the NHS Sheffield Teaching Hospitals, Community Services.

This inspection took place on 17 October 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

There was a registered manager, but they were no longer managing the service. We were informed they were working for the registered provider in another role. The registered provider had appointed a new manager, the former deputy manager, to manage the service. The manager told us they had been managing the service since September 2017, and they had applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 we spoke with told us they felt ‘safe’ and did not express any worries or concerns.

Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs.

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.

People had access to a range of health care professionals to help maintain their health. A varied diet was provided, which took into account dietary needs and preferences so people’s health was promoted and choices could be respected.

All the relatives that we spoke with made positive comments about the care their family member had received and about the staff working at the service.

A programme of activities was in place so people were provided with a range of leisure opportunities.

Our discussions with staff showed that a few staff would benefit from further safeguarding training to develop a greater understanding of their role and responsibilities. There were satisfactory arrangements in place for people who had monies managed by the service.

Accident and untoward records did not always show details of the outcome of the investigation and/or a rationale for the resulting action. Although we did not find this had negatively impacted on people who used the service, we saw there was a risk that reportable incidents may not be shared appropriately with the CQC and/or the local safeguarding authority.

Staffing levels were sufficient to meet people’s needs. During the inspection staff responded to people’s calls for assistance in a timely manner.

We saw the registered provider’s recruitment policy needed reviewing to ensure there was clear guidance in place on what information needed to be obtained about candidates before they were offered employment. This was because we found some shortfalls in the staff recruitment records we viewed.

We recommend the registered provider review their recruitment policy and all staff recruitment files are checked to ensure that all the information identified in Schedule 3 has been obtained, and available to demonstrate fit and proper persons have been employed.

We saw that some staff had not been provided with relevant training, supervisio