We inspected the service on 18 December 2018. The inspection was unannounced. Pinxton Manor Nursing Home 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. The service is registered to accommodate 40 people.

On the day of our inspection 35 people were using 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 continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Staff had received training and knew how to recognise abuse and how to report it. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them. The service provided nursing care and there was at least one qualified nurse on duty at all times. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive an effective service. Staff received the training and support they required including specialist training to meet people’s individual needs. Qualified nurses were supported to maintain their professional qualification and received clinical supervision. People were supported with their nutritional needs. Staff identified when people required further support with eating and drinking and took appropriate action. The staff worked well with external health care professionals, people were supported with their needs and accessed the health services they required. 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. The principles of the Mental Capacity Act 2005 (MCA) were followed.

The environment was adapted to meet the needs of people living with dementia and was accessible to people who used the service.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative. The service had achieved a ‘dementia specialist award and dignity award from their commissioners. People had a person-centred care plan in place for each identified need. Staff knew people well and knew how they preferred to receive care and support. People had opportunities to pursue their interests and hobbies, and social activities were offered and tailored to meet people’s needs and abilities. There was a complaint procedure and action had been taken to learn and improve in response to complaints.

People continued to receive a well led service. People and staff were supported by the management team. There was a clear support structure and staff understood their roles and responsibilities. People and staff were

This inspection took place on 7 and 10 June 2016 and was unannounced.

There is a requirement for Pinxton Manor Nursing Home to have a registered manager and a registered manager was in place at the time of this 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 service is registered to provide nursing and residential care for up to 40 people, including some people living with dementia. At the time of our inspection 37 people were using the service.

People were supported by staff who were kind and caring. People’s choices and decisions were respected. Most of the time care and support respected people’s privacy and dignity. People’s independence was supported.

People received responsive and personalised care from staff who understood them. People were supported to engage in enjoyable interests and activities, either with other people or in activities that could be started and stopped to suit people’s choices. People were asked for their views and people knew how to raise concerns or make suggestions.

The registered manager had taken steps to make sure people were cared for safely. Sufficient numbers of staff were deployed to meet people’s needs. Any risks to people were identified and assessed and monitored. Medicines were well managed and safely stored and administered.

Staff sought people’s consent before they provided care and support. Some people were subject to restrictions and the provider had identified where their support needed to be reviewed. This ensured the principles of the Mental Capacity Act (MCA) 2005 were followed.

People were supported to enjoy mealtimes and received sufficient food and drink that met their nutritional needs. Staff were supported through supervision and training and demonstrated knowledge of people’s needs. Staff received training in areas that were relevant to the needs of people using the service. People were supported to access other health care services as required.

The registered manager was viewed as being open and approachable and involved in the day to day management of the service. The registered manager was supported in their leadership by motivated and supportive staff. Records were maintained and checks on the quality and safety of services provided to people using the service were completed.

Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what the people who used the service, relatives, and the staff told us. During our inspection we talked with six of the people who used the service, three relatives, and four members of staff. Some of the people who lived at the home were not able to give their views due to their mental health needs.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The people we talked with told us they felt safe at Pinxton Manor. The home had a calm and friendly atmosphere and people appeared comfortable and well-cared for. One person said, “I’m very settled here and it feels like home. Everybody’s very nice. I have no grumbles at all about this home.”

The manager had reviewed the security of the home following an incident when a person who was not safe to do so had left the home unaccompanied. When we visited there was a notice on the front door reminding staff and visitors of the need to keep the home secure. This helped to ensure there would be no repeat of this incident.

The manager and staff understood their responsibilities under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS). We identified that some improvements were needed to the home’s own mental capacity assessment form and the manager said this would be addressed.

Is the service effective?

Staff got on well with the people who used the service and cared for them in a warm and supportive way. One relative told us, “I like the way some of the carers talk to my (family member). They are so kind and gentle in their approach.” Another said, “The staff are really kind and take an interest in my (family member).”

The people who used the service told us they were pleased with the care at Pinxton Manor. One person on bed rest said, “I’m very comfy here. The staff bring me cups of tea and juice all day and they always have time for a chat.” Another person said, “I’ve never had to wait for the staff. They always come straight away when I need them.”

People told us they enjoyed the daily activities provided by the home’s two activity co-ordinators. These included reminiscence, home baking, chair exercises, and trips out to a local garden centre. One person said, “We have out hair done one week and then our nails the next and a lady comes round doing activities.”

Relatives made many positive comments about the home including, “This home is always nice and clean”, and “My (family member) always appears comfortable and happy when I visit.”

Describing their experience of life in the home one of the people who used the service told us, “The views are wonderful and I have a very nice bedroom which is kept beautifully clean for me. And it’s very quiet at night so I always get a good night sleep.”

Is the service caring?

We observed a nurse caring for a person who was on bed rest. She took this person a drink and encouraged then to drink it themselves. She spent time interacting with the person and making them smile. She did not rush them and made sure they were comfortable and safe before she left.

One person showed us a new shopping bag a member of staff had bought them as a present. It had pictures of their favourite animal on it and they told us they were very pleased with it.

Is the service responsive?

A relative told us their family member had asked to move rooms because the one they were in was too warm for them. The relative said they spoke to the manager who arranged a move within days. The relative said, “I was impressed at how quickly this was done and the manager even said that if my (family member) was not happy in their new room they could go back to the old one.”

Another relative said, “I haven’t got any concerns about my (family member’s) care. They are always clean and well-cared for when I visit.” They told us that if their family member needed to see a doctor, dentist or optician the home arranged this without them having to ask first.

We spent time in one of the lounges observing how staff cared for some of the people who used the service. Staff interacted well with people and were knowledgeable about their lives and families. This enabled them to chat to people about things that interested them. We saw one staff member looking at a photo album with one person, and another going round topping up people’s cold drinks. At tea-time there were enough staff on duty to ensure that people who needed assistance with their meal received it.

Is the service well-led?

During our inspection two of the people who used the service joined us in the office to see how the inspection was progressing. We saw they were comfortable coming into the office and finding themselves a chair and were made to feel welcome by the registered manager.

We saw the registered manager got on well with the people who used the service and was knowledgeable about their care needs. A relative commented, “The manager is usually around and easy to find. I often pop into the office for a chat. She is approachable, as are all the staff. If I have anything to say I just go and say it and I do get listened to.”

We found the home had not had a residents and relatives meeting since August 2013. We discussed this with the manager who said she would discuss this with staff with a view to holding one of these meetings in the near future.

As part of this inspection we spoke to five members of staff including the manager. We also spoke with six people who used the service and two relatives.

People we spoke with were happy with the care provided. We found that each person had a detailed care plan in place and that these had been reviewed on a regular basis helping to ensure that they reflected people’s needs. However we found that action need had not always been followed through. People had access to health services such as GP’s.

We found that medication was given to people in a safe way and that the provider had detailed records for medicines. There was not always sufficient information for staff about when to give a person medication that was “as required”.

The majority of staff were up to date with mandatory training in key areas such as safeguarding and moving and handling. There was evidence that staff had also attended additional training such as dementia care and training in dignity.

The provider had received one formal complaint in the last 12 months. This had been investigated and we saw that appropriate action had been taken.

We did not speak to people who used the service on this follow up inspection. Please see our previous report for a summary of what people told us.

We spoke with seven people who use the service, four relatives and seven members of staff. One of these included the manager who had been in post three weeks.

All the people we spoke with were very happy with the care in the home. A relative stated “it’s one of the most pleasant homes I’ve visited. What I’ve seen has always been good”. Another relative stated “what I’ve seen is the best in a difficult job”.