This comprehensive inspection visit took place on the 7 August 2018 and was unannounced.

Prestwood House 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. Prestwood House is registered to accommodate 59 people in one building. Some of the people living in the home are living with dementia. At the time of our inspection 40 people were living at the home. Prestwood House accommodates people in one building and support is provided on three floors. There are a variety of communal areas that people can access.

There is a registered manager in place. 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.

Some people were placed at an increased risk as we saw poor moving and handling during our inspection. 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. Improvements were needed to the environment to support people living with dementia.

The actions plan the home had in place did not identify all areas of improvements. Improvements were needed to how complaints were responded to. We found concerns with some information including how pressure management was documented within the home. There were no systems in place to review documentation in the home however the provider had identified this as an area of improvements.

We found people were happy with the care they received. They were supported in a kind and caring way by staff that were trained and new them well. New staff had the opportunity to participate in an induction which they enjoyed. Staffs suitability to work within the home was checked by the provider. People’s privacy and dignity was maintained and people were supported to remain independent and make their own choices. Friends and visitors felt welcomed by staff and were free to visit at any time.

Risks to people were considered and reviewed and this included the environment and equipment. There were enough staff available to offer support to people and they had received training and were aware of procedures to protect people from potential harm. Staff were also aware of whistleblowing procedures and were confident to follow this if needed. They felt supported and listened to by the home manager.

Medicines were managed in a safe way. The home was clean and well maintained and infection control procedures were in place and followed. The home worked alongside health professionals and when needed referral and support was provided. People enjoyed the food and were offered a choice. People also had the opportunity to participate in activities they enjoyed.

Audits were taking place and information was used to make improvements within the home. The provider sought feedback from people and relatives. We were notified of significant events and the provider was displaying their rating.

We inspected this service on 14 June 2016 and it was an unannounced inspection. Our last inspection took place in November 2014 and we found that some improvements were needed. We found some people who used the service and their relatives thought that there was not always enough staff around to keep them safe and meet their needs, we also found that some people did not received their medicines as prescribed. There was a lack of knowledge around mental capacity and capacity assessments had not always been completed. People did not receive personalised care and were not involved with planning this. We saw that quality monitoring was completed however this was not effective in identifying any shortfalls. The provider sent us an action plan showing us how they were going to make improvements. At this inspection we found the provider had made some improvements in most areas, some additional improvements were still required in one area.

Prestwood house provides residential and nursing care for older people some who maybe living with dementia. The service was registered to provide accommodation for up to 59 people. At the time of our inspection 37 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 were not always involved with reviewing their care and did not always receive personalised care that was in line with their preferences. We found people’s care needs were not always recorded correctly to ensure the correct action was taken.

People felt safe and were supported by staff that had an induction and training that helped them support people. Equipment was maintained and tested to ensure it was safe for people to use. When risks to individuals were identified we found staff knew about these and they were managed to keep people safe. Medicines were stored, administered and recorded in a way to keep people safe from the risks associated to them. There were enough staff available to support people.

We found staff understood the importance of gaining consent from people and when needed people’s capacity had been assessed. When people were unable to make decisions these had been considered and made in people’s best interests.

People had access to health professionals and referrals were made on behalf of people when needed. Staff were kind and caring towards people. People knew how to complain and felt confident complaints would be dealt with.

People enjoyed the food and the choices that were available to them. People made decisions about how to spend their day and felt they were treated in a dignified way. People’s privacy was upheld and they were happy with the activities that were available for them to participate in. Relatives were free to visit anytime and they felt welcomed by staff.

Quality monitoring was completed by the provider and was used to make improvements to the home. The opinions of people who used the service were sought and this information used to bring about changes. Staff felt supported and were given the opportunity to raise concerns. People told us the home was well managed and the provider understood their responsibly around registration with us.

The inspection took place on 4 November 2014 and was unannounced. We had carried out a previous inspection on 26 November 2013 where it was identified that the provider needed to improve the way in which people received care and welfare. Following this inspection the provider sent us an action plan to tell us that the required improvements had been made. We found that the provider had made the necessary improvements.

Prestwood House provides residential and nursing care for older people with physical disabilities or dementia. The Home offers accommodation for up to 59 people. There is a registered manager in place who has been in post at the home for several years. 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.

There was an effective staff recruitment process in place ensuring that staff were fit to work with adults.

There were personalised risk assessments in place to help keep people safe. People who used the service felt safe with staff, but some people felt that there was not always enough staff around when they needed help.

We found that some people may not have received their medication as prescribed because medication procedures were not always adhered to.

People who used the service received care which was based on best practice because staff had the knowledge and skills to meet people’s needs. Staff induction, training and supervision were good and staff felt supported in their roles.

Consent to some care and treatment had been sought but there was a lack of staff knowledge around mental capacity. People with reduced capacity to make decisions had not undergone a mental capacity assessment.

People who used the service were supported to have enough to eat and drink and maintain a balanced diet. People’s nutritional needs were monitored well.

People were supported to maintain good health and had access to health care services.

People who used the service felt that staff were kind, helpful and respectful towards them. Staff developed positive caring relationships with people and respected and promoted people’s dignity and privacy.

There was little evidence of participation in care plans, but people who used the service felt supported to express their views and felt involved in their care.

Care plans contained information about how people liked to receive care but not everyone thought that the care they received met their personal needs. Some people thought that there was not always enough staff around to provide the right care to them at the time they wanted it.

Care plans contained information about people’s interests and there was some activities and entertainment arranged. Some people who used the service thought that life in the home was boring.

People who used the service and their families felt able to raise concerns and knew that they would be addressed by the staff and/or manager.

The provider had developed a positive culture by ensuring that people were included and listened to. There was an open door policy in place and visiting at any time.

The service was well managed and there had been consistency of manager and senior staff over the years. People who used the service felt that the manager was approachable and helpful.

There were systems in place to help drive improvement and deliver high quality care but the current system of audits had failed to identify areas for improvement. These included safety procedures relating to medication and manual handling and the provision of person centred care.

We visited Prestwood House Nursing Home in May 2013 and found improvements to the service were required. The provider had sent us an action plan detailing how improvements would be made; we reviewed this as part of this inspection. In order to target our inspections effectively we also continually gather information about services. This may include information from people who use services, family members, health professionals or staff. Before this inspection we reviewed the information we held for this service. The information also directed us to review the care and welfare provided by the home.

At the time of the inspection there were 38 people living at the home. During this inspection we spoke with people who lived at the home, visitors, staff members and the registered manager. The people we spoke with on the day of the inspection were generally complimentary about the staff and the care provided.

Improvements to documentation were evident and systems were in place for monitoring care delivery. However we did not find that the delivery of care always reflected the care planning and risk assessments which were identified during the assessment of individual care needs. This is particularly important as occasionally the home employed agency staff to support people with their care and welfare.

The visit was unannounced which meant the provider and the staff did not know we were coming.

We involve people in our inspections that have knowledge and experience of using social care services; we call them experts by experience. During the inspection, together with the expert by experience, we spoke with people living at the home, visitors to the service, staff members and the manager.

We asked people living at the home if they were treated with dignity and respect. One person told us: “When people come to get me up they knock on the door and wait until I shout them to come in”. Another person said: “When staff are washing me they are courteous asking me if I’m alright and what do I want doing”.

The care planning, risk assessments and documentation in relation to people’s care needs did not give sufficient information and detail to ensure care was being delivered in a safe and consistent manner.

We saw that people who used the service were provided with a choice of suitable and nutritious food and drink. People we spoke with said the food was good and choices of meals were available. One person said: “Staff always ask me what I would like to eat”.

We looked at how medicines were managed in the home. We found systems were in place for storing, recording and handling medicines.

There was an effective complaints system available to enable people to raise concerns.

We carried out this review to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff at Prestwood House did not know we were coming.

On the day of the visit there were 41 living at the home. We observed that staff were courteous and polite and treated people with dignity and respect. The staff we spoke with were knowledgeable about the care requirements for people. Plans of care for people were available and the information was reviewed monthly.

We asked staff about their understanding of safeguarding (protecting vulnerable adults). The staff we spoke with said they had received training as part of their mandatory training programme and were able to tell us how they would report concerns.

The home had a robust induction programme to ensure all new staff employed at the home were supported within their role. Staff told us they had training provided by the home and had one to one meetings with the manager.

There was a process for the on going quality monitoring of the service provided at Prestwood House. The current systems were being reviewed and updated to ensure the organisation continued to gather feedback on the quality of the service it provided.

During the course of the inspection comments were received from people using the service, and from people visiting at the time. People who were able to share their experiences of living at Prestwood House were positive about the care they receive.

People told us of the open atmosphere in the home, that they were treated with respect, and that visitors were made to feel welcome. They told us of a relaxed and open relationship with the care staff, especially regarding the friendliness of the staff, and the good standards of care, "The nurses are always reliable, always there when I need them, and it’s a good nursing home to live in".

They told us that they find the home clean and fresh, and were complimentary of the quality and presentation of their living areas, "I am very well looked after, it's a home from home, and all the staff are lovely". People said they enjoy their meals, and that their bedrooms are comfortable and warm.