This was an unannounced inspection, which took place on 02 and 06 March 2017. We previously did a comprehensive inspection of this service on 01 and 03 December 2015 the service was rated as requiring improvements overall and was not meeting all the regulations. We also undertook a focused inspection of the service on 07 April 2016, due to concerns about people’s safety; at this inspection we also found that the provider was not meeting all the regulations. During this inspection we found that the provider had taken the appropriate actions to ensure they were meeting the regulations.

Priestley Rose Nursing Home is a privately owned care home situated in a residential area of Birmingham. Nursing care is provided for up to 47 older people who live at the home. There were 41 people living there at the time of our inspection.

There was a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

People received a safe service, because the provider had procedures in place to reduce the risks of harm to people. Staff were trained to help keep people safe and knew the procedures for ensuring people did not suffer abuse or harm.

People received their medicines as prescribed and were cared for in an environment that was well maintained to ensure they were safe.

People were supported by sufficient numbers of staff that were suitably recruited, trained, supervised, supported and monitored to ensure they cared for people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People had a choice of meals and were supported to eat and drink enough to maintain their health and well-being. Staff knew how to support people that may be at risk of not eating or drinking sufficient to maintain their health. People had access to health care professionals when they were unwell, so their health care needs were met.

People and their relatives were happy with the care they received and felt that staff were caring and compassionate towards them. People’s privacy and dignity was maintained and staff encouraged people to be as independent as possible.

Visitors were welcomed in the home, so that people could maintain relationships with people that were important to them. Social activities were provided for people who wished to take part.

People and their relatives were involved in planning and agreeing their care needs, so they knew what care was being provided. Where people had concerns about their care, there were effective procedures in place to handle these concerns. People were confident that any concerns they raised would be acted on and resolved to their satisfaction.

People received a service that was well managed, by a stable management team and there were systems in place to ensure the care people received was monitored. People knew who the registered manager was and felt that she was open and visible in the home. This gave people confidence in the service. People had the opportunity to comment on the quality of the service they received.

This inspection took place on 7 April 2016 and was unannounced. We carried out an unannounced comprehensive inspection of this service on 1 and 3 December 2015. After that inspection we received concerns from social services that a person that lived at the service may have sustained an avoidable injury. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Priestley Rose Nursing Home) on our website at www.cqc.org.uk.

Priestley Rose Nursing Home provides a service for up to 47 people. People living at this home may have a range of different nursing care needs. A registered nurse is available at all times. There were 41 people living there at the time of our inspection.

There was a registered manager in post at the time of our 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.

We previously inspected this service on 1 and 3 December 2015, at that inspection people told us they felt safe. During this inspection we found that although procedures were in place to assess and monitor the risks to people, they were not sufficiently effective to ensure people were safe at all times. Therefore appropriate actions were not always taken to reduce the risk of harm happening to people. Specific concerns were identified in regards to unguarded radiators and pipe works, which had the potential to put people at risk of harm.

You can see what action we told the provider to take at the back of the full version of the report.

We last inspected this service on 15 October 2013. At that time we found that staff references were not adequately checked to ensure they were from an authentic source and photographs of staff were not available. We also found that there was no procedure in place to check that staff employed were physically and mentally fit for the work they did. At this inspection we found that these issues had been addressed.

On the day of our inspection we talked with the manager and the director and looked in detail at the care records for four people. We observed how people were being cared for in the home and sat with five people in the lounge area. We talked with two people who lived there. We visited on a weekday and we spoke with five relatives. We talked with three staff members and looked at four staff files. There were 42 people who lived at the home when we visited.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

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

Is the service safe?

There were procedures in place to safeguard people from abuse. Staff understood their role in safeguarding the people they supported. The staff and manager had a good understanding of whistle blowing policy. This meant people were kept safe.

We saw people were cared for in an environment that was safe and clean. One relative told us, “My mom is clean and she’s well.”

Risk assessments and health and safety measures were in place to keep people safe. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager had an understanding of these safeguards which ensure people’s rights and choices are protected.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People's care and support had been reviewed and care plans updated. Staff had been provided with up to date training in a range of topics including safeguarding people from abuse. Care plans were linked to people’s individual needs, for example, in relation to nutrition and mobility. Staff had a good understanding of people’s care and support needs and knew them well. The service worked well with other agencies and services to make sure people received their care safely and effectively. A member of staff told us, “It’s nice here everyone cooperates.”

Is the service caring?

All staff were aware of peoples choices and support needs. We saw the staff and manager were patient and gave encouragement when supporting people. All the staff we spoke with expressed kindness towards the people they supported. A staff member told us, “I’d say that the care staff are very caring.”

Relatives told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to respect people’s privacy and dignity. We saw that staff were available to support people. One person told us, “The girls are beautiful to me, they are very kind.”

Is the service responsive?

We spoke with the manager who told us she involved other professionals in people’s care when their needs changed. This was so their care could continue to be provided safely and appropriately. Staff were aware that people’s needs varied throughout the day and responded accordingly. People who lived at the home and their relatives were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. People’s feedback was then used to make improvements to the service.

Is the service well-led?

The manager was aware of their responsibilities in meeting the essential standards of quality and safety. Systems were in place for assessing and monitoring the quality of the service. Staff felt well supported and records we reviewed confirmed that staff were appropriately trained and supported to carry out their role safely. Staff told us they were clear about their roles and responsibilities. There was a clear structure of supervision responsibilities within the staff team. Staff felt supported to do a good job. A relative told us, “We have an activities co-ordinator now. The barbeque last week was brilliant. They put things on like bingo and parties.”

During the inspection we spoke with 11 people that lived at the home, three relatives, the manager and four members of staff.

People told us that staff talked to them about their care. We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

All the people that lived at the home and relatives that we spoke with told us that their needs were being met. One person told us, “Yes I am being looked after very well.” We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

All the people that we spoke with told us that they were treated well by the staff. However, we found that the recruitment process did not fully ensure that people were cared for by staff that were suitable recruited.

Everyone that we spoke with said they thought there was enough staff to care for them. We found that there were sufficient numbers of staff employed to meet people’s needs.

All of the people that we spoke with had no concerns about the quality of care that they received. One person told us, “I am really well cared for.” We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

During this planned visit to Priestley Rose Nursing Home 16 April 2012 we looked at whether improvements had been made since our visit on 16 June 2011. There were 43 people living in the home when we visited.

Some people were not able to tell us how they felt about living in the home. To see if people were happy and comfortable we watched how care workers cared for them. We saw that care workers spoke to them respectfully and assisted them when they needed it.

We saw that people looked happy and comfortable in the home. People were generally smiling. People who remained in bed were dressed in night clothes that were clean. People who were out of bed were dressed in clothes that were of their individual styles.

During our visit we spoke to five people receiving a service, three people who worked in the home and four relatives.

People living in the home told us:

“They are doing a good job. Nurses are good and kind.”

“I get choices of meals but I can’t always remember.”

Relatives we spoke with told us:

“I am happy with the service. I can come (and visit) at any time. I can raise concerns if needed.”

“I am very pleased with the care. X tells me the food is nice. X is always clean and tidy.”

All the relatives told us that they were happy with the service provided and that they found the staff helpful and kind. One relative said “The surroundings leave a lot to be desired. Bedding is clean but a real mismatch. There is not enough stimulation (for people who stay in their bedrooms).”

Staff that we spoke with knew about the needs of the people they cared for. They told us that people had choices at meal times. People received meals that met their cultural needs and some people had their food pureed.

Most of the people that we spoke to told us that they were happy living in the home. They were happy with the food they received and they had choices. They said that they were happy with their bedrooms. They said that the manager came round and asked if they were happy.

Some people said they did not feel comfortable with all the people who worked at the home.

This inspection took place on 1 and 3 December 2015 and was unannounced. The inspection was undertaken by three inspectors.

A registered manager was 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.

Priestley Rose Nursing Home provides a service for up to 47 people. People living at this home may have a range of different nursing care needs. A registered nurse is available at all times. There were 41 people living there at the time of our inspection.

People’s rights to give consent to their care and treatment were not fully protected.

Procedures were in place to reduce the risk of harm to people. Whilst staff were trained and knew how to report issues regarding people’s safety, the significance of some incidents was not always recognised by senior staff. Therefore the correct reporting procedures were not always followed.

The majority of staff were caring and sensitive towards people, but there were occasions where staff did not interact with people whilst they were supporting them. People were not aware of how their care was planned and did not feel they were involved in this aspect of their care.

Systems were in place to monitor the quality of the service, and various quality audits were completed. However, shortfalls in practice were not always identified and so were not fully addressed.

People received their medicines as prescribed and safe systems were in place to manage people’s medicines. Procedures were in place for foreseeable emergencies and staff knew the procedures. The environment and equipment used for people’s care were safely maintained. People’s privacy and dignity was respected.

Sufficient staff were employed and suitably recruited to provide care and support to people and ensure their needs were met. People received a service from staff that were trained, supervised and supported to ensure they were able to perform their role.

People enjoyed their food and had a choice of food and drink to ensure they received a healthy diet. People’s health care needs were met and people said they saw the doctor and other health care professionals as needed.

People were able to participate in social activities if they wished. People were confident their concerns would be listened to and acted upon. Systems were in place to listen to, investigate and respond to people’s concerns and complaints.

You can see what action we told the provider to take at the back of the full version of the report.