This inspection took place on 31 May 2017 and was unannounced which meant the staff and registered provider did not know we would be visiting. The service was last inspected on 10 February 2015. The overall rating of the service was good. At this inspection we found the overall rating of the service was good.

The manager had started managing the service in February 2017 and had applied to register with the Care Quality Commission. 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.’

Scarsdale Grange Nursing Home is registered to provide accommodation and nursing care for up to 52 people. It is a purpose built care service. At the time of our inspection 48 people were living at the service.

People we spoke with told us they felt ‘safe’ and did not have any worries or concerns. Relatives we spoke with felt their family member was in a safe place.

Systems were in place to manage people’s medicines. We saw that the system in place to ensure medicines were stored at the right temperature required improvement.

Prior to inspection and shortly after the inspection we received some concerns relating to how people were supported to move. During the inspection we did not see any examples of people being supported inappropriately to move. The manager told us they were aware of the concerns and they were working with the service’s in house trainer to ensure staff followed the correct methods whilst supporting people to move.

Staff had undertaken safeguarding training and were knowledgeable about their roles and responsibilities in keeping people safe from harm.

There was a system in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This monitoring helps reduces the risks to people and helps the service to continually improve.

We did not receive any concerns from relatives or people using the service regarding the staffing levels at the service. Staff we spoke with told us the manager had improved the staffing levels at the service since they had started working there. During the inspection staff responded to people’s calls for assistance in a timely manner

People we spoke with were satisfied with the quality of care they had received. People’s comments included: “I like living here,” “It’s smashing here. I can’t fault it” and “They [staff] go out of their way to make you comfortable.”

In people’s records we found evidence of involvement from other professionals such as doctors, opticians, tissue viability nurses and speech and language practitioners. This showed that people had access to healthcare professionals to support their health.

Relatives we spoke with were satisfied with the quality of care their family member had received. Some of the relatives we spoke with told us they would recommend the service.

People using the service and relatives we spoke with made positive comments about the staff and told us they were treated with dignity and respect.

During the inspection we observed staff giving care and assistance to people. They were respectful and treated people in a caring and supportive way.

Most people we spoke with were satisfied with the quality of the food that was provided at the service. People’s nutritional needs were monitored and actions taken where required. Preferences and dietary needs were being met.

We found people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Staff had received a thorough induction and their training was regularly updated. We saw staff received appropriate support to enable them to carry out their duties.

The service

This inspection was unannounced and was undertaken on 10 February 2015.

Scarsdale Grange Nursing Home was last inspected by the Care Quality Commission (CQC) in July 2013 and was found to be meeting regulations relating to respecting and involving people who use services, care and welfare of people who use services, safeguarding, staffing and assessing and monitoring the quality of service provision.

Scarsdale Grange Nursing Home is a purpose built home which provides accommodation for up to 52 people who require nursing or personal care. The second floor mainly supports people who are living with dementia. There were 47 people living at Scarsdale Grange Nursing Home at the time of this inspection.

There are 52 single en-suite rooms. Accommodation is provided over two floors, accessed by a lift. Shared, adapted bathrooms are situated throughout the home. Each floor has a spacious lounge and dining area.

A registered manager was 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe living at Scarsdale Grange Nursing Home. Conversations with staff and the registered manager demonstrated that they were aware of what constituted abuse. However, one nurse and two care workers were unaware of the need to report safeguarding concerns to the local authority. This meant that concerns may not be always appropriately reported.

On the day of our inspection there were sufficient staff to meet people’s needs and keep people safe. We received mixed responses about the time it took staff to respond when people used their call bells. Some people and relatives told us that staff took longer to respond to call bells on the ground floor of the home.

People told us that they received their medicines on time. Our observation of part of two medication rounds together with our review of records provided evidence that medicines were safely administered. We found some gaps in medication records and found that the record for one controlled medication did not correspond with the amount in stock.

Conversations with staff and observations throughout our visit showed us that staff offered and involved people in a range of day to day decisions. The registered manager demonstrated a clear understanding of the requirements of the Mental Capacity Act, 2005 (MCA). Whilst our observations evidenced that staff followed the principles of the MCA, our conversations with staff demonstrated a lack of knowledge about the important elements of the actual Act and how these related to their practice. For example, whilst staff told us that they had heard of capacity assessments and best interest decisions, they were unable to explain these key parts of the Act.

People received a choice of suitable, healthy, homemade food as well as drinks and snacks throughout the day. Our observations of meal times in both dining rooms was mixed and identified that people on the first floor of the home did not always receive the support and assistance they required.

We saw evidence of the changes which had been made and were planned to the first floor of the home to meet the needs of people living with dementia. For example, new lighting had been installed and contrasting handrails had been added to the corridor areas to promote people’s independence.

The induction in place for new staff was appropriate. Existing staff received regular supervision and an annual appraisal. Staff were positive about the training courses they received.

Our observations, together with conversations with people and relative’s provided evidence that the service was caring. We saw that the registered manager and staff across the home had a good understanding of people’s individual needs and preferences. Staff knew how to respect people’s privacy and dignity; although we did observe two instances of one member of staff not respecting the confidentiality of people living at the home.

Care plans were centred on people’s individual needs and contained information about their preferences, backgrounds and interests. People’s physical health needs were monitored and referrals were made when needed to health professionals. A range of activities were provided within and outside of the home. Activities and resources to occupy and promote the memories of people living with dementia were also provided.

Staff were positive about the registered manager and the way in which she led the service. They told us that the registered manager was always around and was approachable and proactive in trying to make the service as good as possible. The registered manager had clear goals for the service and had made a number of changes since being in post.

A range of checks were undertaken to monitor the quality of the service. People, their friends and family and visiting health professionals were encouraged to give feedback about the service.

During our inspection we spoke with five people currently residing at Scarsdale Grange Nursing Home, some of whom had recently been admitted and others who had lived at the home for a number of years.

People we talked with spoke positively about the home, the manager and the staff. They all told us they were happy living at the home and felt safe. We received comments such as “Yes it’s alright here, very nice. The staff are very nice and look after you well, they treat you with respect”, “I really enjoy living here, you get everything you need”, “I don’t often have to ask for things as they just bring everything really” and “It’s a pretty decent service here.”

People told us that the menus were varied and they enjoyed the food. They also told us they were able to make suggestions about menus. We received comments such as “The food is really good and there are always plenty of drinks”, “Meal times are fixed but if you’re not hungry they will save it for you to have later if you want or they will get you something else when you’re ready”.

No one we spoke with had any concerns or complaints and could not think of any areas where the home needed to improve. Everyone we spoke with felt confident to raise any concerns they may have with the manager or a member of staff.

During our visit we spoke with five people using the service, two relatives and multiple members of staff from each discipline.

People using the service and their relatives that we spoke with were positive about the home.

People using the service told us that their opinions were sought so that they were involved in decisions and that they had a choice. We observed positive interactions between staff, people using the service and their relatives throughout the visit.

People using the service and their relatives told us that care and treatment was planned and delivered in a way that ensured people’s safety and welfare and they were involved in their care. Some comments included “The staff always tell me what’s going on and ask me what I want to do. They do a good job.” and “I’ve been involved with my care”.

All the people and relatives we spoke with said they had no concerns about abuse in the home. One person using the service told us “I feel safe here. I would tell the staff if I didn’t.”

We found that there were enough qualified, skilled and experienced staff to meet people’s needs.

We found that there was an effective system to regularly assess and monitor the quality of service that people receive.