The inspection took place on 5 and 6 December 2018 and was unannounced.

People living at St Martin’s Grange 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 75 people and specialises in providing care, treatment and support for older people. The service was split over three floors which were all accessible by stairs or a lift. There were 57 people using the service at time of inspection.

We last inspected St Martin’s Grange in November 2017. At that inspection the service was rated overall requires improvement with a rating of good in caring. At our last inspection we found that there were breaches in regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the third consecutive time the service has been rated requires improvement.

At this inspection we found the provider had made improvements to meet the requirements of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some improvements had been made but further improvements were required to demonstrate how the provider was meeting the requirements of regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not always protected from avoidable harm as safeguarding concerns had not been identified by management staff and referrals were not made to the local authority in a timely manner.

The registered manager had left the service and we had not received notification of this.

Accidents and incidents were not always reviewed and analysed to identify actions or trends.

There were quality assurance and auditing processes in place but they were not always effective. The service carried out a number of audits including infection control and medicines management, However, some audits had not always been completed or actions carried out fully. Following the inspection the interim manager supplied evidence that the outstanding audits had been completed and were up to date.

Improvements had been made to infection control procedures. However, actions identified in the audit were not carried out. People knew their responsibilities about the prevention and control of infections within the service. Staff had received training and there was protective equipment readily available.

Improvements had been made to risk assessments and they were individual and detailed which meant that staff understood safe practices which helped keep people safe.

Improvements had been made and medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with regular audits undertaken by clinical staff to ensure safety with medicines.

Staffing levels were adequate to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. Registered nurses had the necessary permissions to practice.

The service understood their legal responsibilities for reporting and sharing information with other organisations but this was not always identified and done in a timely manner.

People had been involved in assessment of their care and support needs. They had their choices and wishes respected. The service had made improvements to work in partnership with professionals.

People were involved in what they had to eat and drink and were encouraged to do this independently. People were happy with the quality, variety and quantity of the food.

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 service actively sought to work in partnership with other organisations to improve outcomes for people using the

St Martins Grange is purpose built to accommodate up to 75 people. 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. It has four individual units which are spread over two floors. The ground floor accommodation consists of Oak (20 beds) and Fern (12 beds). Upstairs consists of Willow (18 beds) and Birch (25 beds). Some people living in the home had complex physical health needs and some people were living with dementia. At the time of our inspection there were 71 people living at the home.

This inspection took place on 14, 16 and 23 November 2017 and was unannounced.

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.

We last inspected St Martin Grange in June 2017. At that Inspection the service was rated overall requires improvement with a rating of good in caring. At our last inspection we found that there were breaches in regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found the provider had made improvements to meet the requirements of regulations 9 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some improvements had been made but further improvements were required to demonstrate how the provider was meeting the requirements of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Improvements had been made to how risks were identified and managed. However further improvements were required to ensure risks to people were consistently monitored and managed.

Staff knew how to identify and respond to abuse. They knew which agencies they should report concerns about people's care. However not all concerns had been shared with the local authority. The provider took action to report these concerns during our inspection.

People received their medicines when required but some improvements were required to the recording of prescribed creams. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

Improvements had been made to the cleanliness of the home and training and guidance had been provided to staff on their responsibilities for infection control. However further improvements were required to support staff understanding of their roles and responsibilities in relation to infection control and hygiene.

People had care plans which contained detailed information about their needs and interventions required. Improvements had been made in planning and reviewing of people's needs but further improvements were required to ensure all care plans were detailed and relevant. People’s preferences and choices for their end of life care were discussed with them and recorded in their care plans.

Improvements had been made in developing opportunities for people to attend activities in the home. Further improvements were required to support people to follow their own personal interests.

People received support to ensure they had enough food and drink. However improvements were required in the monitoring of food and fluids.

The provider had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and incidents and accidents. We found the audits were not always effective at identifying shortfalls in the service. Improvements were needed to make sure quality monitoring processes were effective in identify

St Martins Grange is purpose built to accommodate up to 75 people. It has four individual units which are spread over two floors. The ground floor accommodation consists of Birch (20 beds) and Fern (12 beds) both of which provide residential care. Upstairs consists of Willow (18 beds) and Oak (25 beds) both of which provide nursing care. Some people living in the home had complex physical health needs and some people were living with dementia. At the time of our inspection there were 72 people living at the home.

We inspected St Martin Grange November 2015. At that Inspection the service was rated overall good with improvement required in well led. At this inspection we found some improvements were required.

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.

The provider had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service. Improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received.

People were at risk as individual care records were not consistently kept up to date or instructions from other health professionals followed. Where risk assessments were in place they did not always contain accurate guidance for staff to safely support the person.

People's health was monitored by registered nurses and senior staff to make sure they received effective care and treatment to meet their physical and mental health needs. However records had not been consistently completed in line with care records. One health professional told us, “Documentation is poor, there seems to be an overall problem in regards to staff being able to ensure records are kept up to date”.

A recruitment procedure was in place and staff received pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. However there was currently a number of vacancies which meant many shifts were being covered by agency workers.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. Where concerns were identified with people’s nutrition, staff sought support from professionals such as GP’s and speech and language therapists. However the guideline provided was not always followed. Where people required special diets due to risk of choking, we observed guidance was not always followed.

Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely and medicine administration was recorded on an electronic system. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns, and people who lived at the home said they would be comfortable to discuss any worries or concerns with staff.

People’s relatives told us they were made to feel very welcome when they visited St Martins Grange, they could visit at times convenient to them, there were no set visiting times or unreasonable restrictions.

People and their relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. The provider had systems in place to collate and review feedback from peop

This inspection took place on 5 November 2015. It was carried out by one inspector and one Specialist Advisor.

St Martins Grange is purpose built to accommodate up to 75 people. It has four individual units which are spread over two floors. The ground floor accommodation consists of Birch (20 beds) and Fern (12 beds) both of which provide residential care. Upstairs consists of Willow (18 beds) and Oak (25 beds) both of which provide nursing care. Some people living in the home had complex physical health needs and some people were living with dementia. On the day of our inspection there were 68 people living in the home.

There was a registered manager. 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.

St Martins Grange opened in June 2015. It was established following a merge of two former care homes. There had been significant changes for people and staff. The registered manager took the lead to support people and staff in the changes that had taken place. They had taken steps to ensure people had a smooth transition.

People had clear, person centred care plans however there were sometimes gaps in recording specific information. For example, staff did not always sign to say when cream had been administered or when a person had been repositioned to protect their skin. There were inconsistencies in people having their care plans reviewed.

There were insufficient quality checks in place which meant that these gaps were not picked up and no were actions taken.

There was regular use of agency staff to cover the shifts because of staff vacancies. The registered manager had advertised and recruited staff however they were unable to start employment as there were delays in the criminal records checks being returned.

People and staff told us staff had the right skills and experience. Staff told us they received supervision and appraisals and were encouraged to develop their skills through training such as apprenticeships. The training records were unclear as they were in the process of being put together. However the residential manager was able to talk us through the training requirements and the training that had been attended.

People were treated with kindness and respect. Staff were patient and courteous and responsive to people when they were distressed.

People had the opportunity to participate in social activities which included one to one time with staff. People’s interests and hobbies were recorded and staff involved them in planning events and day to day activities. People living with dementia had some specific resources available for example memory boxes.