This was an unannounced inspection that took place on 12 April 2017.

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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection on the day.

The Bernard Sunley Nursing and Dementia Care Home is a care home which provides accommodation and nursing care for up to 60 older people, some of whom are living dementia. At the time of our inspection there were 48 people who lived there. The home is purpose built and set over two floors, with a passenger lift to all floors. The home is split into three units and had a variety of communal areas including lounges, dining rooms, quiet areas and a garden.

At our previous inspection on 22 December 2016 and 5 January 2017 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to the failure to assess and act upon risks to people. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 1 June 2016. We also made one recommendation to the provider in regard to the requirements of the Mental Capacity Act (2005).

During this inspection we found that improvements had been made. People were as safe as possible because risks associated with their health or care had been assessed and monitored. Staff were aware of the risks and what action to take to protect people from harm.

Staff had been trained and understood their responsibilities to protect people's rights under the Mental capacity Act 2005. Further training has taken place shortly after this inspection.

People’s care had been planned and the staff knew people well. Although a few care plans required some updating this did not affect the care people received. The provider has informed us in their action plan how they intend to ensure care plans always reflect the most up to date information and we will assess the effectiveness of this at our next inspection.

People were protected from being cared for by unsuitable staff because safe recruitment processes were followed.

There were sufficient numbers of staff deployed to meet people’s needs safely. Staff responded to people in a timely way.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP or psychiatrist and administered appropriately.

Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a contingency plan that identified how the home would function in the event of an unforeseeable emergency such as fire, adverse weather conditions, flooding or power cuts.

The provider ensured staff had the skills and experience which were necessary to carry out their role. Care was provided to people by staff who were trained and received regular supervisions and appraisals from their line manager. People told us they felt supported by staff.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff maintained people’s health and ensured good access to healthcare professionals when needed. For example, the doctor, dietician or district nurse.

The provider had a number of ways of checking the service and making improvements. This included listening to people and their relatives and taking action to improve.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. People were cared

The inspection of The Bernard Sunley Nursing and Dementia Care Home took place on 22 December 2015 and 5 January 2016 and was unannounced.

The Bernard Sunley Nursing and Dementia Care Home is a care home which provides accommodation and nursing care for up to 60 older people, some of whom are living dementia. At the time of our inspection there were 54 people who lived there. The home is purpose built and set over two floors, with a passenger lift to all floors. The home is split into three units and had a variety of communal areas including lounges, dining rooms, quiet areas and a garden.

At the time of our visit 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.’

Although risk assessments were in place we noted inconsistencies in the recording of information on risk assessments which could put people at risk of harm. Arrangements in place to identify and support people, who were nutritionally at risk, were not up to date or monitored to minimise risk. This meant that people were placed at risk of harm as appropriate guidance and best practice was not always followed.

There were inconsistencies with how staff were effectively deployed to meet people’s needs. The staff levels deployed had an impact on the care and support people received.

People had enough to eat and drink throughout the day and night.

People’s care and support needs could be affected due to records not being fully completed or kept up to date. Although there were systems and arrangements in place, they were not robust or effective enough to monitor, reduce risks or escalate identified issues.

Staff had understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Mental capacity assessments were not always fully completed and DoLS applications had been submitted in accordance with current legislation. We made a recommendation that the provider reviews their systems and ensures information is completed in line with the requirements of the Mental Capacity Act 2005.

People were cared for by caring staff. People’s privacy was respected and promoted. We did see examples of caring practice from staff. People’s preferences, likes and dislikes had always been taken into consideration and support was provided in accordance with people’s wishes.

People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The home worked effectively with healthcare professionals and was proactive in referring people for treatment.

People told us they felt were safe at the home, one person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Fire safety arrangements and risk assessments for the environment were in place to keep people safe. There was a business contingency plan in place to minimise the risk to the home in the event of an emergency such as fire, adverse weather conditions, power cuts and flooding.

Recruitment practices were safe and relevant checks had been completed before staff commenced work. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted a good quality of life.

People received their medicines when they needed them and the administration and storage of them were managed safely. Any changes to people’s medicines were prescribed by the person’s GP.

People told us if they had any issues they would speak to the staff or the registered manager. People were encouraged to v

We spoke with three people's relatives and used our SOFI tool to observe the care received by people with dementia. They were were positive about the service provided and commented “I cannot fault it” and “They always contact us about any issues.” We saw that people had positive interactions with staff.

The provider was in the process of changing their care planning documentation for people. We found however, that, whether people had the old or the new care planning paperwork there were gaps in their care planning records and there was not always written evidence that people’s care needs had been fully assessed and regularly reviewed. We observed people’s care and reviewed records that demonstrated that people’s care had been provided, despite the lack of care planning documentation.

People had been provided with a choice of foods that met their dietary needs and they had received appropriate support.

We found that the environment was clean and that there were infection control measures in place.

We saw that people’s medicines had been managed appropriately.

We found that staff had undergone appropriate checks before they started work.

There was a complaints system in place which people had been made aware of.

We spoke with people who used the service and their relatives. They were very satisfied with the quality of the service. We were told ‘the quality of care is exemplary’. Another person told us ‘I like it a lot here and I am happy’. We found that people were involved where possible in the planning of their care and that where they were unable to contribute their relatives had been involved. We were able to observe that people who had dementia were experiencing a good quality of care and interactions from the staff.

We saw that people had care plans and risk assessments and the provider was re-designing the documents to make them simpler.

The provider had taken steps to safeguard people. Staff had received both training and supervision. We spoke with relatives who told us that they felt that people were safe at the home.

There were sufficient staff to meet people’s needs. There was currently a higher use of agency staff than the provider preferred but they were actively recruiting to the vacant posts and had taken measures to try and ensure continuity for people who used the service.

The provider was monitoring the quality of the service they provided in a variety of ways that included questionnaires, audits and meetings.

The provider had been completing and submitting the required notifications to the Care Quality Commission however due to an administrative error they had not been received. The provider has begun the process of re-submitting them.

People who use the service told us they are involved in the planning of their care; that their named nurse discuss their support options and treatments with them and their family.

They were able to make changes to their care at any time. An example given was," I usually have my bath in the morning, but sometimes I ask not to have it until in the evening and I am accommodated"

People who use the service told us they are able to make choices in their meals. They told us they could have a cooked breakfast if they wanted, but tend mostly to have a light breakfast. They told us a strict eye is kept on their weight as they are weighed often. We have a choice of two hot meals at lunch time or the chef will make something for us if we do not feel for what is on the menu. They said the food is good and the servings are ok, although sometimes it is too much.

People who use the service told us they felt safe and well looked after by staff. They described their relationship with staff as good, especially with their personal care worker and felt able to raise any concerns with them. People told us they have never needed to complain officially, as the manager deals with their concerns right away to their satisfaction.

People who use the service told us the home is generally clean and tidy. There are domestic staff employed to do the cleaning and they have their bedroom cleaned daily. Their laundry is taken and returned the same day. They told us the water is of a suitable temperature and they can have a shower or bath as requested.

People who use the service told us they are given their medication at the right time by their nurse. Their medication is requested by their GP and when changes or new medication are needed the GP and the nurse both explain the changes to them and their family.

People who use the service told us they liked the service. One person told us they choose the service for a relative and when it was necessary for them to receive care they choose this service. They told us the service is clean and comfortable and that they liked having their own bedroom with en suite facilities. We were told there is a room available for relatives to stay overnight if they travelled from far away, or if a person was unwell.

People using the services told us they are being supported to use equipment such as hoists safely .