We inspected Valley Lodge Care Home with Nursing on 12 February 2018. This was the provider’s first inspection of the service since they changed their registration to Ashmere Derbyshire Limited in December 2016. The inspection was unannounced. The service is registered to provide personal and nursing care for up to 64 people. The main part of the service accommodated up to 52 people who were living with a range of medical and age related conditions. The Extra Care Unit provided care for up to 12 people living with dementia. On the day of our inspection there were 43 people living at the service, including two people who were being treated in hospital.

A registered manager was in post and present on the day of the 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.

People received care and support from staff that were appropriately trained and competent to meet their individual needs. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. The nursing staff were supported to keep their clinical skills up to date and revalidate their registration with the Nursing and Midwifery Council. Staff received one-to-one supervision meetings with their line manager.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to guide staff on how to keep people safe from harm.

People were supported with patience, consideration and kindness and their privacy and dignity was respected. People were protected from potential discrimination as staff were aware of and responded effectively to their identified needs, choices and preferences. People’s individual communication needs were assessed and they were supported to communicate effectively with staff.

Thorough staff recruitment procedures were followed and appropriate pre-employment checks had been made.

Systems were in place to ensure medicines were managed safely in accordance with current regulations and guidance. People received medicines when they needed them and as prescribed.

The registered manager worked in cooperation with health and social care professionals to ensure people received appropriate healthcare and treatment in a timely manner. People were able to access health, social and medical care, as required.

People and their relatives confirmed that staff sought permission before offering personal care. Appropriate arrangements were in place to assess whether people were able to consent to their care. Where people lacked capacity to make decisions for themselves the provider took appropriate steps to ensure decisions about care were in people’s best interests and their rights were upheld. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints