Aldbourne nursing home provides accommodation and nursing for up to 40 older people some of who are living with dementia. The home is situated on one level with two communal lounges and dining area, with a central kitchen and laundry. There is also a conservatory where people can sit.

At the time of our inspection there were 38 people living there.

The inspection took place on the 5 and 6 July 2016. The first day of the inspection was unannounced. At our last inspection of Aldbourne nursing home in May 2015 we found the provider did not meet some of the legal requirements in the areas we looked at. The provider wrote to us with a plan of what actions they would take to make the necessary improvements. We found during this inspection that the provider had undertaken all the necessary improvements required to fully meet people’s needs.

The service had a registered manager employed at the home. 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 were supported by very kind, caring and compassionate staff that would go the extra mile to ensure people received an excellent and personalised high standard of care. We found staff had an excellent knowledge and understanding of people’s needs, interests, likes and dislikes. We observed a range of warm and affectionate interactions during our inspection, with people using the service sharing jokes with staff and not hesitating to seek assistance where required.

People received personalised care that was responsive to their individual needs. People had access to activities that included their individual hobbies and interests. Links with the local village community had been established and people were supported to participate in events held within the local village such as fetes and other events that were meaningful to them. Time was spent on a one to one basis with people who chose not to attend group activities.

People, relatives and health and social care professionals spoke positively about staff and felt they had an excellent understanding of people’s individual needs to ensure they received personalised care from all staff. Health professionals told us that the service was committed to supporting people to remain independent or regain any independence lost. They gave examples of how people were supported to live the lives they wanted.

People were safe living at Aldbourne nursing home. There were enough staff on duty to meet people’s care and support needs safely. People received their medicines as prescribed and at the correct times. We saw that risks were managed through regular assessments and associated care plans and reviewed periodically throughout the year. Staff displayed a good understanding of how to keep people safe from potential harm or abuse.

The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support Training was comprehensive and regularly refreshed, with staff attending a range of training as well as training specific to the needs of people using the service, for example dementia awareness.

People spoke positively about the food and told us they received enough to eat and drink. Catering staff were knowledgeable about people’s likes, dislikes and dietary requirements. Action was taken by staff when they were concerned about people’s health and well-being.

There were effective pre-employment checks for the safe recruitment of staff, including criminal records checks and obtaining character references. New staff were inducted into the role with a combination of attending core training, shadowing experienced staff and completing the care certificate workbook.

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At the last inspection on 12 November 2013 we found people who were prescribed thickening agent had not received an appropriate assessment to determine whether they were at risk of swallowing difficulties, and therefore if the use of thickening agent was necessary. We found there was lack of guidelines available for staff relating to moving and handling (and equipment used). Assessments regarding managing people's pain did not provide enough detail. National guidance (NICE 2011) suggests people unable to verbally communicate their needs should 'assess whether the person is in pain, using an observational pain assessment tool if helpful'. We issued a compliance action to ensure improvements were made.

The then acting manager and Nominated Individual sent us an action plan stating the work had been undertaken to address the shortfalls we identified.

At this inspection, there was a new management structure in place. We were told a new Nominated Individual and manager had been identified and would register with us shortly. Staff described the management team as “very approachable and effective.”

We saw improvements had been made. Appropriate assessments had been completed by the Speech and Language Therapist and their recommendations were being followed. Guidance regarding use of thickening agent and use of equipment for moving and handling was available for staff. One member of staff said “there is more information available for us now so it is clear what is expected.”

People told us they were happy with the service they received. Comments made included "the staff are very nice, caring, polite and respectful." A relative explained "X always looks clean and comfortable when I visit, they tell me they are happy here and that the staff help them as they want and expect. The important thing for me is that X is happy."

During our inspection we were told the registered manager, (who is also the nominated individual) was not available due to leave. The general manager was available. We spoke with three people who lived at Aldbourne nursing home. We also spoke with three care staff, one nurse and two ancillary staff.

We spoke with one relative who was visiting at the time of our inspection, and another relative by phone shortly after our inspection.

We saw people had varying levels of dependency with most people requiring some support with their personal care and mobility. The care we observed was patient and unhurried. For example people were supported to mobilise independently with the use of walking aids. This promoted independence and reduced the risk of pressure ulcer development and other risks associated with immobility.

We observed people were well presented following assistance with their personal care. They seemed relaxed in their home. Some people were engaged in an activity in the lounge which they seemed to enjoy. One relative explained there was always "a nice atmosphere, happy home."

Staff communicated in a friendly, professional manner. One person told us “they (staff) are very good. They are busy and I sometimes wait for help, but that happens everywhere.” Another person explained the staff are "pleasant and gentle." A relative told us the staff "are kind but there is a lot of bank staff which does not provide continuity."

People’s care records were concise and easy to follow. Each person had a summary of their care needs in their room. However they did not always correlate with people's nursing care records which were kept in the manager’s office. The nursing records included a more detailed plan of care and communication records from visiting healthcare professionals. A relative said "the care plan in the bedroom is not current."

We saw people in their bedrooms had drinks, some were in easy reach for the person, others were not. Some drinks were thickened as stated in the person's care plan, others were not. There was varying degrees of guidance available for staff to follow. This resulted in descrepancies when staff described to us the consitency when using thickening agent.

The general manager told us no staff had been employed since our last inspection. We saw the policy for staff recruitment had been revised since our last inspection.

We had received notifications without delay. The registered person (provider or manager) must notify us regarding certain incidents effecting people, and when a person has passed away.

During our inspection we spoke with five people who lived at Aldbourne nursing home. We also spoke with five care / nursing staff, three ancillary staff and an activities co ordinator. We spoke with two relatives and a GP.

The views of everyone we spoke with, along with our findings were summed up

through what people told us.

People told us “they (staff) don’t ask you to do things you don’t want to do.” Other people told us “it’s ok here.”

We spoke with two staff, both were able to explain their understanding of consent, however they were not able to describe their understanding of mental capacity assessment and Deprivation of Liberty Safeguards (DoLS). We discussed this with the registered manager as an area for improvement.

People were satisfied overall with the care and support they received.

People told us their home was clean.

During lunch time, we observed staff providing support to people in a patient manner. People were using specialist adapted crockery to enable them to eat their meal independently. Staff helped people to cut their food in an unobtrusive way.

We were asked by two people (on separate occasions) where their bedrooms were. No signs or aids were available to assist people to find their way around the home and gardens.

SOFI was used during mid afternoon to observe two people in the lounge area. During a period of 25 minutes there were two staff in the same area laying tables, but they did not speak to the people sitting there.

A healthcare professional told us staff were proactive at following their instructions, and were available to provide information about a person when requested.

People we spoke with had not had to make a complaint but knew how to do so if they needed to.

The service has not notified the Care Quality Commission appropriately of certain incidents which had occurred in accordance with legal requirements.

People told us they had received information prior to deciding to live at Aldbourne Nursing Home.

Their needs were assessed by the registered manager and they were fully involved in decisions about how their care was delivered.

We observed staff treating people with affection, kindness and patience. Staff demonstrated how well they knew people’s needs and ensured people were treated with privacy and dignity.

We spoke with two relatives of people living at Aldbourne Nursing Home. They told us they were very satisfied with the care and support provided. They told us Aldbourne Nursing Home was “homely”.

Everyone we spoke with was complimentary about the staff. Examples of comments were: "The staff are very kind and caring, cheerful and attentive." "There are always plenty of staff on duty whenever we visit."

People told us they had plenty of opportunities to get involved in having their say about how the service was run. They also told us they were confident if they reported any problems, they would be dealt with promptly and effectively.

Shortly after our visit we spoke to a healthcare professional who told us the staff were very good at communicating with them, and reported any problems promptly. They had provided training to the staff to enable them to understand people’s specific healthcare needs.

People living in the home told us that the staff were professional and treated them with dignity and respect. We were told that personal care was delivered to a good standard.

People told us they felt safe in the home and were well treated by the staff team. Several people said they knew how to complain or raise an issue and that the staff and manager listened when they did this.

We spoke to seven relatives who were all were positive about the quality of care and support and the approach of the staff to the meeting of peoples needs. Comments made included, “the staff are excellent”, “I cannot fault the care, my mother is very happy here” and “we have been very satisfied with everything so far”.

They told us they were provided with information about the home and the services that were available.

The relatives of one person who had moved in recently said they were very pleased with the manner of the admission and that the home and the staff had done everything they could to manage their relatives anxiety and ensure that needs were met.

Staff told us they felt confident about approaching the registered manager or general manager over concerns or suggestion for improvements to the delivery of care and support.

All the staff we spoke to said they believed they worked well as team and provided a good standard of care and support. Staff told us they received a good level of training and were well supported by the managers of the service.

Aldbourne nursing home is privately owned and provides accommodation, nursing and personal care for up to 40 people. At the time of our inspection there were 29 people living there. The home also provides short term respite care to people and their families requiring a break. The home is within walking distance of the centre of Aldbourne village with which it has active community links.

The inspection took place on 7 and 11 May 2015. This was unannounced inspection. During our last inspection in November 2013 we found the provider satisfied the legal requirements in the areas that we looked at.

A registered manager was employed by the service. 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 registered manager, matron and staff had knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards is where a person can be deprived of their liberties where it is deemed to be in their best interests or for their own safety. Whilst necessary Deprivation of Liberty Safeguards applications had been, or were in the process of being submitted by the provider, the requirements of the Mental Capacity Act were not always followed when assessing people’s capacity to make decisions.

We looked at four care plans and found that guidance did not always reflect people’s current needs and identify how care and support should be provided. This meant that people were at risk of inconsistent care and/or not receiving the care and support they needed.

Audits were carried out periodically by both management and key staff. Whilst there were systems in place to monitor the quality of the service provided, where areas for improvement were required actions to address these had not been identified.

People praised the staff and registered manager at Aldbourne nursing home for their kindness and compassion. People said they had developed caring relationships with staff and were treated with dignity and respect.

People told us they felt safe living at Aldbourne nursing home and they were well cared for. Systems were in place to protect people from abuse. Staff knew how to identify if people were at risk of abuse and what actions they needed to take to ensure people were protected.

Staff understood the needs of the people they were supporting. Care and support was provided in a considerate and compassionate manner. Staff took time to talk to people. Activities were provided which included yoga, day trips, quizzes and arts and crafts.

Staff were appropriately trained and understood their roles and responsibilities. The staff had completed training to ensure that the care and support provided to people was safe and effective to meet their needs. Staff received a comprehensive induction and training to support them to carry out their roles correctly.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.