All Hallows Nursing Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides nursing care. All Hallows Nursing Home accommodates up to 50 adults, the majority being older people, in one adapted building.

There were 34 people living in the service when we inspected on 9 April 2018. This was an unannounced comprehensive inspection.

There was a registered manager 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection of 27 October 2016 this service was rated requires improvement. The key questions for safe, effective, responsive and well-led were rated as requires improvement and caring rated as good. There were breaches of Regulation relating to care planning and governance. At this inspection, improvements had been made and the service was now rated good.

You can read the reports from our last inspections, by selecting the 'all reports' link for All Hallows Nursing Home on our website at www.cqc.org.uk.

There were systems in place to provide people with a safe service. Staff were trained and understood how to safeguard people from abuse. Risks to people were managed well and staff were provided with guidance about how to mitigate risks. There were systems in place to provide adequate staffing levels to people who used the service. Staff recruitment processes were robust. Medicines were managed safely. There were infection control processes in place which reduced the risks of cross contamination in the service. Where incidents had occurred, the service had systems in place to learn from these and use the learning to drive improvement in the service.

Staff were trained and supported to meet people’s needs effectively. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. Staff worked with other professionals involved in people’s care to provide people with an effective and consistent service. People’s nutritional needs were assessed and met. 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 environment was appropriate for people using the service.

People were treated with care and compassion by the staff. People’s privacy and independence was promoted and respected. People were listened to and their views about how they wished to be cared for were respected.

People’s care was assessed, planned for and met. Care records guided staff in how people’s preferences and needs were met. Social activities were in the process of being improved. People’s choices were documented about how they wanted to be cared for at the end of their life. Compliments received by the service demonstrated that caring and compassionate care was delivered at the end of people’s lives. There was a complaints procedure in place and people’s complaints were addressed and used to improve the service.

The service had systems in place to monitor and improve the service provided to people. There were ongoing improvements being made in the Trust intended to further improve the service provided to people.

All Hallows Nursing home provides accommodation and nursing care for up to 50 people. It also provides rehabilitation services and end of life care. When we inspected on 27 October 2016 there were 40 people using the service. This was an unannounced inspection.

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.

During this inspection, we found that the registered provider was in breach of two regulations 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

We found that care plans focused primarily on the clinical aspects of people’s care, but contained less information to guide staff on how to support people with their emotional and social care needs. Having this information would help staff to tailor individual needs more fully.

A range of risk assessments were in place, but some risks had not been identified, such as those associated with choking. This meant that staff were not provided with guidance on how to reduce risks to people in this event. In addition risk assessments relating to bed rails did not reflect the most up to date guidance to ensure staff followed best practice, and we have made a recommendation about this.

Quality assurance systems were in place, but needed to be analysed more fully to understand its significance and to ensure that the care people were receiving was responsive to their needs. A complaints procedure was in place. However, analysis and oversight of feedback received was not sufficiently robust to ensure themes were identified and lessons learnt.

Best practice was not being promoted or considered fully for people who were most vulnerable, such as people approaching the end of their life, and people who were living with dementia.

People’s nutritional needs were assessed, but the service needed to improve how they supported the specialist nutritional needs of people living with dementia. We have made a recommendation about this.

People were supported by staff to take their medicines safely. However, protocols which guided staff on when to offer medicines which were prescribed “As required” were not in place. Guidance was not in place for topical applications, such as creams.

People had access to activities, however, people were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people. Staff needed further training in how to provide meaningful activities which support the specialist needs of people living with dementia.

People sought consent from people before providing support. However, some staff did not understand what the Mental Capacity Act meant for people living in the service, and how this could impact on the care they received.

Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff respected people's privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

Safe recruitment procedures were in place, and staff had undergone recruitment checks before they started work to ensure they were suitable for the role.

The culture in the service was welcoming, friendly, and person-centred. The management team presented as open and transparent throughout the inspection, seeking feedback to improve the care provision.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We spoke with four people and they were generally pleased with the service they received. One person told us, “I’m well looked after. It is very nice and I like being here.” Another person described the service as, “Very good, but no one’s got time to just chat so it’s rather lonely.”

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People were cared for, and supported by, suitably qualified, skilled and experienced staff. There were effective recruitment and selection processes in place with appropriate checks undertaken before new staff took up their appointments.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. However, insufficient action had been taken to ensure that personal notes were securely held, posing a threat to people's privacy. The service undertook to tackle this issue immediately.

Records and checks relating to the management of the service helped ensure that a safe environment was maintained.

We carried out the inspection on this occasion because concerns were raised with us regarding the rehabilitation of people using the service before returning to their own home and medication issues.

We did not talk with the people living in the All Hallows Nursing Home on this occasion; we concentrated on reviewing the concerns that had been raised with us. When we last visited the service on 9 November 2012, people told us that they liked living there, that the care staff showed them respect and worked hard to look after them. They also told us that they were comfortable in the service. One person told us that they were glad to be in the service, saying that the staff were, “Only ever helpful.” Another person said that the service was, “Comfortable.”

We found that people were protected against the risks of receiving care or treatment that was inappropriate or unsafe and that people were given their medication at the time they needed them, and in a safe way.

We talked with four of the people living in All Hallows Nursing Home. They told us that they liked living there, that the care staff showed them respect and worked hard to look after them. They also told us that they were comfortable in the service. One person told us that they were glad to be in the service, saying that the staff were, “Only ever helpful.” Another person said that the service was, “Comfortable.”

We spoke with four people who used the service who told us that they were consulted about the care and support they were provided with and the staff listened and acted on what they said. One person said, "They (staff) always ask me if I want to get up in the morning." Another person said, "The manager told me that I could make my own mind up about what time I go to bed.”

We saw that staff received training essential for caring for older people and when talking to them we found that they were knowledgeable about safeguarding adults. People told us that they felt safe living in the service. They told us that they were comfortable living in the service and two of them told us that they had not needed to make a complaint. Two people told us that they had made a complaint. However, they had been listened to and action was taken immediately.

People we spoke with told us that they were happy with their care and that staff were supportive and helpful to them. People said that the staff responded promptly to the call bells and were always cheerful and pleasant.

People also told us that they were visited by other health professionals such as the GP, dentist, or chiropodist.

Some people told us that they were aware of the activities provided within the home, but they did not wish to join in. These people usually remained in their rooms and said that they had enough to occupy them.

People spoke positively about how they were supported at mealtimes. They told us that staff helped them to get into a comfortable position, where they could manage to eat independently.

During our visit on 03 August 2011 we spoke with a number of people living in the home who told us that they felt able to raise any questions or concerns they may have with staff and that the manager was very approachable. They were complimentary about the staff, saying things like “They look after me well” and “they are lovely.”

We also spoke with three visitors who said that the staff were able to meet their relative’s needs very well.

People with whom we spoke were complimentary about their experience of All Hallows Nursing Home. They said “I am very happy here; I am satisfied.” And “I am well looked after.” One person told us that the home was not as quiet as they had expected. “There is too much going on.”

A person visiting a family member told us that they were very satisfied with the care their relative received. They told us that the home was clean and they had no concerns about cleanliness.

During our visit a number of people remained in their own rooms mostly because they were being cared for in bed or did not wish to join in with organised activities and were happy to read or watch television. However two people told us that they would like to have someone to talk to.