We inspected this service on 13 September 2018. Austenwood Nursing Home is a ‘care home’ registered to support up to 35 people. People in care homes receive accommodation as well as personal and nursing care under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection there were 31 people living at the service.

At our last inspection in December 2015 the service was rated Good overall. At this inspection we found the service improved its responsiveness to Outstanding and remained Good overall.

We found the service was exceptionally responsive to people’s needs. There was a clear emphasis on putting people and their individual needs at the forefront of the service delivery. Staff were empowered and focused on improving people’s lives and well-being. People achieved positive outcomes as result of care received. There was an exceptional activities provision that took account of people’s individual preferences effectively enhancing their sense of purpose.

People were extremely complimentary about the support they had from staff and told us staff were ‘superb’ and that the staff respected what was important to people. Comments from people included, “The staff help me and know what I need, sometimes almost before I know myself” and “The staff seem to know exactly what to do and look after me well”.

The feedback from people’s relatives was also excellent and reflected people’s relatives were ‘delighted’ with the care at the service which left the relatives ‘confident that the family have made the right choice’. An external professional told us, “I would have absolutely no qualms about placing my mother in Austenwood if she required care. I have total confidence that the home is run professionally”.

People knew how to raise concerns and they told us there was nothing they would like to change about the service. The provider demonstrated a proactive and innovative approach to complaints management and the management saw concerns as a way of improving the service.

The staff ensured people were supported to have a dignified death. Staff worked in collaboration with professionals to ensure people receiving end of life were pain free. Staff provided empathy and emotional support to wider families of people receiving end of life care. The management demonstrated proactive approach and put systems in place that ensured people and their relatives were well informed and prepared for the unexpected aspects of people’s deteriorating conditions.

People continued to be safe and they told us they felt safe. Staff had a good understanding of safeguarding matters and knew how to report any concerns. People's medicines were managed appropriately and people received their medicines as prescribed.

People benefitted from skilled and knowledgeable team that received relevant, ongoing training. Staff told us they were well supported and praised the team work. There were sufficient staffing to keep people safe and the provider ensured safe recruitment practices had been followed.

Risks to people, including individual risks, environmental risks as well as infection control risks were all managed appropriately to ensure people were safe. The provider had a system to record and manage accidents and incidents and ensured appropriate action had been taken in response to these. The team used reflection to ensure lessons learnt were considered and to improve the service further.

Staff were compassionate, kind and caring and they developed meaningful rapport with people living at the service. People’s dignity, privacy and confidentiality was respected and people were supported to remain independent as much as possible.

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 and people’s rights to make own dec

Austenwood nursing home is based in Chalfont St Peter in Buckinghamshire. The service is registered to provide nursing care to older people. Austenwood is registered to provide care to for up to 35 people. At the time of our inspection 34 people were living at Austenwood. The service is an independent service with the management team consisting of a deputy manager, the proprietors and the registered manager.

This inspection was undertaken on the 1 & 8 December 2015 and was unannounced.

Austenwood had 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.

Austenwood had undergone extensive refurbishment and building works since its last inspection. We found the home to be light, airy clean and had a homely feel. Renovations meant the service was able to tailor the service to meet the needs of people who require nursing care. For example, access from people’s rooms to communal gardens and specialised bath equipment.

At the time of our inspection the service was preparing for Christmas. We found the home to have a relaxed and calm atmosphere. Christmas songs were playing and people were being supported to decorate the home’s communal Christmas tree. The service had ensured where people were cared for in bed, they had their own room decorated as they wished.

The service had a longstanding staff team including the registered manager who had been at Austenwood for 13 years. Some staff we spoke with had been in post for 10, 13 and 15 years and some staff have been at Austenwood for over 20 years. Relatives we spoke with told us this was very important and there was good consistency of staff.

Relatives and people who lived at the service were complimentary about Austenwood. They told us that they felt staff were kind, caring and respectful. We carried out observations over both days of the inspection and found staff treated people with kindness, compassion and respect.

People’s safety was upheld at Austenwood by staff who were appropriately supported, trained and checked to undertake their roles. The service had a stable nursing team in place who were responsible for the oversight of people’s medical well-being.

People were supported by staff who knew their needs well. Staff were aware of their responsibilities under the Mental Capacity Act (2005) and were able to demonstrate how they protected people against potential abuse.

People and relatives told us they felt involved in the care that was provided. Management had an open door policy and relatives told us they could visit whenever they liked. We found the service had a clear complaints policy in place and took pride in their achievements.

We have made a recommendation around the accessibility of detail and information in care plans.

People's needs had been assessed and their care and treatment was planned and delivered in line with their individual care plan. People's care plans were regularly reviewed and updated.

Staff were provided with appropriate training to give them the knowledge and skills to undertake their roles competently.

The premises were comfortable and kept warm. Each person had their own room, which they had personalised to their taste.

Daily activities were provided on a one to one basis and in group sessions for those who wished to take part. Family and friends were welcomed and invited to special events celebrated in the home.

People told us they felt safe and knew who to speak to if they had concerns. One person said 'If I was not happy with something I would tell them but I've never had to make a complaint, they are very good.''

People we spoke with told us the care staff treated them well and were kind and respectful towards them. They said they were consulted with and their views sought in decisions about their care. Comments included ''I feel he is safe here. He tells me the staff are all very nice, nothing is too much trouble for them.'' ''They look after me well...they are a super bunch of girls.'' ''I am listened to.''

People told us that they and/or their family had been given the opportunity to visit the home before they moved in to ensure it met with their needs and expectations. They said that the staff treated them as individuals and respected their views and choices. They told us they were consulted with about any changes to their care and support and were able to make decisions about their day to day care. They said they were provided with opportunities to take part in activities and were happy with the care and support they received.