Bourne House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bourne House Nursing Home provides care and support to up to 40 people, many of whom have physical disabilities and are living with dementia. On the day of our visit there were 31 people using the service.

The service had a manager in post who was in the process registering with the Care Quality Commission. 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 the last inspection carried out on 17 March 2017, the service was rated Requires Improvement, with Requires Improvement in safe and well-led. We found that actions were not taken in good time to review people’s care records, the Care Quality Commission was not notified about the important events taking place at the service and medicines management was not always appropriate.

At this inspection we found that improvements had been made and we rated the service Good.

People received their medicines as prescribed and when they required them. At the time of inspection, the service took actions to improve storage of people’s medicines and reviewed the ‘when required’ medicines as necessary. Sufficient numbers of staff were provided to meet people’s care and support needs. Staff were aware of potential risks to people and took actions to protect people from the risk of abuse and incidents and accident taking place.

Staff had the necessary guidance when they required it and were appropriately training for their role. People had support to meet their nutritional and health needs. Staff supported people to make decisions for themselves as legally required by the Mental Capacity Act 2005 (MCA). The service was making improvements to meet people’s living with dementia care needs.

People, their family members and healthcare professionals described staff as kind, friendly and caring. People were encouraged to follow their own routines and carry out activities when they wanted to. People’s personal preferences were identified and supported as necessary. The service took action to improve communication and activities provided for people to enhance their interaction and social inclusion.

Staff responded to people’s changing care and support needs as necessary and in good time. Relatives were involved in people’s care planning and also provided regular feedback about the service delivery. The service worked to improve people’s care records and were in the process reviewing all the support plans.

Good leadership was provided at the service to monitor the care being delivered for people and action was taken to improve where necessary. The service fulfilled the requirements of their registration with the Care Quality Commission and submitted statutory notifications as required. The staff team were involved in planning the care delivery for people and knew what was required of them in their role.

We undertook an unannounced comprehensive inspection on 17 March 2017. At our previous comprehensive inspection in March 2015 the provider was in breach of the regulation relating to staff training and rated ‘requires improvement’ for the key question ‘is the service effective?’ At a focused inspection in September 2015 the provider had met the breach and their rating had improved, meaning they were rated ‘good’ overall and for each key question. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Bourne House Nursing Home’ on our website at www.cqc.org.uk.

Bourne House Nursing Home provides accommodation, personal and nursing care to up to 40 older people, many of whom are living with dementia. At the time of our inspection 36 people were using the service.

The same registered manager at out last inspection remained 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.

Care records did not provide an accurate and complete record of people’s care. Care plans and risk assessments had not been regularly reviewed and were not always updated in response to changes in people’s care. The management team’s audits had identified that improvements were required to the quality of care recording. However, this action had not been completed by the time of our inspection.

There were some medicines stock errors meaning there was a risk that people would not receive their medicines as prescribed. There was also a lack of protocols in place to instruct staff when to administer medicines prescribed to be taken “when required”.

The registered manager had not adhered to all of their Care Quality Commission registration requirements and had not submitted notifications about key events that occurred at the service.

The provider was in breach of the legal requirements relating to good governance, safe care and treatment and notification of incidents. You can see what action we have asked the provider to take at the back of this report.

There were sufficient staff to meet people’s needs and staff provided people with prompt and timely support. Staff were aware of the risks to people’s safety and their responsibilities to safeguard people from harm.

Staff received regular supervision and training to ensure they had the knowledge and skills to undertake their roles. They were aware of the requirements of the Mental Capacity Act 2005 and adhered to these, including supporting people in line with the restrictions approved in applications to deprive people of their liberty. Staff supported people with their nutritional and health needs, and liaised with healthcare professionals as and when needed.

Staff were kind and caring in their interactions with people. They engaged with people in a polite and friendly manner and were aware of people’s different communication methods. Staff involved people in decisions about their day and treated them with dignity and respect.

Staff continued to provide people with the level of support they required and met their needs. This included in regards to pressure ulcer care, diabetes care and dementia care. Procedures remained in place to investigate any complaints received and ensure, as much as possible, any concerns raised were resolved to the satisfaction of the complainant.

People, their relatives and staff were asked for their views and opinions about the service through the completion of surveys and attendance at meetings. Staff felt well supported in their roles and felt there was close team working.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 17 March 2015 and a breach of legal requirements was found. We found that staff did not always receive appropriate training in order to undertake their roles in line with best practice. This was with particular reference to staff that were on night duty.

We undertook this focused inspection to check the provider had followed their plan and to confirm they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bourne House Nursing Home on our website at www.cqc.org.uk

We undertook this unannounced focused inspection of Bourne House on the 15 September 2015. The home provides accommodation and personal care for up to 40 people. The service specialises in the nursing care and support of older people who may be living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During this inspection we found the provider had taken appropriate action to ensure staff had attended training courses.

This unannounced inspection took place on the 17 March 2015. At our last inspection on the 24 June 2013 eight regulations were inspected and we found no breaches of legislation.

Bourne House is a care home providing personal and nursing care for people with dementia. It provides accommodation for up to 40 people.

The service has 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.

The provider had ensured there were sufficient staff on duty who had been appropriately recruited to meet people’s needs. However, not all staff had received appropriate training to ensure the care they provided was safe. You can see what action we told the provider to take at the back of the full version of the report.

People were supported to maintain good health by having access to a number of healthcare professionals according to their needs. Healthcare professionals were positive about home and the way the provider worked with them in people’s best interests. People received their medicines when they required them. Staff were knowledge about safeguarding adults at risk and knew what do if they suspected abuse.

The provider had policies and procedures in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff were aware of this legislation and knew how to implement it and to make sure people are only deprived of their liberty in a safe and correct way. People were asked for their consent to care and treatment whenever possible.

People had personalised care plans which were reviewed regularly. People and their relatives were encouraged to express their about the care plan and the service as a whole.

People felt the manager took their views on board and responded appropriately. There were quality assurance systems in place to continually monitor the service and make improvements were necessary. The manager ensured they learnt from any accidents and incidents that took place in the home so they risks of a reoccurrence were minimised.

The recent environmental changes meant the home has been refurbished to make it more suited to people living with dementia.

Staff knew about the people they were caring for. Staff were kind and caring and maintained people’s privacy and dignity. People were encouraged to be as independent as possible. There was a range of activities they could participate in for they wanted to.

We spoke with fifteen people who use the service, five family members, nine members of staff and the manager during this unannounced inspection.

People said they were happy with the care and support provided by staff and said "staff call me by my name", "they look after me", "they give me the help I need", "staff are kind, good and helpful". People spoke positively about the food they were given.

Relatives said they were kept informed of any changes and were welcome to visit anytime. They said staff were "good", "kind", "patient" and they saw enough staff to help people. They felt their relative was safe and said the environment was kept clean.

Staff were happy to be working at the home and said they provided good care to people in a homely environment. They said they had the training and support they needed to carry out their role.

People looked well cared for and were wearing clean clothing. We saw some good interactions between staff and people who use the service. Staff clearly knew individuals, what they liked, how they preferred to be helped and about what was important to them. However we saw some occasions when practice infantilised people who use the service. The manager was made aware of this and said she would address this with staff.

Improvements could be made to the environment with the use of pictures and or names on bedroom doors and signage around the home. Information could be in pictorial and larger print to make it more accessible.

People who use the service told us that they had not visited before they moved in, one person told us that their relatives had visited and chosen the home as they felt it would be best place for them. Three relatives we spoke with told us that they had visited a number of homes in the area and chosen this one and were happy that they had made the right choice.

People told us they had a choice of meals and said "I like the food" and "the food is ok". People said that they could join in with activities if they wanted to. We saw some group and individual activities taking place during our visit with a list of regular activities displayed around the home.

Visitors said "I am always made to feel welcome", "staff are lovely", "the food is excellent" and "they keep me informed".