This inspection took place on 22 and 23 September 2016 and was unannounced. The previous inspection of Castleford House Nursing Home had been in January 2014. At that time there were no breaches of the legal requirements.

The service is a care home with nursing, registered to accommodate up to 43 older people. The maximum number of people the home accommodated at any one time was 41 because two of the shared rooms were used by one person. At the time of our inspection there were 38 people in residence. People had general nursing care needs. The majority of people either also had a diagnosis of dementia or had a degree of cognitive impairment. The home is a converted Victorian hunting lodge set in large gardens on the hillside above Chepstow. There are 31 bedrooms for single occupancy and five shared rooms with screening in place to provide privacy. The home has a large dining room called The Boat House Bistro, a large communal lounge with a TV and a quiet room/library area plus ‘tea room’. Accommodation is spread over three floors, with a passenger lift, chair lifts and a platform lift making all areas of the home accessible.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

The service had taken all the appropriate measures to ensure people were kept safe. Staff received safeguarding training and knew how to report any concerns they had about people’s safety and welfare. Staff also received moving and handling training and were guided by manual handling ambassadors who had received extra training. Where people needed to be assisted to move, their moving and handling needs were assessed and a safe manual handling plan was devised. This meant people were moved safely using the appropriate methods and equipment.

Any risks to people’s welfare were assessed and management plans put in place to reduce or eliminate that risk. All the appropriate checks to maintain the premises and facilities were completed on a regular basis. The management of medicines was safe and people were administered their medicines safely.

Staffing numbers for each shift were kept under review by the registered manager and adjusted as needed. Because of a number of recent admissions the number of staff on duty had been increased. There was a qualified nurse on duty at all times along with senior care staff and care staff, maintenance, catering and domestic staff. Staff were provided with regular training and were supported by their colleagues, the deputy and the registered manager to do their jobs effectively.

People were provided with food and drink which met their preferences and dietary requirements. Where concerns had been identified with weight loss, food and drink intake and body weight was monitored. Arrangements were made for people to see the GP and other healthcare professionals as and when they needed to.

People were looked after by staff who were kind and caring. They ensured people’s privacy and dignity was maintained at all times. Where possible people were involved in making decisions about their care and relatives were included where this had been agreed.

People received personalised care and support that met their specific needs. They were encouraged to express their views and opinions and have a say about how they wanted to be looked after. The staff acted upon any concerns they had in order to improve the service although some minor improvements were needed in the way complaints were handled and managed. Those people who had end of life care needs were supported to remain at the service.

The staff team were provided with good leadership and management by the registered manager. Feedback from people and their families was sought to identify areas where they could do better. The provider had robus

We were unable to speak to people who used the service because of their varying stages of dementia and resulting communication difficulties. We spoke to staff and relatives of people who used the service. We looked at the care files for four people who used the service. Each care file contained personal information for each person and a ‘who am I’ document. This contained valuable information for staff about people’s life experiences. We looked at the training records for staff. This showed that the majority of staff had received up to date safeguarding training. We looked at two incidents that had taken place in the nine months before our inspection. This showed that they had investigated the incidents appropriately and liaised with other agencies such as the local authority responsible for safeguarding.

During our inspection we noted the home to be clean. Cleaning schedules were in place across the home and we saw that these had been completed consistently. The registered manager told us that there had been no complaints made about the care people in the home had received. We spoke with two relatives of people who used the service. They were both complimentary about the care their loved ones received. Their comments included “I like this home, they provide very good care”. “They are very caring to my mother and to us as a family”. “It’s excellent here, it’s run like a big family home”. “There is nothing they could do better for my mother”.

We found that the home was providing a good standard of care and accommodation. The manager had continued to keep under review how the home was operating and had continued to introduced changes, which had benefitted people using the service. We saw evidence of how care plans had been reviewed to ensure that they reflected the care and treatment choices of people living at the service. People told us that: "staff asked what I liked and disliked". People also told us that: “staff spoke and spent time with them".

We looked at all of the communal and some of the individual rooms at the home. There was a programme of redecoration and refurbishment which was ongoing. Staff had access to suitable health and safety and specialist training, to enable them to care and support people. There had been a relatively low turnover of staff. During discussions with staff they demonstrated that they understood the needs, and respected the choices of people living at the home. Staff also demonstrated a clear knowledge of the support needs and likes and dislikes of people who had recently moved to Castleford House.

A relative told us that the homes admission procedure meant that the person was assessed by the manager before moving in, to help ensure that all their needs could be met.

A person living in the home told us that they were well looked after and that the staff always treat them with respect. They told us the food is quite good but there could be more choice.

Another person told us that all the staff are very good and that they deal with any concerns quickly, usually little things.

A person living in the home told us they liked going out in the minibus.

Relatives gave us the following comments; “the staff are marvellous, if I am going to be late I phone, and they tell my husband to avoid him getting anxious”, “I could not wish for a better home and the staff are fantastic”.

Two relatives visiting the home together told us, ”the home is brilliant, the staff are kind and the facilities are good”.

People living in the home told us that they were able to make their own decisions about their care, for example; when to be moved, when to get up, when to go to bed and when medication is administered.

One person told us that the doctor is called in when necessary and that their health is fine and they feel safe as the staff treat them with respect.

Other relatives told us; “the food is good here I visit every day”. “The home is always clean”. “My husband’s room is fine and the laundry is too” and “It feels like home here and it never smells”.