We undertook an unannounced inspection on 29 September 2016. At our previous inspection on 13 May 2014 the provider was meeting the regulations inspected.

Chegworth Nursing Home provides accommodation and nursing care for up to 43 older people. At the time of our inspection 42 people were using the service, some of whom were living with dementia. The home specialises in supporting people requiring end of life care and wound management.

A registered manager was 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.

There were sufficient staff at the service to meet people’s needs. Staff were allocated to support individuals and this enabled them to build caring trusting relationships with people. Staff had the knowledge and skills to meet people’s needs and these were updated through the completion of regular training courses and discussion during supervision sessions.

Staff treated people with respect. They spoke and interacted with them in a caring and friendly manner. Staff knew the people they were supporting and provided care in line with their wishes and preferences. Staff respected people’s privacy and maintained their dignity.

The registered manager assessed people’s needs and developed care plans outlining how those needs were to be met. People and their relatives were involved in discussions about their care needs. The staff had the knowledge to support people with wound care. When people had been admitted to the service with pressure ulcers staff had provided people with the care they required in order for these wounds to heal.

Staff assessed the risks to people’s safety and plans were in place to manage and mitigate those risks. This included providing people with the equipment they required. Risk management plans were reviewed in response to incidents that occurred at the service to prevent recurrence of similar incidents.

Processes were in place to keep people safe. This included ensuring staff were aware of their responsibilities to safeguard people and to report any concerns of possible abuse to their manager and the local authority safeguarding team so appropriate action could be implemented to protect people, where required.

Staff were prompt to identify when people required support with their health. Staff undertook some screening processes to identify possible infections so prompt treatment could be sought. Staff liaised with the GP and undertook weekly ‘ward rounds’ to review people’s health needs. Staff liaised with other healthcare specialists as required and supported people in line with the advice provided. This included seeking advice about people’s nutritional needs.

The service was part of the Vanguard initiative. This initiative was about supporting people with their healthcare needs within the care home by trained and knowledgeable staff in conjunction with other community healthcare professionals and about smoother transitions between the care home and admissions to hospital. The registered manager felt being part of this process had strengthened their processes to support people with their healthcare needs and ensured people received the support they required in a timely manner.

Staff provided people with end of life care and support in line with their wishes and preferences. Advance care plans and ‘co-ordinate my care’ records were available so all professionals involved in the person’s care were aware of their wishes. Staff supported people to be at their preferred place at the end of their lives and staff stayed with the person so they did not die alone. The service had been accredited as part of the Gold Standards Framework (GSF) recognising the ability of the staff to provide quality end

When we visited Chegworth Nursing Home there were 33 people using the service. We spoke with eight of the people using the service, five relatives, the area manager, the registered manager and two members of staff. We reviewed four people's care plans and three staff files.

We considered our inspection findings to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People who use the services told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had been trained to understand when an application should be made and the process for submitting an application. This meant that people were safeguarded as required.

The manager had ensured there were sufficient numbers of staff on duty, appropriately qualified to meet the support needs of people who used the services. This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed together with them, and they were involved in their care and support planning. People told us that they had been involved in their care and support plans and that the plans reflected their needs. We inspected four people’s care files. They included essential information about the person, needs and risk assessment information, care plans and records of health care appointments. Relatives told us that the care and support that their relatives received was good. One person said about their relative’s care, “it covers all their needs and when the needs change the care plan is updated”.

Is the service caring?

People were treated with respect and dignity by the staff and they were assisted by kind and supportive staff. We saw that staff showed patience and professionalism and gave appropriate encouragement when supporting the people who use the services. The eight people we talked to said the staff treated them well and respected their wishes, dignity and privacy. One person said, “I like living here. The staff are so caring, it’s more like a family home”. Other comments included, “the care is really good and the staff are very kind” and “my mother is very happy here, the care and support she gets meet her needs”. We observed that staff knocked on people’s doors before entering their rooms and asked if it was convenient for them to go in. This reflected the caring environment that we found on the day of the inspection.

Is the service responsive?

Relatives of people who use the services told us that if a person’s needs changed, their care and support would be tailored to those changed needs. We saw that care plans were reviewed regularly and changed appropriately. This was important as this helped staff understand what people wanted or needed or how they were feeling.

All the people who use the services we spoke with knew how to make a complaint. There was an appropriate complaints procedure in place and discussions we had with relatives and staff indicated that they would be supportive of anyone who needed to complain. People can therefore be assured that complaints would be investigated and action taken as necessary.

Is the service well-led?

We saw that the service worked well with other agencies and services to make sure that people were supported in a co-ordinated way. It was clear that the main objective was to support people in the most appropriate way to meet their assessed risks and care needs.

The manager carried out regular checks to assess and monitor the quality of services provided and took appropriate action to address any issues or concerns raised about service quality.

The views of people who use the services, their representatives and staff were listened to by the manager. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service.

We undertook this inspection visit because we were aware that building work was being undertaken to extend and modernise this service. During this time temporary accommodation had been provided for some of the people living there.

We found that the provider was working closely with building regulators and the fire safety officer to ensure that people were safe during this time. The temporary accommodation was warm and well appointed. People told us that they were being kept informed of what was happening all the time.

On the day that we inspected Chegworth Nursing Home there were 36 people using the service. Some people had a degree of dementia or short term memory loss however, several of them were able to talk with us about what it was like to live there. People told us that they were very happy living in the home. They said that the staff were “wonderful” and “so kind and lovely”. They told us that both the provider of the service and the manager were very approachable and if they ever had any concerns they could always talk to them. Visitors told us that they always felt welcome in the home and that staff kept them informed about any changes in their relative’s health.

People told us that they were free to spend their days as they wanted to, joining in with activities or occupying themselves. There were activities arranged for those who wished to participate including trips out of the home. Those people who were mobile were free to walk around the home as they wished and out into the garden.

We saw that care was planned and delivered in line with people’s individual care needs. Families were involved in discussions about how people liked to be supported. Regular reviews made sure any changes were identified and addressed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of foods and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We spoke with several people who use the service, to ask them about what it was like to live in the home.

The inspector also spoke with both the Registered Provider and Registered Manager, a trained nurse, three healthcare assistants and the chef.

In addition, we looked at a sample of records kept by the home as evidence of how peoples care needs are being met.

The inspection team was lead by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of care service.

During our visit we also used the Short Observational Tool for Inspections (SOFI). SOFI is a specific way of observing people who may not be able to communicate with us.

From our observation and the comments we received it is clear that people who live at Chegworth are very happy. They told us “You couldn’t wish for better. We looked at hundreds of places before we chose this one” and “it’s a very nice place to live. Couldn’t be better”

They also said the staff were very kind with one saying “if it wasn’t for them I wouldn’t be here"

We received comments about the food such as "we enjoy the food that we have" and “the chef is really good, excellent”.

We asked people if they felt safe living in Chegworth and if the staff were sympathetic to their needs. One told us “yes,you see how they talk to you?” We observed the scene she was referring to, a staff member re-assurringly talking to another momentarily distressed resident across the room.