This inspection took place on 05 and 09 December 2016 and was unannounced.

Cheswardine Hall nursing and residential home is registered to provide accommodation for 48 people who require nursing or personal care. Some of whom are living with dementia. At this inspection 27 people were living there. The provider informed us that they had made a decision to reduce the number of double occupancy rooms to single for people thereby reducing their overall capacity. However, they remain registered to provide accommodation for 48.

A registered manager was in post at the time of this inspection. 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 on 12 January 2015, we identified one area where the provider was not meeting the requirements of the law. We identified that staff and the management team did not fully understand and apply the principles of the mental capacity act. We asked the provider to make improvements to address this lack of understanding. Following publication of the report in June 2015 the provider sent us an action plan telling us what they would do to make improvements and meet the legal requirements in relation to the law. We found at this inspection the provider had taken the necessary measures to increase their understanding and application of the MCA.

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse.

People had individual assessments of risk associated with their care. Equipment required to reduce risks to people was provided promptly and was appropriate to people’s individual needs. Staff knew what to do in order to minimise the potential for harm.

People were supported by enough staff to safely meet their needs. People received help with their medicines from staff who were trained and assessed as competent to safely support them.

The provider followed safe recruitment practices and completed checks on staff before they were allowed to start work.

The provider had systems in place to address any unsafe staff practice including retraining and disciplinary processes if required.

People received care from staff that had the skills and knowledge to meet their needs. New staff members received an induction to their role and were equipped with the skills they needed to work with people.

Staff attended training that was relevant to the people they supported and any additional training needed to meet people’s requirements was provided.

People’s rights were maintained by staff members who were aware of current guidance and legislation directing their work. People were involved in decisions about their care and had information they needed in a way they understood.

Staff received support and guidance from a management team who they found approachable. People had positive and caring relationships with the staff members who supported them.

People and staff felt able to express their views and felt their opinions mattered. People’s likes and dislikes were known by staff who assisted them in a way which was personal to them.

People had their privacy and dignity respected by those supporting them. People had access to healthcare when needed and staff responded to any changes in needs promptly and consistently.

People were supported to eat and drink sufficient amounts to maintain good health. People’s personal likes and preferences were known by the catering staff who supported them to make decisions regarding their diet.

The provider undertook regular quality checks in order to drive improvements. The provider engaged people and encouraged feedback. People felt confident they were listened to and their

We spoke with nine people using the service. All spoke positively about the service. Comments included, "Staff are marvellous" and "They really look after us". Someone told us "Sometimes I can't sleep at night. Staff make tea and come and sit on the bed and talk to me. This helps me, the staff are brilliant".

We spoke with five visitors who expressed high levels of satisfaction with the service. A relative of a person needing palliative care told us, "They have definitely extended (the person's) life. Care has surpassed all our expectations".

People were involved in planning and reviewing their care and treatment. Where people did not have the capacity to do so, relatives were involved in making decisions in the person's best interests.

People's care records contained detailed information about their needs. They had access to a range of health care specialists as part of their care and treatment. People enjoyed breakfast in their bedroom. One person told us, "It relieves the pressure of having to get to the dining room. It is more relaxed". People were able to make choices about their daily lives.

People had a positive dining experience with many choices. Suitably nutritious food and drinks were available at all times with assistance from staff if needed.

There was a safe system of medication in place. People received medicines safely and as prescribed.

Staff recruitment checks were in place to ensure people were protected from potential harm.

People told us that they were very satisfied with the care they received in the home. One person told us, "You won't find anything wrong here". People told us that the staff were, "Wonderful", and that there was, "Not one you couldn't say was kind".

Relatives we spoke with were also very complimentary about the home. One said the care was, "Fantastic", and described their relative as being, "As happy as they've ever been".

We saw staff taking time with people and treating them in a polite, respectful way. Staff were very attentive to people's needs.

We found that people had been involved in planning their own care. Care plans were person centred and were designed to help people retain as much independence and control as they were able to. One person told us, "They only give me as much support as I need".

We found that care plans were detailed and up to date and that they gave the staff the information they needed to support people. The staff told us they felt well supported by the management.

This inspection took place 12 and 13 January 2014 and was unannounced. At our previous inspection no improvements were identified as needed.

Cheswardine Hall nursing & residential home is registered to provide accommodation with nursing and personal care for a maximum of 48 people. On the day of our inspection 35 people were living at the home.

The home had a registered manager in post who was present for our inspection. 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.

People’s ability to make their own decisions about their care had not been appropriately assessed. Staff did not understand what they would need to do if people did not have the capacity to make their own decisions.

Risks to people had been assessed and staff understood how to minimise these risks to ensure people’s safety. Although staff knew how to minimise these risks it was not always clearly recorded in people’s care records.

Risks associated with the environment and equipment were assessed and regularly monitored by the provider’s maintenance staff and outside professionals.

Staff knew how to protect people against the risk of abuse or harm and how to report concerns they may have. Information was available to staff on the process they must follow if they had concerns.

People’s medicines were given when they needed them by staff who were trained appropriately. Arrangements for meeting people’s health care needs were in place and people saw health care professionals when they needed to.

People were supported by staff who had the skills to meet their needs. Staff had received training relevant to their roles and felt supported by the managers at the home.

People told us they were content with how they spent their time but some relatives felt there was a lack of stimulation. People were supported with individual interests and group activities when they wanted this.

People received care and support when they needed it. Staff treated people as individuals and knew their preferences in relation to their care. People were treated with dignity and were offered choices in a way they could understand.

People and staff felt involved in what happened at the home and they found management approachable. The home had good links with the local community. The provider had quality assurance procedures in place which monitored the quality of service the home provided.

You can see what action we told the provider to take at the back of the full version of the report.