Cholwell House Nursing Home is a service providing care for older people. It is registered to accommodate up to 51 people who require nursing and/or personal care. At the time of the inspection, 39 people were living there

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to stay safe and receive care with minimum risk to themselves or others. People received their medicines safely. People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us, and we saw, their healthcare needs were met. People were supported to eat and drink according to their likes and dislikes. People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People or their relatives were involved in decisions about the care and support they received. People’s choices were respected and staff encouraged choice for those who struggled to communicate with them.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Some records needed to be improved; however the registered manager was aware of this. People were supported to follow activity programmes. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

The home was well led. People, their relatives and staff spoke very highly about the management and told us they felt the service was outstanding. Staff were highly valued and appreciated and morale was very high. Staff told us they were very well supported and the management went out of their way to help. The registered manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

Further information is in the detailed findings below.

We carried out this inspection on 18 August 2015 and this was an unannounced inspection. During a previous inspection of this service in November 2013 there were no breaches of the legal requirements identified.

Cholwell House Nursing Home is registered to provide personal and nursing care for a maximum of 51 people. At the time of the inspection there were 38 people living in the home. The home provides care to people living with dementia.

A registered manager was in post at the time of 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 and associated Regulations about how the service is run.

People and their relatives said they felt the service was safe. Staff received training in safeguarding adults and knew how to report actual or suspected abuse. The service ensured there were sufficient staff on duty to meet people’s assessed needs and safe recruitment procedures were completed.

People’s risks were assessed and risk management guidance was recorded where appropriate. People were cared for in a clean, hygienic environment and the equipment used to support people was regularly serviced to ensure it was safe. People’s medicines were managed safely and a regular review of incidents and accidents was completed.

People and their relatives said the staff at the service provided effective care. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. Staff were aware of how the Mental Capacity Act 2005 impacted on their work and demonstrated how they empowered people through choice.

Staff at the service received regular training to meet the needs of people at the service. With the support of the provider, staff told us they were able to obtain additional qualifications and comprehensive training in delivering care for people living with dementia was given to staff. Staff were also supported through performance supervision and appraisal.

People at the service were supported as required with food and drink and staff were observed supporting people where required.

People and their relatives gave very positive feedback about all aspects of the care they received at the service. The services compliments log also contained similar positive information. The staff we spoke with knew people well and we made observations that showed people were relaxed in the company of staff. We observed that people’s privacy and dignity was respected and people’s visitors were welcomed to the service.

People and their relatives told us the service was responsive to their needs. Care records contained personalised information and care was delivered in line with people’s needs. Staff understood how to be responsive to people’s needs and the service provided activities for people to partake in. The views of people’s relatives were sought and where required the registered manager had actioned requests. The service had a complaints process which people and their relatives felt they could use and would be listened to.

People, their relatives and staff spoke very positively about the registered manager and the leadership of the service. Staff told of receiving a high level of support and guidance from the registered manager and spoke of a strong team bond within the staff team. The service had achieved and sustained a high level of accreditation in end of life care and had been recommended by the awarding body as a finalist in the ’Care Home of the Year’ awards 2014.

The registered manager had established good links with the local community, and relatives of the people had passed away at Cholwell House Nursing Home were invited annually to a service of remembrance. There were innovative methods to monitor and improve the quality of the service provided.

Many of the people who used the services at Cholwell House were unable to tell us their experience of living there because of communication and cognitive impairment. Therefore we spoke to relatives of people who were visiting, to staff working on the day of the inspection and to the manager. We also spent time observing people and staff in order to assess the level of care that people received.

We saw that people who used the service had their dignity maintained and that their care was planned and reviewed as their needs changed.

One relative told us "I feel 110% confident that my wife is safe and happy here" and a member of staff told us "I love working here, it's like being part of a big family".

We saw procedures that were in place to protect vulnerable people from abuse, and we spoke to staff who confirmed that they had been trained and regularly updated on how to identify and report safeguarding issues.

We saw that staff had been trained in infection control procedures and that people were protected from the risk of the spread of infection. We saw evidence that staff received regular support to perform their role and that they all had regular appraisals.

We saw how the manager monitored the quality of service provided to people and relatives told us they felt happy to speak to anyone if they had any concerns about any aspect of their relative's care.

Some people were unable to tell us their experience because of cognitive or communication impairment. We therefore spent some time observing people in three of the lounges. This allowed us to assess people's experience of life in the home.

People told us that they were assessed before they came to live at Cholwell Nursing Home.They said they were involved with developing their care and support plan and that staff treated them kindly and politely. For example one person said “I am happy here I have no complaints”. Another person said “I am happy this place is perfect for what I wanted”.

We saw the provider had a policy on safeguarding people from abuse. The staff had attended training to ensure people who lived in home were protected from the risk of abuse.

We found staff were trained and supported to deliver care to an appropriate standard.

We saw people were protected from the risk of spread of infection. Staff followed the infection procedures and received appropriate training.

We found the provider had an effective system in place to regularly monitor the quality of service that people received.

We spoke with two relatives who all spoke positively about the support their relatives received. Comments included, "the staff are all good with my relative” and “I wouldn’t let my relative come here if I didn’t have the confidence in the home. People with dementia need to be treated as friends rather than patients and that is what is happening here”.

We visited Cholwell House on 10 August 2011. The service cares for people in various stages of dementia and, for the majority of these people, it was at an advanced stage. When we arrived at 9am, most of the people were up and dressed, and had breakfast. Some were sitting in the three lounge areas and others in the sunroom. Activities were taking place with some people in one of the lounges, others were reading the newspaper, looking at photographs and books, or listening to music. We saw one resident singing and dancing with a member of staff.

To gather information during our visit we observed lunch delivered to most of the people living at Cholwell House and watched the interaction between staff and people they looked after. We met and talked with five people who were visiting people who lived at Cholwell House. We also met and talked with six members of staff including the registered manager, a director of the company that runs Cholwell House, the chef, two of the nursing staff, and a healthcare assistant.

We were told by visitors that Cholwell House was "like walking into a home-from-home", "everyone is friendly, and we can't ask for anything more for Mum". We were also told that the home has a "brilliant activities coordinator" and "when we are not here, it's reassuring that Mum's in good hands". Another visitor said that the manager was "extremely competent" and "wonderful at organisation". We heard that members of staff were "very caring and conscientious".

We asked staff about working at Cholwell House. We were told that staff "look forward to coming to work" and "I get a lot out of coming here". A regular member of agency staff, a qualified nurse who has experience of working in many other healthcare settings, told us "all the staff here are here for the residents" and "small things seems to matter". We were also told that "care really seems to make a difference".