The inspection took place on 21November 2016 and was unannounced.

Claremont Nursing Home provides residential and nursing care for up to 52 older people, some of whom may be living with dementia or a physical disability. The home is divided into two areas for those requiring nursing care or for those living with dementia. The home is purpose built and accommodation is over one floor. At the time of this inspection there were 50 people living within the home.

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. 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.

Processes were in place to help ensure only those people suitable to work within the home were employed. Staff received an induction, ongoing training and competency checks to help them meet the needs of those living within the home. Staff received regular formal and informal support.

People received care and support from staff that enjoyed their work and felt valued by the management team. Staff worked well as a team and supported each other. We saw that the home was organised and that it ran efficiently.

There were enough staff to meet people’s individual needs. People told us that they received the support they needed and, during our visit, we saw that people received prompt assistance.

Staff were caring and thoughtful in their approach to supporting people who used the service. People’s dignity and privacy was maintained and staff were respectful. People had choice in how they spent their day and their independence was encouraged as appropriate.

Processes were in place to help protect people from the risk of abuse and local safeguarding policy was adhered to. Risks to those that used the service, staff and others had been identified, assessed and managed. Premises were maintained and regular checks were in place. Accidents and incidents had been recorded and analysed to identify any trends or contributing factors in order to help mitigate future risk.

People received their medicines appropriately, safely and as prescribed. Healthcare provision was regular, prompt and received as required.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s capacity to make decisions had been assessed and DoLS applications made appropriately. Improvements were required in relation to assessments being decision specific. However, the service had identified this and were working towards introducing documentation to support this.

People, and where appropriate their relatives, had been included in the planning of the care and support they received. Care plans were individual to each person and met their needs. People told us they received the care and support they required.

The service provided assistance with meeting people’s social and leisure needs. The people we spoke with told us they enjoyed the activities provided by the service and there was enough for them to do.

People’s nutritional needs were assessed and met. People received the diets they required and meals were provided at a time they wanted. Although they had mixed opinions on the quality of the food, they agreed they had choice in what they ate and assistance when and if required.

The provider had a robust system in place that monitored the quality of the service. It was used effectively, thoroughly, and drove improvement. People’s feedback was sought, listened to and used to further develop the service. Actions required to improve the service were regularly monitored to ensure completion.

People spoke positively about the management of the home. They told us that the management team were approachable, helpful and visible. People had confidence in th

We assessed if people’s medicines were being managed safely following concerns we identified and raised during our inspections in 21 October and 23 December 2013. During this inspection, we found there were improvements in the records. The provider had put in place audits of medicines and records which showed medicines were being administered as intended by prescribers. We found that there was good information available about people’s medicines to assist staff in safely administering people’s medicines.

Prior to our inspection we had received information from the local authority safeguarding team regarding the care and support provided to people. These concerns had been investigated by the provider and the safeguarding team and measures had been put into place by the service to ensure that people were provided with a safe and effective service.

During our inspection we looked at the care and support provided to the people who used the service. We spoke with four people who used the service and two relatives and we looked at the care records of four people who used the service. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People told us that they were happy living in the service. One person said, "I am happy." A person's relatives told us that they were satisfied with the care and support that their relative was provided with.

Prior to our inspection we received a concern on the Care Quality Commission (CQC) website where people could share their comments about the service. The information received told us that there were concerns about a person's diet. We made a referral to the local authority safeguarding team, who were responsible for investigating safeguarding concerns. This issue was investigated by the local authority.

We looked at the care records of four people who used the service and spoke with five people. One person said, "Yes, I get enough to eat, sometimes too much and I have to leave a bit." Another person said, "They (staff) are always on hand, I never have to ask twice (for drinks)." We found that the provider took appropriate action to ensure that people's dietary needs were met.

We assessed if people’s medicines were being managed safely and followed up on issues we identified and raised during our inspection of 21 October 2013. During this inspection, we found there were gaps in the medication administration records and that there were numerical discrepancies of medicines so we could not be assured people were being given their medicines as intended by prescribers. We also noted additional poor practices relating to the recording and administration of medicines. We found that whilst there was some good information available about people’s medicines there was still a lack of written information to assist staff in safely administering other medicines.

The service was split into two units, 'The Lodge' provided care and support to people living with dementia and 'The House' provided nursing care.

Our inspection of 12 August 2013 found that improvements were needed in 'The House' in infection control and the care provided to people. During this inspection we found that improvements had been made.

We found that call bells were answered promptly and care and support was provided to people when they needed it. We asked 10 people who used the service of their call bells were answered promptly. One person said, "Oh yes, they are very good." Another person said, "They come as soon as they can, I have no problems." We found that the service was clean and hygienic. People spoken with confirmed that the service was kept clean. One person said, "It is spotless." Another person said, "They keep it very clean."

Our inspection of 12 August 2013 we checked the medication management in 'The Lodge' and found that people were protected by the medication procedures and processes. However, prior to this inspection we received concerns about the management of medication in the 'The House.' During this inspection we looked at the medication processes and procedures in 'The House.' We found that the service did not protect people against the risks associated with the unsafe use and management of medication by way of appropriate arrangements for the recording, using, safe keeping and safe administration of medicines.

The service was split into two units, 'The Lodge' provided care and support to people living with dementia and 'The House' provided nursing care. There were 46 people living in the service at the time of our inspection.

We spoke with nine people who told us that the staff treated them with respect and kindness and listened and acted on what they said. One person said, "They (staff) are all lovely." We saw that the staff interacted with people in a caring, respectful and professional manner. This was confirmed by seven people's visitors who we spoke with.

People and visitors in 'The Lodge' told us that they were happy with the service provided. People living in 'The House' told us that they were happy with the service but often had to wait for their call bells to be answered. One person who had needed support said, "I had to wait ages." Visitors in 'The House' also told us that call bells were not answered promptly. We found that the provider was aware of this issue and was taking action to address this.

We looked at the care records of eight people and found that they identified how their needs were met. People were protected by the service's medication procedures.

We saw staff records that showed that they were trained and supported to meet people's needs.

We found that the service was clean and tidy throughout. However, there was an offensive smell in 'The House'. We found that equipment in the service was safe and fit for purpose.

We spoke with eight people who used the service who told us that the staff treated them with respect.

People spoken with told us that their needs were met. One person said that the care provision was "Very very good." Another person said "They fall over backwards to help you."

People told us that the staff listened to them and acted on what they said. One person said that they chose when they went to bed and got up in the mornings. Three people said that they were provided with choices of food and drinks. One person said that the food helpings were "Very generous." Another person said "If I want a small portion of food I am given what I want."

People were complimentary about the activities that they were provided with. One person said "There is plenty to keep me busy."

During our visit on 30 December people made very positive comments about staff and the home. They told us that staff are kind and helpful and that the staff know them well. People informed us that there are always enough staff on duty and that if they pull the cord in their room, the staff always come quickly. They also told us that the hairdresser visits weekly and that they see their GP, the District Nurse, Chiropodist and Optician when they need to. People also informed us that they know how to complain and that if they had any concerns they would speak to a member of staff.

We observed staff talking nicely, calmly and patiently to people. We observed staff moving people appropriately and we note that the people living in the home were nicely dressed, clean and presentable. We also saw staff patiently helping people walking around the home.