We undertook an inspection of Culverhayes Nursing Home on 11 and 12 April 2018. Culverhayes Nursing Home provides accommodation for up to 65 people requiring nursing care. The service offers care to people with mental health needs and to those living with dementia. People live in one of three dedicated areas of the service according to their particular needs, Hayes, Culver and Lymore Wings. At the time of our inspection 64 people were living at the service and another person was due to move in.

At our last inspection in October 2015 we rated the service Good. At this inspection we found the evidence did not continue to support the rating of Good. .

People felt safe living at the service and staff were able to tell us what action they would take to keep people safe and protect them. The management of medicines was carried out safely. However the registered persons’ attention was drawn to improvements that could be made regarding the storage of drinks thickener and the accessibility of guidance relating to ‘as required medicines’’

The environment was suitable for people living with dementia. People were accommodated in small groups and there was signage and use of colour to help people find their way around. The home was clean, well maintained and equipped. A range of activities were provided and people were supported to get involved in activities outside the service.

People received effective care because their needs were assessed. Staff were trained in core topics to meet people’s specific needs such as safe handling and different aspects of dementia care.

People’s rights were upheld as required by the Mental Capacity Act 2005. They were supported to make choices and if they lacked capacity to make some decisions these were made in their best interests.

The service provided food and drink that met people’s need and referrals were made if people had swallowing difficulties or lost weight. Some people would benefit from pictorial menus or visual cues to support them making meal choices.

Staff were kind and caring and knew people well. They treated people with dignity and respect and provided care in a relaxed and compassionate manner.

People received responsive care as plans relating to their specific health needs contained sufficient detail. Some end of life care plans could be improved with more information about people’s wishes at that time of their life.

The registered manager led a positive team who felt valued. Visiting healthcare professionals confirmed that the staff worked with them to ensure people received the care they needed.

People and their relatives could be confident that their views would be sought and listened to about the service. We found a number of improvements had been made in response to this feedback.

The inspection took place on 30 October 2015 and was unannounced. The service was last inspected in 22 August 2013 when it was compliant with the legal requirements at that time.

Culverhayes Nursing Home provides nursing care for up to 65 people. People who live at the home have dementia and other complex mental health needs. There were 64 people at the home on the day of our visit.

There was a registered manager for the service. 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.

Risks to people’s safety were properly identified and well managed. The staff understood how to keep people safe. There were sufficient numbers of suitable staff employed to meet people’s needs and help to keep people safe. There were safe systems in place to manage and administer people their medicines.

People were well cared for and were relaxed and comfortable in the home and in the company of the staff. Everyone we spoke with complimented and praised the staff who supported them. Comments included, “The staff are all beyond reproach, they are so clued in to what people need” and, “They go the extra mile for my relative they make me feel they care so much.”

The GP who visited the home at least three times a week praised the staff and their caring attitude. They also spoke very positively about the way staff understood the complex needs of people who lived at the home.

The staff team received regular training and support. This gave them the knowledge and skills to meet people’s needs in an effective and individualised way.

The environment was designed to enable people to move freely around the home. There was an outside enclosed garden people could easily access.

People and their relatives were involved in the planning of their care. Feedback was sought so that care was flexible and provided in the way people preferred.

People’s representatives knew how to make a complaint. There was a system in place to ensure that complaints were managed in accordance with the provider’s complaints policy.

There were quality monitoring systems in place to ensure that the safety and suitability of the service was effectively monitored. Action was taken where needed to improve the service.

At this inspection we looked at record keeping. This was because it was an area which had been identified as needing action at the previous inspection. The provider sent us an action plan following the inspection. We found they had taken necessary action and were now compliant.

During this inspection we met with people and staff in all four of the different areas of the home. We also met with the home manager. We looked at the records of four of the people we met in detail and discussed their care and treatment needs with staff.

We found people had clear records which reflected what we observed, and staff told us. This included people who needed support with all aspects of their daily lives, such as nutrition and fluid intake. There were clear records relating to treatment of people’s medical conditions. This included where people had wounds.

People who were living with dementia had clear care plans and monitoring records about meeting their dementia care needs. These reflected what staff told us. Records were completed in a non-judgemental way and were individual in tone.

We visited Culverhayes Nursing Home on 4 July 2012 and spent the day at the service. Culverhayes was divided into three distinct areas. The area called ‘Culver’ could accommodate 19 people; ‘Hayes’ could accommodate 26 people; and ‘Lymore’ 20 people. Each area was covered by a registered nurse and varying numbers of care staff, dependent upon the shift concerned and needs of people. The home had two dedicated activities coordinators and a professional kitchen providing three meals a day.

We met and talked with people who were living at the home on the day we visited. The home was accommodating 65 people, some of whom with a diagnosis of dementia and others with mental health needs. We were able to see all of the people living at the home on the day of our visit, although some were not well enough to communicate their views to us.

We met and talked with a number of visitors to the home, including relatives, carers and healthcare professionals. We talked with various members of the staff team, including the manager, nursing staff, care workers, the chef and kitchen staff, and the activities team.

During our visit we observed care given to people, looked at care records and talked with people and visitors about their experiences of Culverhayes Nursing Home. We talked with the staff about how people were able to provide consent. Staff told us about keeping people at the home safe from abuse and their training in this area. We looked at care records to see if the care people needed was understood and being safely delivered. Staff told us about their training and supervision and how they were supported to do their job.

We observed care being delivered safely and with kindness and patience. People who lived at the home told us “I am happy here” and “they look after me well”. One person said “the food’s good” and staff were “very kind”.

We met with a number of visitors to the home. Relatives and friends of people at the home told us “staff here are brilliant”, “the family are made to feel welcome” and “we could not ask for a better place”.

We met two healthcare professionals visiting the home, one of whom was from local GP practice that supports people living at the home. The GP told us the care notes were “particularly good”. These records and staff knowledge enabled the doctors attached to the home to get to know people “very well”.

We found staff knew people well. Where possible they made sure people understood what staff wanted them to do and what was happening to them. Staff knew about safeguarding people from abuse and how they were supported by the home to raise concerns.

Care records we looked at contained plenty of detail about how to look after people but they did not carry a basic assessment of people’s needs in order to make it clear why people needed certain forms of intervention.

Culverhayes provides a service for people who have dementia which can make communication difficult. We were able to gain some comments that people liked the home and were happy there. We spoke with some people living at the home or their relatives / friends during the site visit. People told us that they felt safe at the home and that staff were “kind and caring”. They felt that the food was usually “excellent” or “lovely” and that they were given plenty to eat at times that suited them. People said that they could eat meals in their rooms if they did not wish to go to the dining room.

People said that their rooms were warm and comfortable and that they felt safe. They said there was always staff around. They also said that they were able to go to their room for privacy when they wished and that staff left them alone for a reasonable time when they did not want to be disturbed.

People said that they were supported to have regular baths or showers and helped to maintain personal hygiene where this was needed.

People were complimentary about the manager of the home.

The service has a robust system for ensuring it continually improves the care and support offered to people.

During our review we have identified where the home needs to make some improvements to maintain compliance.

There were some activities on offer to people at the home. People told us that they enjoyed the opportunities this gave them. Staff spent periods of time giving people one to one attention time which left other people with little to do. This can cause some people to become distressed.

Not all staff had undertaken training on the subject of the Mental Capacity Act. This means that some staff may not have an up to date understanding of the legal rights of people who may not be able to give consent to care and treatment. The provider had recognised this prior to our visit and training had been organised.

We used a number of different methods to help us understand the experiences of people using the service. This was because people using the service had complex needs which meant not everyone was able to tell us their experiences. One person told us “staff are very kind.”

We observed staff were attentive to people’s needs. We talked with staff and they showed a detailed knowledge of the people they were caring for. Staff told us they used this information to meet individual needs. We looked at care records relating to five people. They showed people’s likes and dislikes and life history were recorded. Staff told us they used this information to ensure care was appropriate and to build a rapport with people.

All the people and relatives we spoke with talked positively about the cleanliness in the home and had no concerns. One person showed us their room and told us “I keep my room the way I like it. Staff come in every morning and clean my floors and bathroom, it’s always clean.” Care staff demonstrated a good understanding of infection control. We were shown around all aspects of the home and found it to be clean and tidy.

We spoke with the provider and manager about recruitment when we visited. We looked at records which showed there were effective recruitment and selection processes in place.

We looked at quality information and how this was audited. We saw the provider had recorded information about accidents and incidents and evaluated these for potential service improvements. We looked at five people’s care records and found the monitoring and audits of some care, and the delivery of some care was not consistent. This meant processes set up to ensure care and treatment plans were evaluated were not effective for all people.