Daneside Court is a nursing home which can accommodate up to 64 older adults who need residential or nursing care. The home is owned by HC-One Limited. The service is a two storey purpose built home with a range of lounges and communal space for people to use. They have single room en-suite accommodation on both floors. The garden has seating areas, is accessible to people and is secure.

On the day of this inspection there were 55 people living at Daneside Court.

At the last inspection on 5 January 2015 the service was rated Good. At this inspection we found the service remained Good.

People and family members told us the staff were kind, caring and very helpful. They said the service and care was excellent. Comments included “I am very happy here”, “The staff are very good” and “The staff are very nice.” People told us that the food was very good. Relatives confirmed that people were safe with the staff and within Daneside Court .

People and family members told us that they had no concerns or complaints about the service. They were aware of and had access to the registered provider’s complaints policy and they said they would speak to staff if they had any concerns.

Care plans were well documented and held good information about the individual person. Risk assessments were in place as needed and were individually tailored to each person’s needs. All documentation was up to date. Medication was administered safely.

People were supported by staff who were knowledgeable about them and who had undertaken sufficient training to meet people’s needs. Staff recruitment was robust and prospective staff undertook appropriate checks prior to starting work at the service. Staff had good supervision and were encouraged to attend meetings.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were aware of the safeguarding policies and procedures and had received training in safeguarding adults.

The environment was clean and well maintained and the décor was of a good standard.

The registered manager used a range of methods to assess, monitor and improve the quality and safety of the service. These included regular audits across the service and meetings with people, family members and staff to seek their views about the quality of care being provided. A wide range of compliments had been received regarding the service.

This inspection took place on 5 January 2015 and was unannounced. We arrived at the home at 9.30am and left at 4.30pm. The service met all of the regulations we inspected against at our last inspection on 2 May 2013.

Daneside Court Nursing Home is registered to provide personal and nursing care for up to 64 older people. On the day of the inspection 56 people were living in the home.

The home has single room en-suite accommodation over two floors. Each floor has lounges, dining areas and bathing and toilet facilities. There is also a garden, which has seating and tables.

The home has a registered manager who has been in post since 2012. 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.

The experiences of people who lived at the home were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. Relatives told us they had no concerns about the way their family members were treated. Some of the comments from relatives included, “A big weight was lifted when dad came here” and “I`ve never had a problem here – if there was anything wrong they are straight on the phone to let you know”.

People’s needs were assessed and care plans were developed to identify what care and support people required.

People spoke positively about the care and support they received. Comments included: “Staff are nice, they’re very caring”; “I’ve not been here long but staff are spending time getting to know me”; “The staff couldn’t be better”; “Care is good, no complaints at all”.

There were regular reviews of people’s health were referred to appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

People received visitors throughout the day and we saw they were welcomed and included. People told us they could visit at any time and were always made to feel welcome. A relative told us “The home has a lovely atmosphere – I come in a lot and the staff always discuss things with you – the manager is so approachable”.

The staff ensured people’s privacy and dignity were respected. We saw that bedroom doors were always kept closed when people were being supported with personal care.

People remarked that the food was good. One person said, “I eat more now than I’ve ever eaten”.

People could choose how to spend their day and they took part in activities in the home and the community. The home employed activity organisers and volunteers who engaged people in activities in small groups during the day.

Staff received specific training to meet the needs of people using the service and received support from the management team to develop their skills. Staff had also received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff spoken with were confident that any allegations made would be fully investigated to ensure people were protected.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were processes to monitor the quality of the service and we saw from recent audits that the service was meeting their internal quality standards.

At our previous visit in February 2013 we found that people were not protected against the risks associated with medicines. At this visit there had been an improvement to the management of medication which meant medicines were handled safely and appropriately.

We spoke to thirteen people who used the service. They said they were getting the care and support they needed. Some comments made were: - “The staff are fantastic. They will do anything for you.” “The staff are great, they look after you very well.” “I’m very happy here.”

We spoke to seven relatives who were happy with the care and support provided. They described the staff as supportive and caring. Some comments made were: - “It’s a smashing place.” “The staff look after my relative very well.”

During our visit we observed that staff were respectful, attentive and had a caring attitude towards the people who used the service. When people asked for support they received a good response.

We found that people had been assessed before they began to use the service and they had care plans that identified their needs. People's nutritional needs were well met.

There were good systems in place to promote infection control.

The staff were provided with the support they needed to enable them to meet the needs of the people who used the service.

There were good systems in place to monitor the quality of the service which meant that any shortfalls could be identified and improvements made when necessary.

We spoke with three service users and one relative about medicines handling at the home. No-one we spoke with expressed any concerns. One person we spoke with told us that care workers “always ask you about your painkillers and they make sure they are well spaced (through the day)”. A second person confirmed that they had everything they needed to manage some of their own medicines.

However, we found that some of the concerns identified at out previous visit remained to be addressed

Our inspection on 30th May 2012 found improvements were needed to care planning records, the arrangements in place for obtaining the consent of the people who used the service, management of medication and staffing levels.

At this visit we identified that there had been improvements to staffing levels, practices around obtaining consent and care planning records. However, some further improvements were needed to the management of medication.

We spoke to five people who used the service. They said they were happy with the care and support they received from staff. They said that staff were attentive and provided support when it was needed. One person said they would like a change to be made to their bedtime routines which was brought to the attention of the temporary manager. Some comments made were:-

“We are well looked after. The staff are attentive and they come when they are needed.”

“I am happy enough. The staff are very good.”

We spoke to seven visitors who were relatives or friends. All described the care and support provided by staff positively. They said that staff were helpful, caring and respectful.

We spoke to six people who used the service. All were generally positive about the standard of care and support they received. They said the staff were respectful, promoted their dignity and were kind and caring. They said they had their health needs met and the staff ensured that health professionals assessed their well-being when this was needed. The people spoken with said they decided on their own daily routine and got up and retired to bed as they wanted. Some comments made were:-

“I’m happy, it’s a fairly nice service.”

“It’s good here. The staff are good with me.”

“The service is alright, I like the staff, I had a lovely celebration here. I see the doctor when I need to.”

“The staff are very kind and caring. They have been very good to me.”

“The home is clean and safe and I have a nice bedroom. The food is good.”

All the people we spoke to said they felt safe at the home. They said that if they had any concerns about how they were being cared for or treated they would make their views known to senior staff or to a relative.

The people we spoke with had mixed views about the food provided. Two people said the food was good. The remaining four people said that the quality varied from day to day.

Four out to the six people spoken with said they either had not seen or did not recall seeing their care plan. Some people said they had the opportunity to give their views about the service through surveys, residents meetings and reviews of care needs and some people did not think that they were given the opportunity to give their views.

We spoke with four people in the nursing unit and two in the residential unit. The people in the residential unit considered that staffing levels were sufficient. Two of the people in the nursing unit did not think that there were enough staff all of the time. They said that on some days the staff were very rushed and people had to wait to have their needs met.

We spoke to a relative who informed us that the staff promoted the privacy and dignity of the people who used the service. However they were concerned that sometimes there were not enough staff available and about the frequent changes of staff and management.

We asked the commissioners of the service and social workers for their views. Two issues of concern were raised by Cheshire West and Chester Social Services. These were about the frequency that a person was having their personal care needs met and about unclear risk assessment record keeping following an accident at the home. These issues were being followed up by Cheshire West and Chester Social Services.

During our visit in November 2011 we spoke with two people who live on the nursing unit at the home. They told us that care staff and nurses work hard, look after them well and are kind and caring. Neither had any complaints or concerns about their care.

We also spoke with three relatives of people who live on the nursing unit at the home. They told us their relatives are looked after well by staff who are kind and caring and their care and welfare needs are met. However, one relative said there is a lack of activities and stimulation for people living at the home.

All the people we spoke to said generally there is enough care staff and nurses to meet people’s needs. Two said they felt staffing levels are often lower during the day at weekends which meant those staff on duty were very busy at these times. One relative said they had seen many changes to nursing staff during the last year which had disrupted continuity of care. Another person living on the nursing unit said they felt the nursing unit and staff was much better organised since the new clinical supervisor had started working there in August.