What life is like for people using this service:

People expressed dissatisfaction with the numbers of agency staff employed. Although there were sufficient numbers of staff on duty to meet people’s needs there were not enough permanent staff to cover the assessed number of hours. This meant that a significant number of hours were covered by agency staff. On the day of our visit we saw sufficient numbers of staff on duty to respond to people’s needs swiftly. The area manager told us that on-going recruitment was taking pace and records we saw confirmed this. They also informed us that agency staff used were regular staff who knew people well to provide consistency.

People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were detailed risk management plans in place to protect and promote people’s safety. The provider followed thorough recruitment practices to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Staff promoted and respected people's cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

More information is in the Detailed Findings below

Rating at last inspection: Good (report published 13 September 2016)

About the service: Duncote Hall is a manor house with an extension built in 1987 in keeping with the original property. All bedrooms have an en-suite facility and there is a large conservatory which overlooks the grounds to the rear of the building. The service provides residential and nursing care for up to 38 older people, including people l

This inspection took place on 10 August 2016 and was unannounced.

This was the second comprehensive inspection carried out at Duncote Hall Nursing Home.

Duncote Hall provides care and support for up to 40 older people with a wide range of needs, including dementia care. At the time of the inspection there were 35 people using the service.

The service has a registered manager. 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to use the whistleblowing procedure. Risk assessments were centred on the needs of the individual and any potential risks to people had been identified. We saw that risk management plans had been completed to enable them to live as safely and independently as possible. There were adequate numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe

People had their medicines managed safely, and received their medicines in a way they chose and preferred.

Staff were well trained and aspects of training were used regularly when planning care and supporting people with their needs. People told us and records confirmed that all of the staff received regular training in mandatory subjects. In addition, we saw that specialist training specific to the needs of people using the service had been completed. This had provided staff with the knowledge and skills to meet people’s needs in an effective and individualised way.

Staff sought people's consent to care and treatment which was in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

People’s needs were assessed and care plans gave guidance on how they were to be supported. Records showed that people and their relatives were involved in the assessment process and review of their care. A wide and varied range of activities were on offer for people to participate in if they wished. The service had an effective complaints procedure in place and we saw appropriate systems for responding to any complaints the service received.

Staff enjoyed working at the service and felt well supported in their roles. They told us the registered manager was supportive of them. Quality monitoring systems and processes were to make positive changes and drive future improvement.

This inspection took place on 28 May 2015 and was unannounced.

Duncote Hall provides care and support for up to 40 older people with a wide range of needs, including dementia care. There were 38 people using the service when we visited.

The service had a registered manager. 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.

Systems and processes in place for the administration and recording of medicines were not always adequate. This was in breach of Regulation 12 HSCA (RA) Regulations 2014.

Bedroom and communal doors had been wedged open and this put people at risk if there was a fire in the home. This was in breach of Regulation 15 HSCA (RA) Regulations 2014.

People were protected from abuse and told us they felt safe. Staff were knowledgeable about the risks of abuse and reporting procedures.

Risks to people’s safety had been assessed and provided staff with guidance to support people safely.

There were appropriate numbers of staff employed to meet people’s needs.

Robust recruitment policies and procedures were followed to ensure that staff were suitable to work with people.

Staff had received training to ensure they were qualified, competent and skilled to deliver care or treatment to service users. Staff received support via supervision and staff meetings.

Staff knew how to protect people who were unable to make decisions for themselves. There were policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink. People were not always appropriately supported to eat their meals.

People’s physical health was monitored, so that appropriate referrals to health professionals could be made.

People were looked after by staff that were caring, compassionate and promoted their privacy and dignity.

People’s needs were assessed and regularly reviewed.

People were supported to take part in meaningful activities and pursue hobbies and interests.

The home had an effective complaints procedure in place. Staff were responsive to concerns and when issues were raised these were acted upon promptly.

The provider had internal systems in place to monitor the quality and safety of the service but these were not always used as effectively as they could have been.

Staff were well supported and motivated to do a good job.

We saw that people were encouraged to have their say about how the quality of services could be improved and were positive about the leadership provided by the registered manager.

We identified that the provider was not meeting regulatory requirements and was in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When we published our last inspection report in May 2013 we had identified a minor concern that the displayed complaints procedure had not been kept up to date and that therefore the information was inaccurate and inadequate.

We saw that, for example, reference was made to the 'National Care Standards Act 2000' and not to the current 'Health and Social Care Act 2008'. We also saw that there was no contact details for 'The Local Government Ombudsman' or information about the Ombudsman's role if people remained dissatisfied with what action had been taken to resolve their complaint. We did not see any information about the local social services role with regard to receiving complaints from a person funded by them.

When we again visited ‘Duncote Hall’ unannounced on the afternoon of 4 October 2013 we found that the complaints procedure information had been appropriately and accurately updated and was on display inside the home.

We also saw that the information had been amended in the service user guide. This meant that in addition to being encouraged to complain if people were dissatisfied with their care they were also provided with the up-to-date information they needed.

We saw that people had been provided with the contact details and role of external organisations that may be of assistance in resolving a complaint.

We met and spoke in private with three people in the home who told us that they were happy and liked living there. One person we spoke with said, "The staff are all kind and know what to do. Nothing is too much trouble for them. It makes me feel safe."

Everyone we spoke with said that they enjoyed their meals and had plenty to eat and drink throughout the day.

We spoke with two visitors who said they were welcome to visit at any reasonable hour. They said they always found the staff to be helpful. One visitor said, "We are always asked if we want a cup of tea. All the staff seem so friendly."

We saw that the communal areas of the home, such as the lounges and access corridors, were clean and well maintained, attractively decorated, and free from odour. We saw that some areas of the home were being routinely redecorated.

The four bedrooms we saw were comfortable, clean, and each person had personalised their room with their belongings.

The people we spoke with at Duncote Hall told us they received all the help and support they needed from the staff. They told us they were encouraged to do whatever they could for themselves, even if that was very limited, so that they retained their sense of independence.

One person who visited Duncote Hall regularly told us, "I am always made welcome. I can visit mum when and how often I want and that makes us both happy."

We were told that staff encouraged people to join in with activities. One person said, "It is up to me if I want to join in with what is going on. It is nice to be asked because sometimes I change my mind."

The people who spoke to us at Duncote Hall Nursing Home told us they were happy with the care and support they get. The told us they liked the attitude of the staff, that they were friendly and attentive.

Comments from people we spoke to included, for example:

• “I get the help I need and that makes me feel safe here.”

• “I like all the staff. They treat me nicely.”

• “I think the food is really good. You get what you want.”