Eversley Nursing Home provides accommodation, nursing, and personal care for up to 18 people. The service specialises in providing palliative and end of life care. On the day of our inspection, there were 18 people living in the service.

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.

The last inspection took place on 30 September 2015, and the service was assessed as being 'good' in all domain areas and had a rating of 'good' overall.

At this inspection we found standards had been sustained and again rated the service as 'Good' overall.

There were clear lines of accountability. The service had effective leadership and direction from the registered manager who was passionate about providing a high standard of care. The visions and values of the service were embedded into practice and the management team promoted best practice to make further improvements. Partnership working was excellent, for example, working with health care professionals which had been sustained over time.

Staff spoke positively about the registered manager, stating they were approachable, caring and responsive to people's and staff's needs. Involvement through partnership working was sought and guidance implemented within people's care and service delivery.

The service liaised well with external healthcare professionals and people's healthcare needs were being met. A high standard of end of life care was provided; the service had been awarded a ’beacon status’ for the Gold Standard Framework in relation to this.

People were treated with a high level of dignity and respect by both staff and the management team. Staff were patient with people, and skilled in using different methods of communication which reassured people. Good, caring relationships had been developed and staff and the registered manager knew people well. There was a positive, inclusive and person centred culture within the home.

Staff were given regular training updates, supervision and development opportunities. People spoke positively about staff and the support they received. Staff demonstrated a good knowledge of the people and topics we asked them about.

People received their medicines in line with good practice and staff had sufficient knowledge on how to administer, record and dispose of people's medicines safely.

People had access to a range of suitably nutritious food. Individual preferences were catered for. People's nutrition was closely monitored and action taken to investigate any weight loss.

People told us they felt safe and secure living in the home. Staff understood people well and knew how to keep them safe. Risk assessments were in place which provided detailed information to staff on how to maintain people's safety.

Staff were able to recognise abuse and knew how to report concerns if they suspected a person was being abused. Systems were in place to discuss potential safeguarding issues so they were escalated appropriately.

There was a complaints procedure available in the service for people and relatives to raise concerns.

Staffing levels were calculated using a dependency tool, and we observed that people were attended to regularly. Some people told us that would like to see more staff and sometimes felt lonely. The provider and staff members confirmed that additional staffing was brought in where needed, or in the case that a person deteriorated suddenly.

Activity provision was delivered in the form of Namaste care. This is undertaken on a one to one basis, and can include but is not limited to, musical reminiscence, talking, looking at photos, or massage. People can chose how they spend the time, and what they find meaningful

This inspection was unannounced and took place on 30 September 2015.

At the last inspection in April 2014, we asked the provider to make improvements to their risk assessment process. During this inspection, we found that the necessary improvements had been made.

Eversley Nursing Home is a service that specialises in providing palliative care. It is registered to provide accommodation and care for up to 18 people. On the day of our inspection, there were 17 people living at the service.

There was a registered manager employed at the home. 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.

Prior to the inspection, we had received a concern that people were at risk of receiving poor care. We found during this inspection that in response to this concern, the provider had reviewed their procedures with regards to managing this risk and that improvements had been made. Lessons had been learnt and we were therefore satisfied that systems were in place to reduce the risk of people receiving poor care.

People who lived at Eversley Nursing Home felt safe and were happy living there. Relatives were also happy with the standard of care that was being provided and everyone we spoke with recommended it as a place to live.

People were cared for by kind, caring and compassionate staff who listened to people, made them feel valued and treated them as individuals. There were enough well trained staff to provide people with the care they needed.

Eversley Nursing Home worked with other healthcare services to make sure that people received good, comfortable care at the end of their life. The staff were passionate about providing people with the care they wanted at this time in their lives. Eversley Nursing Home has been accredited by the Gold Standards Framework. This is a nationally recognised accreditation that is given to a service that has trained its staff to provide a high quality of care to people nearing the end of their life.

People were given a choice about how they wanted to live their lives and their decisions and preferences were respected. They were asked for their consent by the staff and had access to plenty of food and drink to meet their individual needs. Advice from other healthcare professionals was sought and acted upon when any concerns about people’s health had been identified.

Risks to people’s safety had been assessed and actions taken to reduce any risks that had been identified. The equipment that people used had been well maintained and people received their medicines when they needed them.

The registered manager had promoted a culture where the person was seen as an individual. People and staff felt able to raise concerns without any fear of recrimination. The registered manager demonstrated good leadership.

Systems were in place to make sure that the care being provided was of good quality. The registered manager was pro-active in trying to improve the quality of care that was being provided to the people who lived at Eversley Nursing Home.

Eversley Nursing Home is a home providing accommodation for up to 18 older people. The service states that it specialises in palliative and end of life care. There were 17 people living in the home when we visited. The service provides residential and nursing care to adults who have a physical disability or live with dementia. Eversley Nursing Home has a manager who is registered with the commission.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.

We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The registered manager told us there was no one living in the home currently who needed to be on an authorisation. We saw no evidence to suggest that anyone living in the home was being deprived of their liberty. We found the location to be meeting the requirements of the DoLS.

People told us they felt safe in the home and there were policies and procedures in place to protect people from harm. People told us they received safe and effective care which met their needs and promoted their well-being through staff who were trained and understood their requirements.

People’s care and support needs were recorded but information about their risks was not detailed. This meant people’s risks were not managed appropriately and staff could not follow effective risk assessment management policies as they were not in place. You can see what action we told the provider to take at the back of the full version of the report.

There were 15 people who lived in the home who required two staff to assist them with their care during the day and night. There were not always sufficient staff on duty to make sure that practice was safe, nor that they could respond to unforeseen events. You can see what action we told the provider to take at the back of the full version of the report.

The service followed current and relevant professional guidance about the management of medicines, and staff had sufficient training to enable them to manage people’s medicines safely.

Eversley Nursing Home stated it specialised in end of life care and palliative care. They had completed a three year accreditation with the National Gold Standard Framework (NGSF) on best practice in end of life care and staff had also undertaken specialist training.

We observed that people were treated with dignity and respect by staff who were caring and considerate. One person said, “I can go to the lounge but I don’t choose to and that’s fine with everyone. The care here is all good”.

People’s nutrition and hydration needs were identified and monitored where necessary, through records and observations made during the inspection.

The provider had asked for the views of people in the home, their relatives, staff and other professionals through annual questionnaires. Some relatives and staff had commented about the home not providing meaningful occupation and opportunity for people to engage in activities. During the inspection we were not aware of any activities that took place. Minor improvements were needed to improve the service.

The service provided care and support to people at the end of their lives and we spoke briefly with two people who used the service. They told us that they were very happy with the care and support they received. One person said, "The staff are lovely."

We looked at the care records held by the service which showed that information about people's needs was available to staff at all times and guided them in meeting those needs safely. People who used the service or their families had been involved in preparing care plans wherever possible.

The service ensured that people were treated with dignity and respect and we observed this during our inspection in the way that staff spoke with people who used the service. The service ensured that families were kept informed about their relative's condition and offered support where needed at a difficult time.

Records we looked at were well maintained and clear and were readily available.

We spoke with six people who used the service. People told us that they were happy with the service they were provided with. One person said, "I have been here since (date of admission) and I am very impressed." Another person said, "I have no complaints at all."

People were complimentary about the approach of the staff who supported them. One person said, "They (staff) are very good." Another person said, "They (staff) know me well." Another said, "The carers are nice, they will do anything for you."

We observed the care and support provided to people and we saw that the staff interacted with people in a caring, respectful and professional manner. Before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

We looked at the care records of three people who used the service. These records showed that people experienced care, treatment and support that met their needs and protected their rights.

During our visit we spoke with several people who live in the home. They told us that the care was very good and that staff were kind and knowledgeable.

One person with whom we spoke stated that, “They (staff) are very good to me. They cannot do more. I can tell them what I want them to do for me”. Another person told us that they felt safe at Eversley and trusted staff to deal with their medication.

Another person told us, “They (staff) spoil us. We get drinks whenever we want. It is so nice here. It is a good home, staff are kind and know what they are doing”.

People confirmed that they had a choice and that they were listened to. One person had asked for and had been given a half a pint of beer, together with a smile from the cook and responded in the same way, smiling and showing how much this meant to them.