This was an unannounced inspection that took place on 31 October 2018.

Faversham House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Faversham House is a nursing care home in the Urmston area of Trafford and can accommodate 20 people. At the time of this inspection, there were 20 people living at the service, some of whom were living with dementia.

At our last inspection on 2 February 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a manager in place at Faversham House Nursing Home, who was also the owner of the service. They were in the process of registering with CQC to become the 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.

Risk assessments were in place for people who lived at Faversham House Nursing Home. Risk assessments were tailored around the needs of the person, support measures were in place to mitigate risks and assessments were regularly reviewed and updated. Staff were familiar with people's risks; they received daily updates on people's health and well-being and if their circumstances had changed.

There were safe recruitment procedures in place to ensure staff were of the right character to support vulnerable people. However, we found no evidence of medical statements. Medical statements enable new starters to declare any health condition or disability. The manager said this had been overlooked and confirmed they would review this as a matter of urgency.

Accidents and incidents were routinely recorded and analysed. There was an accident and incident reporting policy in place and staff routinely completed accident and incident documentation. The manager analysed monthly accident and incident reports and established trends that were emerging as a measure of mitigating risk.

Medicines were stored safely and securely, however two people prescribed PRN medicines (medicines to be given 'as and when' needed) did not have protocols in place. The manager was responsive to our feedback and ensured that all protocols were reviewed and updated during the inspection.

The home was acting under the principles of the Mental Capacity Act and people were asked for their consent before support was given. Where people lacked the capacity to make decisions for themselves, appropriate processes were in place to identify the person's best interests.

Staff received regular supervision and told us they received support on a day to day basis. Staff were supported with training, learning and development opportunities.

Confidential information was securely stored and protected in line with General Data Protection Regulation (GDPR). This meant that people's sensitive and personal information was not unnecessarily shared with others.

We observed the mealtime experience and found this to be relaxed and well organised. People received any help, support and encouragement they required to eat and drink promptly.

A person-centred approach to care was evident. Records were tailored around the needs of the person and staff were familiar with the likes, dislikes, preferences and wishes of people they supported.

People were sensitively supported with end of life wishes and preferences. Recor

This was an unannounced inspection which took place on 2 February 2016. We had previously carried out an inspection in August 2014 when we found the service to be meeting all the regulations we reviewed.

Faversham House is a nursing home registered to provide accommodation, nursing and personal care for up to twenty people. On the day of our inspection the home was fully occupied.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). 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 registered manager was responsible for all the services delivered by the provider.

People who used the service told us they felt safe with staff who supported them. They told us staff were available to support them in the activities they wished to do. People were encouraged to make their own decisions and told us staff always promoted their independence. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Recruitment processes were robust and should help protect people who used the service from the risk of staff who were unsuitable to work with vulnerable adults.

Staff had received training in the safe administration of medicines. The competence of staff to administer medicines safely was regularly assessed.

Systems were in place to help ensure the safety and cleanliness of the environment.

Staff told us they received the training and support they needed to carry out their role effectively. There were systems in place to track the training staff had completed and to plan the training required. All the staff we spoke with told us they enjoyed working in the service and felt valued by both the registered manager and the rest of the team. Staff felt able to raise any issues of concern in supervisions and in staff meetings.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and support.

People who used the service had support plans in place. Records were stored electronically and were easily accessible by staff. Records reviewed showed that, where necessary, people were provided with support from staff to attend health appointments. People were also supported by staff to maintain a healthy diet as far as possible.

Care records we looked at showed people who used the service had been involved in developing and reviewing their care and support plans. However some people’s care records were not up to date.

All the people we spoke with told us they felt able to raise any concerns with the registered manager and were confident they would be listened to. We noted systems were in place to encourage people who used the service to provide feedback on the care and support they received.

During our visit, we spoke with two of the twenty people who used the service. They shared some of their experiences at the home. We spoke with one member of care staff, a registered nurse, the chef, the nurse manager and two people who were visiting their relatives.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was clean. Processes for the prevention and control of infection were in place. For health, safety and security reasons, visitors were asked to sign in and out. There were enough staff on duty to meet the needs of the people living at the home at the time of our visit. A qualified member of staff was on duty on each shift.

The people we spoke with who used the service told us they felt safe. One person said “I’m quite safe and I am very well looked after.”

Discussion with staff and examination of records confirmed a programme of training was in place for all members of staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. Staff had all received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

Is the service effective?

People’s health, social and care needs were assessed with them and they were involved in writing and reviewing their care plans. Specialist needs had been identified in care plans, for example, ways to communicate. Care plans were reviewed every month and when people's needs changed. The manager carried out a full re-assessment of people’s needs every six months.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

One person told us “When I first came here I couldn’t stand up. They encouraged me to use the frame and I can walk now.” A relative of another person said “They spot changes early on and they act on it.”

An electronic system was in use throughout the service by all staff, on which everything was recorded and which flagged up when things were due or had not been carried out. This included for example, care records, training and supervision records, environment records and equipment records.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “I love living here” and “Nothing is too much trouble.”

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

In July 2014, the home had received the Dignity in Care award from the local authority. Dignity in Care is a national initiative designed to put dignity and respect at the heart of care services to enable a positive experience of care. Achieving the award is evidence the organisation is striving to provide the best possible health and social care services.

Is the service responsive?

The records we saw confirmed people’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence which showed the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, people who used the service had the opportunity to express their opinions through meetings and questionnaires. One person told us “M (the manager) is on top of everything.”

We looked at a sample of care plans which were stored electronically. We saw that they contained information about the person's medical history. Risk assessments had been completed in relation to moving and handling, falls, nutrition and medication.

We walked around the building and found all areas to be clean and tidy. We saw there was liquid soap and paper towels available in bathrooms and toilets. Hands free sanitising hand gel dispensers were seen affixed to walls around the building and throughout the course of our inspection we observed staff and visitors using them.

We spoke with five members of staff about what training and support they received. Comments included: "You can talk to X at anytime he will discuss any issues." "We have a team meeting every couple of months and supervision every eight weeks." "Training is good; we do lots of training."

We looked at the maintenance file and saw that equipment was regularly serviced. Checks of the fire systems including fire extinguishers were carried out and fire drills were well attended.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC (Care Quality Commission) inspector joined by an

Expert by Experience – a person who has experience of using this type of service and who

can provide that perspective.

We spoke with five people living at the home who told us: "Staff are lovely, we felt comfortable with the staff immediately." "They are very pleasant people." "Staff are familiar with my likes and dislikes." "I can go out as often as I like, to the local shops etc."

One person told us that he does get private time and his privacy and dignity is respected by staff.

We were told that this particular person had discussions with staff about his care and he was involved in making decisions about his care.

One member of staff said that privacy and dignity is very much respected and where possible residents are involved in the planning of their care.

‘I am looked very well’.

A visitor said that her relative was ‘on the whole looked after well’.

Another visitor said that the care was excellent.

One person said that he was looked after as well as could be expected. ‘Staff do what they can but its not always done straight away’.

A member of staff said ‘the care here is good, we all work well together and we give individual care to residents’.

Another member of staff said there is a very friendly atmosphere here all the staff know the residents very well.

One person said ‘the chef is excellent and we have a good varied menu’. Another person said’ the food can vary, sometimes it is the most delicious ever but sometimes it is just ok’.

One visitor said she thought her relative was well looked after and the feels confident with staff care.

Another visitor said she feels there is a really good environment at the home and the staff are kind, gentle and caring.

One person said ‘the staff are lovely, its home from home here’.