This inspection took place on 24 November 2016 and was unannounced.

The provider of Foresters Nursing Home is registered to provide accommodation, nursing and personal care for up to 30 people. At the time of our inspection there were 24 people who lived at the home. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to the first floor. People have use of communal areas including lounges, and dining rooms.

There was a registered manager in post, who was on duty at the time of our inspection. 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.

People and their relatives told us they felt safe and staff treated them well. Staff were seen to be kind and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence.

Staff had been trained and knew how to identify and report signs of abuse to protect and keep people safe. The provider had arrangements in place to recruit, review and manage staffing levels to meet people’s needs.

Staff had received training and supervision, which supported them to deliver care and support to people in a safe way. People’s medicines were available to them and staff knew how to provide the support people needed to meet their health needs.

People were asked for their permission before staff provided care and support so people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests.

Staff monitored people’s health and shared information effectively to make sure people received advice from doctors and health professionals to help people stay healthy.

People were happy with the care and support they received. People were offered a variety of opportunities to do fun and interesting past times if they wished to.

Staff understood what was expected of them and were supported through training and discussions with their managers. There was open communication between the provider, registered manager, relatives and staff. Relatives and staff were comfortable to make suggestions for improving people's individual care and were listened to. Regular checks were undertaken on the quality of the care by the provider and registered manager and actions were taken to develop the home further.

The inspection took place on the 12 February 2016 and was unannounced.

Foresters Nursing Home is located in Clent. The home is registered to provide-personal care and accommodation for up to 30 older people. On the day of our inspection there were 23 people living at the home.

Since our last inspection the registered manager had left and a new manager appointed. There was a manager in post who was in the process of applying to CQC to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Although people had care plans in place, we saw some of the information was did not reflect people’s current support requirements. People and their relatives had not had input into their care plans. Therefore staff could not be sure whether they were caring and supported people in the way they preferred.

People were supported to receive their medicines in a timely manner and medicines were stored securely and at the correct temperature.

People were supported to have drinks and snacks throughout the day, People enjoyed the food they received and were positive about the choice the given to them.

People told us they didn’t have enough activities to do. There was little evidence to support people maintain interests and activities of their choice. People who were confined to their rooms were at risk of social isolation.

People’s care files and personal information were not always kept confidential and secure.

People were protected from harm, the manager and care staff knew how to recognise abuse and what action to take if they suspected it. Risks assessments and risk management plans were in place to but not all staff knew where to find the information.

People were provided with care that protected their freedom and promoted their rights. Staff asked people for their permission before care was provided and gave people choices about their support. Where people had not got mental capacity the provider had engaged relatives and best interest meetings to represent people’s wishes.

People knew how to make a complaint or raise a concern and felt happy to discuss it with the manager.

The provider was in the process of a lot of changes due to the change in manager and the systems in place to monitor and improve the quality of the service were not yet embedded. The manager and provider had identified many improvements that were needed and had plans in place to improve the quality of the service.

The manager promoted a transparent and open culture. They recognised the areas for improvement required at the home and had a home development action plan in place to address the issues.

We spent time at the home watching to see how staff supported people, and talking with people about life at Foresters Nursing Home. We spoke with four people who lived at the home and four relatives. We also looked at records, and spoke with three staff which included the cook, the manager and the operations director.

Throughout our inspection we observed staff were kind and caring to people who lived at the home. One person who lived at the home told us: “I like it here” and: “They (staff) are nice.” One relative said that they were happy with the service being provided and: “Staff are doing a good job.”

We saw that people's needs had been assessed by a range of health and social care professionals. The manager had put measures in place to ensure staff checked and monitored people’s required drink and food amounts, and that they always recorded these. This meant people’s health and care needs were being monitored and met.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people who lived at the home. Staff recruitment procedures also protected people from being cared for by unsuitable staff.

The manager told us about the improvements that were planned for the home environment to ensure that it continued to be a safe and suitable place for people to live.

We found that people who lived at the home and family members were comfortable in raising any complaints that they had.

During this inspection we spoke with four people who used the service and six staff. We also looked at how staff cared for the people who used the service. We saw that people were being given choices around what they wanted to do. We observed that people were receiving care that was meeting their heath and welfare needs. One person we spoke with said, "They really look after me". We saw that people were receiving their medicines on time and in a safe way.

People were given choice and had access to a varied diet. The people who needed extra support with their eating and drinking got the help they needed to ensure they continued to have adequate food and drink.

The people who used the service who we spoke with all gave us positive feedback about living there. One person said that the staff did, "A good job here”. Another said that, “We are all happy here".

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "Plenty of training". Another said they felt it was, "A really supportive environment to work".

There were regular audits of areas of care, and regular feedback was obtained from the people using the service and their relatives.

We visited this service in March 2011 and three compliance actions were issued. This meant the provider needed to improve outcomes for people with regards to developing care plans, meeting the nutritional needs of people and managing medication. We carried out this visit to ensure the provider had complied with the actions required and made the improvements we asked them to make.

During our visit we spoke with the manager, the deputy and three care staff. We also met with the quality advisor for the service and spoke with a visiting relative. We spoke with three people who live at Foresters Nursing Home. Some people who use the service were not able to express their views to us, so we observed interaction between people and staff to see how they experienced care.

We saw staff supporting people with their midday meal, staff were polite and encouraging, and offered people more food or a different meal where they were not keen. We saw that staff supported people to have regular drinks throughout the day which were promptly made from an area in the dining room which meant people did not have to wait for a drink.

A visitor told us they were very happy with the care given to their relative whose eating and mobility had improved. We saw that some people enjoyed visiting the office area and that staff used this opportunity well to welcome and talk with them.

We saw that some people needed support with their appearance and personal care and that this had been attended to.

The manager told us that care plans were being improved so that each person had a plan which contained more personal information. This would include their routines and life history so that staff could provide care in the way people wanted.

When we visited the service we met some people who lived there and also spoke to relatives. People told us the staff are kind, for example one man told us that since he arrived the staff had helped him a lot and as a result he was feeling much better and was able to get about more. Before we visited the home we considered information from some relatives and from health and social care professionals about situations where people’s care had not gone so well. Examples of concerns included care of pressure areas, falls, attention to personal appearance and help with continence care.

When we visited the home we found that there was a caring approach to people who live there and met people who were being cared for well. We found that information about the care people need was not always up to date or correctly written down for staff to refer to. This could cause confusion and put people at risk due to staff not being clear about the correct care to give. After our visit we spoke to two health care professionals who visit the home; they both had a positive view of the care given to people who live at Foresters.

In recent months we have had some information suggesting that some relatives have been concerned about whether their family member always had enough to eat and drink. During this visit we saw people with drinks and checked with staff who told us what help people needed. A relative told us that there is always a drink for the relative in their room. A health professional told us they had not had cause for concern about this area of care. We saw that some important information about people who need a lot of help to eat and drink was not always filled in regularly or with enough detail. This puts people at risk because staff cannot keep a proper check on this aspect of their health.

We saw a member of staff speaking discreetly to a person about whether they needed to have some pain relief. The member of staff then helped them to take the medicine and made sure they had enough water to take it with. Ineffective stock control and ordering systems at the home had lead to the home being over stocked with medication. Records of what was being ordered and of the medication being given to people were not well enough organised to provide a reliable audit trail. This could leave people at risk of not being given their prescribed medication.