The inspection took place on 25 and 27 October 2016. The first day of our inspection was unannounced and we told the provider we would be returning on 27 October to complete our inspection. The service was last inspected on 7 January 2014 and at the time was found to be meeting all the regulations we looked at.

Hendford Nursing Home provides accommodation for up to 34 older people who require nursing or personal care, and those living with the experience of dementia. At the time of our inspection, 24 people were living at the service. This was because the whole of the first floor was being refurbished and new admissions were being restricted until the completion of the work. A new extension had been completed at the time of our inspection and we saw that this provided a comfortable living space for people.

There was a registered manager in post 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.

The provider had systems in place for the management of people’s medicines and staff had received training in the administration of medicines. However, in some cases, the amount of boxed medicines did not correspond with the medicines administration record (MAR) charts.

The risks to people’s safety were identified and managed appropriately and people were cared for safely.

There were regular health and safety audits which indicated that all areas of the home were checked for safety and any areas requiring maintenance were identified.

There were enough staff on duty to keep people safe and meet their needs in a timely manner, and the provider had contingency plans in place in the event of staff absence.

There were appropriate procedures in place for the safeguarding of vulnerable people and these were being followed.

People’s nutritional and healthcare needs had been assessed and were met.

People who used the service were cared for by staff who were suitably trained, supervised and appraised. The registered manager sought guidance and support from other healthcare professionals and attended workshops and conferences in order to cascade important information to staff, thus ensuring that the staff team were well informed and trained to deliver effective support to people.

The provider acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People’s capacity was assessed and they, or their representatives, had consented to their care and support. Processes were being followed to ensure people were deprived of their liberty lawfully.

Staff were caring, treated people with dignity and respect and took into account their human rights and diverse needs. People and relatives told us that people were safe and happy at the service.

Assessments were carried out before support began to ensure the service could provide appropriate care. Care plans were developed from the assessments and reviewed regularly. These were clear and comprehensive and written in a way to address each person’s individual needs, including what was important to them and how they wanted their care to be provided.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

A range of activities was provided which included regular outings. These were varied and took into account people’s likes and dislikes, their backgrounds and any particular interest they had.

People, relatives and professionals we spoke with thought the home was well-led. The staff told us they felt supported by the registered manager and there was

We visited Hendford Nursing Home to look at the care and welfare of people who used the service. This was a follow up visit to see if the service had made improvements after our visit in September 2013.

It was not necessary on this occasion to speak with people who used the service. We spoke with the person in charge who showed us the changes that had been made to ensure they now met the regulation related to infection control.

Prior to the inspection we had received an action plan from the registered manager. This confirmed the steps that had been taken by the home to meet our compliance action.

We found improvements had been made to the service which ensured that people’s risk of infection was minimised.

During our inspection we spoke with two people who used the service, two relatives and five members of staff. We also observed care being given throughout the inspection.

We found that people and relatives (where appropriate) were asked their consent before any care or treatment was offered. We found that the service had copies of forms on people’s care plans that identified where they or their representatives had signed to provide their consent.

People and relatives we spoke with felt the staff were caring. One person told us “They (staff) all work very hard” whilst a relative told us “They (staff) are very kind.” We found that the care that was provided to people was in line with their individual needs.

Although the service was mostly clean and tidy there were areas around the home where there were concerns around infection controls. The service had monitoring systems that identified what areas had been cleaned however these had not been completed for at least three weeks.

We found that the design and layout of the premises was fit for purpose and met the needs of people who received care. For example each person’s room was appropriate for their needs.

We found that the service had an effective complaints procedure. All of the people and relatives that we spoke with told us that they would speak to the manager if they had any concerns. They told us that the concerns were always addressed.

On this inspection we saw that all staff had received up to date mandatory training and that improvements had been made to the staff recruitment processes.

We spoke to three members of staff who were able to tell us about recent training they had undertaken.

This was a follow up visit to check whether the provider had completed the action plan submitted to CQC following their last inspection in February 2012. The action plan related to care and welfare, meeting nutritional needs, management of medicines and training matters.

We were unable to speak to most people who used the service as they had complex needs which meant they were unable to tell us their experiences. We spoke to one person, one health care professional and three relatives of people who lived at the service who all told us that they felt that people who used the service were well looked after and cared for by staff. We also carried out observations throughout our visit and saw that staff treated people kindly and with dignity.

We found that care plans were up to date and there were risk assessments for each person who used the service. We saw that assessments for people who were at risk of pressure sores.

We noted that people were being supported to eat in an appropriate manner and were being offered suitable eating aids where needed.

We looked at staff files and saw that there was information missing in relation to their previous employment and in one case there was information missing to confirm that the member of staff had a right to work in the United Kingdom.

The manager showed us a copy of the staff training matrix which identified that not all of the staff had received up to date mandatory training.

Although many of the people who use the service are not able to give their views directly, we spoke to four people who use the service and three visitors.

Most of the people we spoke to gave positive feedback although one person told us they were frightened of another person who uses the service as they have made threatening comments to them.

Two people using the service told us the staff were kind, caring and helpful. The visitors told us they felt their relatives were well cared for and they knew who to speak to if they were worried or dissatisfied about anything.

We were only able to obtain the direct views of two people who use the service, as other people had more complex needs or communication difficulties.

These two people told us they felt safe in the home and felt their needs were met. We were told people can choose when to get up or when to go to bed and the meals provided are enjoyed. No concerns were expressed about staffing levels and people said they understood they might have to wait a short time for assistance if staff were busy helping other people.

We spoke to four representatives of people who use the service who could not tell us directly of their views. The representatives made very positive comments about the care and support provided.