About the service:

Hoar Cross Nursing Home is a residential and nursing home that was providing accommodation, nursing and personal care for up to 51 people. There were 40 people using the service at the time of the inspection. People had support needs such as a physical disability, those living with dementia or older people.

People’s experience of using this service:

Leadership was visible and included staff in developing the service to ensure it was person-centred. People and relatives all felt the staff team and management were approachable. Consideration had been given to supporting people with their protected characteristics. Quality assurance systems were embedded and effective at analysing information and identifying areas to improve care for people and ensure it was personalised. The service was innovative at helping people to remain independent and used technology to support this.

People were supported by a sufficient amount of safely-recruited staff. Risks were assessed and planned for and people were kept safe by staff who knew their needs and who understood their safeguarding responsibilities. Medicines were managed and administered safely. People were protected from the risk of cross infection and lessons were learned when things had gone wrong.

Staff received training and support to be effective in supporting people, with additional training available in specialist areas for those who chose to. People had access to a range of other health professionals to keep them healthy and plans were in place for people’s health needs. People enjoyed the food and had a range of choices. 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.

Staff were kind and caring and people felt they were treated with dignity and respect. Staff knew people well and had good relationships with people. People were supported to be independent and relatives could visit whenever they wished.

People had personalised care which catered for their preferences. A range of activities and events were available for people to partake in. There was a complaints procedure in place and any complaints received were investigated and responded to. People were supported to have a dignified end of life and the service worked with other health professionals to support people.

The registered manager and management team were well thought of by people, relatives and staff. The previous rating was being displayed and notifications were submitted as required.

Recommendations:

• We have recommended review of previous version of mental capacity assessments.

• We have recommended the consideration of developing personalised end of life plans for people.

Rating at last inspection:

At the last inspection the service was rated Good overall (report published 21 October 2016).

Why we inspected:

This was a routine inspection planned on the last inspection rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to

visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection visit took place on 8 September 2016 and was unannounced. Hoar Cross Hall Nursing Home provides personal and nursing care for up to 51 people. There were 42 people living in the home on the day of our inspection visit.

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.

People were being supported to make decisions about their care and support; although capacity assessments had not always been completed to ensure people could not make some decisions themselves. Where people had restrictions placed upon them, these had been identified and applications had been made to ensure these restrictions were lawful.

People received their medicines at the right time and systems were in place to ensure medicines were managed safely. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed.

There was suitable staffing to meet the support needs of people and the trained staff understood their role and how to support people safely. The staff received support from their manager to enable them to identify personal development opportunities and to raise any concerns they had.

People were encouraged and supported to eat and drink and there was a varied daily choice of meals. People’s special dietary requirements were met and where concerns were identified, people’s weight was monitored. Health care was accessible for people and appointments were made for regular check-ups as needed.

People chose how to spend their day and they took part in activities in the home and the community. The activities were varied and organised to meet the interests of people who used the service. People felt well looked after and supported and had developed good relationships with staff.

People also said they felt listened to and any concerns or issues they raised were addressed. Quality assurance reviews were completed to measure and monitor the standard of the service and drive improvement.

This inspection was unannounced which meant the provider and the staff did not know we were coming. At our last inspection on 22 October 2013 we made one compliance action regarding medication management. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in this area.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate medicine administration practices were well managed.

This inspection was unannounced which meant the provider and the staff did not know we were coming. Forty one people were in residence when we undertook our inspection. We spoke with eight people living in the home, two visitors, seven staff and the registered manager. Everyone spoke well of the home, one person using the service said, “The staff are respectful; when I want anything they help me straight away." Another person told us, “We are very lucky to be here and I know they understand me.”

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We checked to ensure medication was stored and administered in a safe way. We found medication management needed improvement.

People told us that care and support was provided by skilled staff who knew their needs well. We found the service was well led because we saw the provider managed risk to the service effectively.

We carried out this visit to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming. We carried out this visit as part of our schedule of planned inspections.

Forty two people were in residence when we visited. We spoke with nine people living in the home, a visitor, five staff and a visiting healthcare professional.

People's privacy and dignity were respected. We saw staff knocking on people's doors and waiting for an answer before entering. People told us they could spend time in any area of the home or alone in their bedroom when they wanted to. People using the service were able to give good accounts of how privacy and dignity were upheld, one person told us, “The staff are always very considerate, they cover you with a towel, make you feel at ease and are always thoughtful and respectful.”

We were able to see that people received care and support that met their individual needs. People using the service had care records which had been written in a style that people understood, and people confirmed they had decided how they wanted to be supported. The care records included pictures and photographs to support understanding.

Staff ensured people were able to continue to go out and do the things they enjoyed. People told us, “We choose where we want to go and how to spend our time.” We saw that people using the service were encouraged to be independent and they told us they were able to be involved in running the home. One person said, “I like to clean and tidy my own bedroom and the staff here encourage me all they can.”

People told us they felt safe living at the home and would talk to staff, family or an advocate if they had any concerns. We saw that the people living there and their relatives were asked for their views about the home. One visitor told us. “It is fabulous here, second to none; it offers excellent care and gives me peace of mind.”

We look at the homes infection control procedures and found the home to be clean, hygienic and well maintained.

We looked at the recruitment procedures for staff and found that suitable systems were in place to protect people using the service.

We looked at ways in which the home assessed its own quality and safety and saw good, clear and well recorded systems were in place.