The inspection took place on 23 February 2018 and was unannounced.

Hutton Village is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Hutton Village provides accommodation and nursing care for up to 40 older people including those living with dementia. Accommodation is located over two floors. There were a total of 37 people living at the service at the time of our inspection with two further people due to be admitted on the day we inspected.

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.

At the last inspection, the service was rated as Good overall but was rated as Requires Improvement in the domain of safe. Areas identified as needing improvement included infection control practices, medicine management and water safety. At this inspection we found the service had addressed the concerns we had raised and the rating has now improved to Good in all domains.

Medicines were managed safely however improvements were still required with regard to the recording practices regarding administration of creams and lotions. We made a recommendation that the service review its systems and processes for administering topical applications.

At the previous inspection people did not have their own slings which represented an infection control risk. This had been rectified, people now had their own equipment and good infection control practices were adhered to. Regular checks of the environment and equipment were undertaken to ensure the premises were clean and safe.

Robust systems and processes were now in place to ensure water safety and prevent the risk of legionella. The heating and plumbing systems had been upgraded and regular checks of water temperatures, flushing of water pipes and quarterly water testing was completed.

Staff were sometimes slow to respond to call bells. However, the service had recognised this failing and extra staff had been deployed and an action plan put in place to address this concern.

Individual risks to people had been assessed and were regularly reviewed. Management plans were in place to support staff to keep people safe. People told us they felt safe and relatives said that their family members were well looked after. People were protected from the risk of abuse as staff had received training in safeguarding and were aware of their responsibilities and knew how to report any concerns.

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 received training to equip them with the skills and knowledge required to support people effectively. Staff felt well supported by the management team.

People were supported to have enough to eat and drink however, the recording of people’s food and fluid intake required strengthening. We made a recommendation that the service review their system for monitoring food and fluid intake.

People were assisted to stay healthy and received timely support to access healthcare professionals when their health needs changed. The home environment met the needs of the people who lived there and the building was in a good state of decoration and repair.

Staff were kind and caring and treated people with dignity and respect. Staff knew people well and people felt listened to and included in decisions about their care and support. Independence was supported and encouraged. Visitors were made welcome at the serv

The inspection took place on the 24 and 27 July 2015 and was unannounced. Hutton Village Nursing Home provides care and accommodation for up to 39 older people. There were a total of 29 people living at the service at the time of our inspection.

The service has 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.

Environmental risk assessments were in place and while we found that there were arrangements in place to manage risks, there were gaps such as in the documentation. This meant that the home was not always able to evidence actions that they had taken.

Individual risks were identified and managed. There were a range of assessment tools in use and we saw that equipment was in place and people were referred promptly when their needs changed.

The Provider had robust systems in place to ensure that the staff they recruited were properly vetted. There were sufficient numbers of staff on duty to meet people’s needs People told us that they felt safe and staff were clear about what abuse was and their responsibility to report matters of concern.

Medicines were not always consistently managed. We found clear systems in place for the administration of solid and liquid medicines however the arrangements in place for the oversight of creams and lotions were less robust.

The home was clean and staff were clear about the infection control arrangements in place. However moving and handling slings were shared which could place people at risk of infection.

Staff had undertaken training relevant to their role and were being supervised.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice.

People enjoyed their food and received a varied choice of nutritional meals. Support was available for those who needed it. People health was monitored and they had access to health care support.

Staff had good relationships with the people living in the service. People’s care needs were assessed and the assessment included a social history and details of their care preferences. People were supported to maintain their interests and take part in a range of activities.

Complaints were taken seriously by the provider and there was documentation in place to show that concerns had been investigated and actions taken.

The home had recently been refurbished and people were positive about the changes and the management of the home. We saw that the manager was accessible and visible. Quality assurance and governance systems were in place and a range of audits were undertaken and used to drive improvement.

During our inspection, we spoke with four of the 35 people who used the service. We also spoke with one person's relative and six staff members. We looked at five people's care records. We also looked at staff training records, health and safety checks, staff and resident meeting minutes and records of the checks the provider’s representative completed to monitor the quality of the service provided.

We considered our inspection findings to answer 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?

When we arrived at the service the manager checked our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service. They also told us that they would feel able to speak up if they had concerns or worries and felt that they would be listened to.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

Quality checking systems were in place to manage risks and assure the health, welfare and safety of people who received care at the service and the staff who supported them. We saw records which showed that the health and safety in the service was regularly checked.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated. This meant that staff were provided with up to date information about how people's needs were to be met safely and effectively.

We spent time observing mealtimes and saw that staff provided sensitive assistance where people required support or encouragement to eat their meal. This meant that people’s nutritional intake was effectively supported.

Is the service caring?

People told us that they received the care they needed. One person said, “I am as happy as a sand-boy, the staff are so wonderful and really look after me. It's a nice atmosphere, I am glad to wake up in the morning here".

We observed that staff were kind to people they supported and interacted with people in a caring and professional way. Another person told us, “I am not exaggerating, it is wonderful. Staff are really lovely. They go out of their way for you, they are like family. Staff do their job well. It is not just about training although that comes into it, but they have more than that. You could not ask for better”.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. A visiting relative said, "The care here is marvellous and they want to help. They respect our preferences and let us do what we like. Staff even learnt some basic words in our language to help with communication".

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service well-led?

The provider had procedures in place to support the manager and to ensure that quality checking systems were in place. This was used to manage risks and to assure the health, welfare and safety of people who received care at the service.

A visiting relative said, "The home is very well managed. The manager and deputy work as a team and both really know what they are doing. The manager came and introduced themselves and they are always available and approachable. They make time for you."

We noted that the two previous registered managers had left the service and the deputy manager was acting manager until the newly appointed manager started.

We spoke with five people who used the service who were all very positive about the care and support that they received. Care records showed care was delivered in accordance with the care plans. One person told us, "It’s like home from home."

The service raised awareness of safeguarding people from abuse through training and posters. Staff we spoke with were clear on what they would do if they had concerns. People who used the service felt confident to speak with staff if they were worried about their welfare.

The medication administration records (MAR) folders included the service’s medicines policy. There was record of staff signatures and a list of people’s diagnoses and allergies so staff were aware of people’s needs at a glance. However, we found that there were some discrepancies with the quantities of medication.

There were some systems in place to reduce the risk and spread of infection. The service worked from a procedure folder which outlined cleaning schedules. However, we found that there were areas that required improvement.

The service had recently started an audit plan which stated which audits were to be completed and the frequency they were to be carried out. We spoke with people who used the service who felt confident that if they brought a complaint to the service that they would address it.

When we visited Hutton Village Nursing Home on 6 February 2013, we spoke with four people who used the service and one person's relatives. This was to help us understand the experiences of the people currently living at the home. We also spent some time observing staff interaction with people using the service. We noted that staff ensured that people were involved in decision making about all aspects of their care and support.

Hutton Village Nursing Home was homely and there was a relaxed atmosphere in the home. The staff were friendly and welcoming to visitors and polite in their approach to each other. People were supported to enjoy different activities within the home at a pace that was appropriate to them.

We observed that people's care records were comprehensive and contained relevant information to show how care should be delivered. It was clear that people using the service or their representatives were involved in the planning of care and decisions made.

We were told that staff were supported in their roles, both through the training offered and through the formal supervision process. Staff said that the manager was very approachable and we found this comment was echoed by people and their representatives that we spoke with.

People with whom we spoke said they felt their privacy, dignity and right to make choices was respected. One person said, "I am quite independent and allowed to retain this. I have never felt that my dignity was affronted here."

People said they were happy with the quality of the care they received at Hutton Village Nursing Home and that they enjoyed the opportunities provided for social activities there. One person said, “I get good care; I am quite comfortable and am happy to stay here.” Another person said, "It is actually very nice here, you can have whatever food you want. If you fancy a coffee or biscuits anytime they will get it for you. The care is good, the staff are gentle. There is a list of activities given to us; I do join in as they are good.”

People told us that they felt safe and that they would feel able to voice any concerns. One person said, "If I have any complaints the manager comes and listens and they try to do it for you. I do indeed feel safe here; I know I am quite safe."

People told us that there were enough staff to meet their needs and that they enjoyed their interactions with staff. One person said of the staff, "They are friendly and we joke and have a laugh and I like that." Another person told us, "The staff are friendly and they really do help me."