This inspection took place on 21 and 25 April 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Kingsway Nursing Home provides nursing and residential care for up to 42 older people with dementia, younger people with alcohol related brain damage and people with mental health needs. On the day of our inspection there were 41 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected the service in March 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, meeting the needs of those people with a dementia type illness. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff told us they were fully supported in their role. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

Without exception people, visitors, and health and social care professionals said staff were extremely caring. For example, the care was, “Exemplary” and “Person centred to the highest degree”. The service had a holistic approach to the care they provided and had carried out extensive research into the benefits of using animal assisted therapy and aromatherapy in a care setting.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. A member of the staff had won an award for dignity in care at the Great British Care Awards in 2016. People who used the service, visitors and staff had been involved in creating a dignity tree to describe what dignity meant to them.

People who used the service were placed at the heart of the service and were encouraged to be involved in the running of the home and were made to feel valued.

Staff were trained in providing end of life care and care plans were in place to ensure people’s end of life plans and wishes were recorded.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The registered provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

Staff felt supported by the managemen

We inspected this service on 19 February 2015 and it was unannounced.

Kingsway Nursing Home is registered to provide nursing and residential care to people with mental health needs. The home is can accommodate up to 42 people and is built over two floors. Kingsway Nursing Home is located in the village of Langley Park, close to local shops and a short distance from the city of Durham.

At the time of the inspection 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.

Care plans were written in a person centred way taking account of people’s preferences and associated risk assessments were carried out and written in a way that kept people who used the service safe and helped them maintain their independence.

Robust recruitment and selection processes were in place and appropriate pre-employment checks had been carried out to ensure people who worked in the service were not prohibited from working with vulnerable adults.

Policies were in place for prescribed medicines, when required medicines and homely remedies. Staff that dispensed medicines were properly trained and regular checks were carried out to ensure medicines were dispensed, stored and administered correctly.

Regular supervisions and appraisals were carried out and comprehensive records were kept to show what was discussed. Additional supervisions were carried out if required.

People who used the service were cared for and supported in a way that was person centred and individual to their needs. Care plans and risk assessments were regularly reviewed to ensure people’s care needs were appropriately managed.

Regular reviews were carried out to ensure people’s medicines were appropriate to their needs. Changes to people’s medicines and individual care needs were accurately recorded to ensure staff were aware of these.

There was a formal complaints procedure in place and people who used the service were given

information on how to raise a complaint if they wished.

Information about advocacy services was available to people who used the service. People who used the service were supported to access advocacy services.

The provider had a quality assurance system in place which was used to ensure people who used the service were cared for in a clean and safe environment.

Complaints were recorded and where appropriate investigations carried out.

Accidents and incidents were recorded and reported to CQC in line with regulations. The registered manager carried out regular reviews of accidents and incidents to establish if there were any trends.

During our inspection we asked the provider, staff and people who used the service specific questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were cared for by staff that had carried out appropriate training. People were aware of how concerns could be raised and were protected from potential harm because the provider had a robust recruitment process.

All the people who used the service had personal evacuation plans in place so that they could be assisted from the building in the case of an emergency.

Is the service caring?

People who used the service were treated as individuals and were encouraged to be as independent as possible.

Care plans and risk assessments for people who used the service were person centred and included enough information to ensure staff had the appropriate knowledge to care for them.

Is the service responsive?

We saw people who used the service had regular reviews of their care. We saw changes to people’s care were made as soon as the need was identified.

The provider had a business continuity plan in place to ensure people continued to be cared for in the event of an emergency.

People who lived at the home were helped to access dentists, opticians, and chiropodists to help ensure their wider health needs were being met.

Is the service well led?

We spoke with three members of staff who worked at the home. Staff told us they were happy working there and felt they were fully supported in their roles. One person told us, “It’s lovely here”, and, another told us, “I feel totally supported.”

Staff told us they were happy with the manager of the home and felt that they would be able to approach her if they had any concerns.

The home had a number of audits which were carried out regularly to ensure the quality of the service was good. Action plans created following audits showed the provider used the information gathered to think of ways to improve the service.

Is the service effective?

People who used the service were involved with the planning of their care and the level of assistance they wanted. If people did not want to be involved in planning their care the manager tried to get involvement from a relative or friend.

People’s care plans gave details about their likes and dislikes, preferences and religious beliefs.

We spoke with some of the people who used the service and the staff who worked there.

Everyone we spoke with said they were happy at the home. People who used the service told us they enjoyed living at the home and they liked the staff. One person told us “They (the staff) are lovely.”

Staff told us they enjoyed working in the home and felt they were valued by the service and the people who lived in the home.

The home had a relaxed and friendly feel to it. People who used the service were encouraged to chat to staff and were treated with dignity and respect.

People who used the service were encouraged to participate in their own care planning and where they were not able to do this they had a family member or advocate to speak on their behalf.

We saw regular meetings were held with both staff and people who used the service. Minutes were taken and action points recorded and acted upon.

Staff at the home were taken through a comprehensive induction process when they started working at the home and there was an ongoing programme of training to ensure staff were equipped to deal with situations that may occur in the home.

We spoke with several people who used the service. Everyone we spoke with was complimentary about the care provided.

We observed staff providing care and support to people throughout the inspection. There was a calm, friendly atmosphere around the home and people were seen to respond positively to the staff throughout. We saw people’s care and welfare needs were met. People using the service said “I’m walking much better than when I first came in here. My confidence and self-esteem has improved.”

The building was clean and well maintained. People we spoke with said “They spring clean your room. It’s always clean.” A visitor told us “It’s always warm and clean in here.”

People told us the staff treated them with dignity and respect. One person said about the staff “They respect my wishes but at the same time encourage me.” Another said “They afford me with privacy, dignity and respect.”

We saw people were fully involved in making decisions about their care. For example, some people had an advocate to speak out on their behalf and make sure any decisions made were in their best interests. One person said “They ask my permission to weigh me every week.”

We found the home operated a good recruitment procedure. This helped to make sure only the right staff were employed to work in the home.

We did not speak with people about this outcome due to the nature of the compliance action that was set at the previous inspection. Instead we spoke with the manager. We also looked at records relating to the care provided to people using the service.

We spoke with some of the people living in the home. Everyone spoke positively about the care being provided. One person told us they could compare this care home to another one they had lived in. They said “This is the best place I’ve come to. I didn’t like the atmosphere in the other home. I’m allowed to have a pet cat, which I never thought would happen.”

People told us they could choose how to spend their day. They told us “you can stay in your room and don’t have to join in the activities if you don’t want to. I didn’t like that about the other home, I was told what to do. I’m very happy here.”

They told us that the staff looked after their health care needs. They said that the staff would get the doctor out if they were unwell and that the chiropodist regularly visited the home.

People told us “I definitely feel safe here.” They said “They are approachable and ask me all of the time if I’m OK.”

People we spoke with said they felt there were enough staff on duty to meet their care needs.

Some people, because of their dementia care needs, could not tell us what they thought about living in the home. We spent time watching how staff interacted with them. We saw that staff talked with people in a respectful manner and had a good understanding of their communication and psychological needs. Staff always made sure they got down to the person’s eye level when communicating with them, and treated them with dignity and respect. We heard staff address people respectfully and speaking quietly about private matters.