Nayland House is owned by Larchwood Care Homes (South) Limited. It provides accommodation and personal care and support for up to 54 people, at the time of our inspection there were 49 people living in the service. The service is supporting a range of people's needs, including older people and people living with dementia. Nursing care is not provided at Nayland House. 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 our last inspection, in November 2016 we rated the service Requires improvement in all key questions apart from Caring, which we rated as Good. Which meant the overall rating for this service was requires improvement. At this comprehensive inspection, which we carried out on 27 September 2018 we found evidence that the service had made the necessary improvements for us to rate the service as Good in all key questions.

During that last inspection we found evidence that improvements were needed to ensure staff were consistently monitoring for any potential risks during care delivery that could impact on people's welfare. Also, although staff received training they did not always put it into practice. We found shortfalls in staff's knowledge of supporting people living with dementia.

We also believed that improvements were needed to ensure all people had access to stimulating occupation or activities, which met their individual needs. During our previous inspection we found that systems were in place for assessing and monitoring the quality of the service that people received. However, implemented changes and improvements were not always being effectively embedded in practice to drive continuous improvements.

During this inspection people living in this service told us that they felt safe and very well cared for. There were systems in place which provided guidance for care staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. Risk assessments were in place to identify how the risks to people were minimised. There were sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support.

Both the registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. Meaning that people living in the home were still being supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s needs were assessed and the service continued to support people to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to have access to healthcare services.

We saw many examples of caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff continued to protect people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed. People were supported at the end of their lives to have a comfortable, dignified and pain free death.

The registered manager told us that they were well supported by the organisation. The peop

This unannounced inspection took place over two days, 25 and 28 November 2016. At the time of the inspection there were 43 people living in the service. Nayland House was previously inspected in January 2015 and was rated requires improvement with breaches of regulations in The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection the provider sent us an action plan to tell us what improvements they were going to make. During this inspection we found action had been taken. However, we also identified areas that further work was needed to increase the service’s overall rating and ensure that people are provided with good quality care at all times.

Nayland House is owned by Larchwood Care Homes (South) Limited. It provides accommodation and personal care and support for up to 54 people. The service is supporting a range of people’s needs, including older people and people living with dementia. Nursing care is not provided at Nayland House. 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.

People and their relatives felt that the service was providing safe care. Risks to people were being assessed and appropriate measures taken to minimise risk, without unnecessarily restricting people's independence. However we found improvements were needed to ensure any potential risk to people were being identified and continuously acted on.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

There were sufficient numbers of staff to provide safe care, and the service were proactively recruiting to vacant posts. People were cared for by staff who were safely recruited, inducted, supported, supervised, and appraised. Staff received training in core skills to support them providing a safe service. However some health and safety training needed to be embedded in practice. This will ensure staff are continuously monitoring for any shortfalls as part of their practice and take action to address them.

The service provides specialist dementia care. We found improvements were needed in staff’s understanding of dementia care to enable them to support people in providing effective person centred care. This included staff’s knowledge of supporting people to have access to meaningful stimulus, tailored to their level of dementia. The registered manager had made arrangements for further training. The skills and knowledge gained will need to be monitored and embedded in practice to support continuous improvement. We have made a recommendation to enhance people’s wellbeing through meaningful occupation and use of sensory items to further support this.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff. Staff had good relationships with people who used the service and their relatives. Staff spoke about people with compassion, interactions with people were caring, respectful and supported people's dignity.

People told us that the food was good, they were offered choice and that they were supported to have enough to eat and drink. Dietary needs and nutrition were being managed and advice sought from appropriate health professionals as needed. Health care needs were met through being supported to access external health care professionals.

People’s, relative’s and staff’s views were sought about the service, and their feedback used to monitor the quality of the service, and be influential in driving improvements. They told us the registered manager, and provider’s representativ

This inspection took place on 13 January 2015 and was unannounced.

Nayland House is a residential care home which provides accommodation and personal care and support for older people, many of whom had been diagnosed with dementia. This service is registered for up to 54 people. On the day of our inspection there were 49 people living at the service.

There was a registered manager in place. 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 and associated Regulations about how the service is run.

People’s safety had been compromised in the management of their medicines. We could not be assured that people received their medicines as prescribed. Internal audits had failed to identify errors in medicines records, which meant that people were at risk of not receiving their medicines as prescribed.

Staff received the support and training they needed when starting their employment in order to carry out their duties. However, staff had not received training in the Mental Capacity Act 2005 and related Deprivation of Liberty Safeguards. This meant that staff lacked understanding with regards to their roles and responsibilities in supporting people’s best interests when they lacked the capacity to make decisions about their everyday lives. The management told us that training was planned for the near future.

Staff had the required knowledge to recognise abuse and understood their roles and responsibilities in reporting any safeguarding concerns to the relevant authorities.

We were not assured that the provider’s system for the recruitment and selection of staff was robust in protecting people from risk as gaps in employment had not been identified and discussed with staff. References had not been validated to ensure they had been provided by the most recent employer as is required.

Staffing levels had been assessed according to the dependency levels of people who used the service. Staff and the manager told us that staff absences were managed well from within the staff team.

The dining experience for people who used the service was positive and where people required assistance by staff to eat and drink, this was provided with warmth and understanding.

People had access to a range of health care professionals which included general practitioners, dieticians and community nurses in response to health concerns that had been identified.

Staff received regular supervision and access to annual appraisals which provided opportunities for discussion and planning of staff training and development needs.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

To enable us to assess people’s wellbeing we talked with five people who used the service and two people’s relatives. We also spent time sitting with people, observing the care they received and the level of staff interaction.

There were sufficient staff on duty to meet people’s needs. We saw that staff were attentive to people’s needs, that they respected people’s privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

People told us they were comfortable and liked living at the service. One person told us, “I decided I would be better off if I moved in here and I haven’t been disappointed.” Another person told us, “There is always someone around if I need help” People told us that staff always asked their consent before they supported them, one person told us, “The staff are helpful and sit and chat to me.”

The people’s relatives were complimentary about the service and found that the staff were caring and supportive. They told us that, “I have no worries about leaving after a visit.”

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from Infection and that staff had received training in infection control and food hygiene. We saw that the provider had an effective system in place to enable people to make complaints and for them to be managed properly.

We spoke with seven people who lived in the service. People told us they enjoyed living at Nayland House and they liked their room. One person said the staff were "Kind and very good to me". They said they were helped to go out when they wished. We were told they sometimes had the opportunity to visit a local garden centre or local country areas in a minibus. People said they felt safe and that staff were kind to them. One person told us they had resident’s meetings and they could “Tell the manager or staff if there were any problems”.