We inspected Nazareth House on the 18 and 19 October 2016. The first day of the inspection was unannounced. There were 60 people using the service at the time of the inspection. We last inspected Nazareth House on 11 April 2014 where we found all the regulations that we looked at had been complied with.

Nazareth House is registered to care for up to 62 people who require nursing or residential care. People of all religious faiths are welcomed. It is a purpose built home that is attached to the convent of the Sisters of Nazareth. The home is situated in large well-kept gardens within easy reach of public transport and the motorway network. There is plenty of car parking and the home is only a short distance from Prestwich Village. There is level access to the front of the home, a lift to both floors and wide corridors allowing wheelchair access.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.

We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred. Staff were able to demonstrate their understanding of the whistle blowing procedures (the reporting of unsafe and/or poor practice).

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

We saw people looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected. People’s care records contained enough information to guide staff on the care and support required. The records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. We saw that people were involved and consulted about the development of their care plans.

People told us they received the care they needed when they needed it. They told us they considered staff were kind, had a caring attitude and felt they had the right skills and knowledge to care for them safely and properly. We saw that staff treated people with dignity, respect and patience.

The activities provided were varied and people who used the service told us they enjoyed taking part. We saw that people's religious, cultural and dietary needs and beliefs were respected.

Procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. All areas of the home were secure, clean, well maintained and accessible for people with limited mobility; making it a safe environment for people to live and work in.

We saw that appropriate environmental risk assessments had been completed in order to promote the safety of people who used the service, members of staff and visitors. Systems were in place for carrying out regular health and safety checks and equipment was serviced and maintained regularly. Procedures were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and water supply.

The medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment.

Staff were also able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for peop

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service effective?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, speaking with a relative, speaking with management and from looking at records.

Is the service safe?

We saw that systems were in place to protect the rights of people who lacked the capacity to make decisions about their own treatment, care and support. Senior staff were able to fully demonstrate that they had a good understanding of capacity and consent. and knew the procedure to follow in the event of a Deprivation of Liberty Safeguard being required.

Systems were in place to ensure that management and staff learnt from any complaints made.

Is the service caring?

People we spoke with were complimentary about the care provided. We were told, “Lovely, all very nice” and “Very good, no problems here”. A relative we spoke with told us, “The care is marvellous. It is really excellent”.

All staff were trained in The Six Steps to Success programme which aims to enhance ‘end of life care’ for people.

Is the service effective?

People were assessed before they were admitted to the home to ensure their needs could be met.

People’s health was regularly assessed and monitored to ensure that their health and welfare was protected.

Specialist equipment was in place to aid comfort and help in the prevention and treatment of pressure ulcers.

Is the service responsive?

Information in the care records showed that the staff at the home involved other healthcare professionals in the care and support of people using the service.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

Is the service well led?

There were a number of quality assurance systems in place to ensure people were cared for safely.

The service worked in partnership with other organisations to support care provision and service development.

During our visit, we spoke to six people who used the service. They told us about their experiences at the home, although some were unable to speak with us in detail. They were mainly positive about the home and the staff; however, we did find some areas of non-compliance.

We also spoke with seven members of staff.

The atmosphere was relaxed and homely; we observed staff interacting with people who used the service and it was clear that there were good relationships between them.

There were large gardens with seating and parking. There was an accessible entrance and a lift. Accommodation was provided in three units over two floors and we saw that rooms were light, clean and personalised with people’s belongings. Each unit had a separate dining area and a lounge area, although we observed that most people stayed in their rooms. A room was available for families to stay if necessary.

There was a chapel and we were told that Mass took place every day.

We saw that a range of activities was provided and we heard how these were designed to stimulate, for example, to promote hand/eye co-ordination, sensory stimulation and mental stimulation. Staff told us that visitors were encouraged to engage in activities with their relative and we saw a list of suggestions, which included the benefits to be gained, displayed in the home.

A variety of information was displayed around the home, such as complaints, the home’s core values and named dignity champions.

During our inspection we looked at the care records for five people living at Nazareth House. In all cases people were assessed prior to moving to the home. Their care needs were usually reassessed every month and we saw evidence that their needs were being met.

We observed people being treated in a dignified way. People’s records showed that personal choices had been taken into account in the way their care was delivered.

The people we spoke with were very complimentary about the home, the staff and their care. Their comments included “I’m so lucky being here. All the staff are so genuine and caring”, “I couldn’t ask for more. This place is absolutely brilliant and the care I get couldn’t be better” and “All the staff are excellent. They do everything I need them to do”.

The home was spacious and well maintained, and regular checks were carried out to ensure it was safe.

Staff received regular training that was monitored by the Manager. They had an annual appraisal meeting with their manager and staff told us they felt well supported at work.