Neville Court is a purpose built nursing home for 20 people with complex physical, mental health and or behavioural needs. People are supported in two units, each for 10 people. At the time of the inspection there were 20 people using the service.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were safe as there were robust management procedures in place and these were used by staff who knew how to report any concerns promptly. Risks were managed based on personal preference and were focused on promoting positive risk taking as far as possible.

Staffing levels ensured people had choices and options throughout the day. Staff were competent and were skilled in managing people, ensuring their independence was promoted wherever possible.

People were able to eat and drink as they chose and were supported where necessary.

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.

The environment was comfortable and based on people’s own choices of décor and furnishings.

Staff demonstrated kindness and compassion in all interactions with people, and were able to use their skills well in managing more complex behavioural needs. People’s privacy and dignity was promoted.

People had access to the wider community as well as the local one, and staff worked as a team to ensure people could get involved in whatever they chose.

Care records were person-centred and covered all aspects of a person’s support needs, showing a holistic approach.

The home was managed by a competent and experienced manager who had a clear vision and focus which was embedded in the home. Staff felt well supported and we received much positive feedback about the home from relatives.

The registered manager was driven by the need to constantly reflect and ensure the best possible outcomes for people in the home and the quality assurance processes ensured this was evidenced.

Further information is in the detailed findings below.

We carried out this inspection on 22 June 2015 and it was an unannounced inspection. This meant the provider did not know we were going to carry out the inspection. The last full inspection at Neville Court was in June 2014 and we found the home to be fully compliant with the regulations inspected at that time.

Neville Court is a purpose built nursing home for up to 20 young people, cared for on two separate units, each for ten people with complex physical, mental health and or behavioural needs. On the day of our inspection, there were 20 people living at the home.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was present on the day of our inspection.

People and their relatives told us they felt the service was safe, effective, caring, responsive and well led. Comments included; “I’m really safe [at the home] and I’m not worried in the slightest”, “[The service] asks what I want to do and see to it that I can”, “[Staff] are lovely, nothing is too much trouble. I feel like they’re my family” and “I always say if there’s something I want different. There’s no point in keeping it to yourself. When I make any suggestions, [staff and the registered manager] take it on board.”

People were protected from abuse and the service followed adequate and effective safeguarding procedures. Care records were personalised and contained relevant information for staff to provide person-centred care and support.

Staff were well supported, received regular supervisions and were given regular training updates. There were additional non-statutory training course available that staff could sign up for if they wished. There were details of training courses and sign-up sheets in the staff room.

We found good practice in relation to decision making processes at the service, in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

There were good, regular quality-monitoring systems carried out at the service. We saw that, where issues had been identified, the manager and regional manager had taken (or were taking) steps to address and resolve them. Some audits and checks had not been signed off when completed. The registered manager said they would ensure all audits and checks were clearly signed and dated in future.

At the time of this inspection, twenty people were living at Neville Court. As part of this inspection we attended the Care Homes Open Day on 20 June 2014 where we spoke with family members, people who lived at the home and staff. On the day of the actual inspection we observed the care people received, spoke with people who used the service, the registered manager and members of staff, as well as reviewing relevant documentation. This meant in total we spoke with three family members and seven staff.

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, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

People were safe because staff provided appropriate care that met their needs and supported their rights. We observed care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Assessments of needs had been carried out, in order that an appropriate plan of care could be formulated. Risk assessments were in place for people who used the service in relation to their support and care provision; so that action could be taken to minimise any risks, at the same time, taking the least restrictive option to safeguard people.

We found systems and processes were in place to safeguard people from harm. This was because staff had received training and the knowledge to identify signs of abuse and take appropriate action to safeguard people.

The registered manager was familiar with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This was demonstrated by the action she had taken as a consequence of the landmark Supreme Court Ruling that stated people are deprived of their liberty if they lack the capacity to make decisions about their care and residence, are subject to continuous supervision and control under the responsibility of the state and lack the option to leave their care setting. This demonstrates the registered manager keeps herself up to date on decisions that impact on care services and that safeguards in line with current legislation are being implemented appropriately in order to protect people’s safety and welfare.

Systems were in place to make sure the manager and staff analysed and learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. We found that appropriate action had been taken by the manager and staff to minimise the risk of similar events and continually improve.

Is the service effective?

Staff involved people who used the service, their family members and other relevant professionals when assessing and planning care. This was to ensure people received effective and suitable care and their wellbeing was promoted.

Staff were properly trained and supervised which ensured people were looked after and cared for to an appropriate standard.

Is the service caring?

Our observation of interactions between staff and people who used the service and discussions with their family members confirmed that staff treated people with respect and people’s privacy and dignity was always maintained.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We looked at the following comments from the service’s annual survey review carried out in 2013 included, “… I have nothing but very high regard for management and staff”, “…[family member] …, always seems happy and content when I call to see her. All the staff are pleasant and helpful and the atmosphere within the home is a good one. During my visits it is always good to see the quick response of staff to the requirements of the service users”, “always very professional and caring. Always aim for best possible solutions to problems. I would have no hesitation in recommending Neville Court to other colleagues or professionals” and “over the past years I have had the need to visit Neville Court on numerous occasions. On each visit I have been made very welcome by friendly staff. Due to the complex needs of patients at Neville Court I have been required to assist with meetings to discuss best interest decisions. The manager is always very helpful and knowledgeable about all aspects of care needs of the people living at Neville”.

We saw staff interacting with people who used the service and demonstrating positive relationships they had with people. Staff treated people in a respectful way when providing their day to day care and responded in a calm and appropriate manner even when people showed behaviours which may challenging. Our observations of staff demonstrated they had a clear understanding of people’s needs, individual likes and preferences and showed commitment for people’s wellbeing.

Is the service responsive?

Staff responded promptly to any changes in people’s needs and generally care plans were updated accordingly. Services were organised so that staff were able to meet people’s needs. People accessed a variety of social activities to meet their individual aspirations and interests. People were supported to maintain relationships with family members and friends to maintain social inclusion.

We were informed by family members and staff that the manager was responsive in listening to their concerns and complaints.

Is the service well-led?

A registered manager was in post. Discussions with the manager and our findings during the inspection confirmed she was fully conversant with her responsibility with regard to the management of the regulated activity. She was focused on the delivery of person-centred care.

The manager encouraged an open and transparent culture, promoting communication between people, staff and other stakeholders.

The service had quality checking systems in place to manage risks and assure themselves of the health, safety and welfare of people who used the service and staff.

Family members confirmed they completed surveys about the service, where their opinions of the quality of the service were asked.

Staff we spoke with also told us they felt supported by the management of the service.

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

On this inspection we spent our time on the Bretton Unit at the service.

We observed that the care that people received was safe and appropriate and met their needs. For example, we saw people engaging in activities, being moved, receiving their medication and supported with their meals in accordance with their individual plans of care. Suitable equipment was available to meet people’s needs that was properly maintained.

Food and drink met people’s individual dietary needs. For example, one person said, “Meals are ok. I have a good breakfast, so don’t always want dinner, but I’ll have a good tea.” Another person was choosing to have their cooked breakfast at tea time, because they preferred that than the choices on offer.

People were given their medicines when they needed them, safely.

The design and layout of the home was suitable for the people that lived there. The environment was clean and people were protected from the risk of infection.

Sufficient numbers of staff were on duty to keep people safe and meet their health and welfare needs. Staff said, “It’s the best staffed home I’ve worked in, but there are a lot of residents on 1:1 and who need observation. It’s a very good home in my opinion” and “it’s one of the most staffed places I’ve ever worked.”

Staff and other records associated with the management of the service were kept and records detailing people’s health and social care needs were in place and stored securely.

We spoke with four people who lived in the home. Three of these people told us that staff always knocked on their bedroom door before entering. People who lived in the home and their relatives said staff were polite.

People told us there were meetings held for the people who lived in the home. They said they could choose whether to attend these meetings with one person saying, “I can please myself”. People also had choices about what time to retire on an evening and what food to choose. One person said “I have salads as I like them”. They also said that there were activities to take part in, but they would choose what they wanted to do. This included relaxing on their own if they wised to.

Two people told us that they were involved in their care planning meetings with other professionals. They said they were happy in the home and that they liked their rooms and the staff.

People told us that the home ensured that they saw other medical professionals when they needed to, for example, the dentist or GP. They also said that the food in the home was nice.

People’s relatives told us that they were happy with the overall care provided in the home. They also said that the staff “Make time to take X out”.

All of the people who we spoke with and their relatives told us that they felt people were safe in the home. Relatives told us that they were kept up to date. Everyone said they felt able to raise any concerns and these would be dealt with.

When we spoke to people about their experiences of living at the care home their comments included:

“They’re good to you. They look after me, making meals. They’re lovely”.

“Staff do a good job helping me with bathing, showering and washing”.

People spoke about the activities they took part in. These included listening to music and playing draughts.

When we spoke to people it told us they had meetings, so they could make their points about the service. One person said it was to be able to make grumbles, but there wasn’t a lot to grumble about. They said the meetings were good because you were able to say any ideas.

Everyone we spoke with had no complaints about the care provided and they felt safe and secure living at the home.

In our conversations with people it told us people using the service felt staff were very caring, considerate and they were all good to them. They said they were friendly and helpful.