We inspected this service on 4 October 2016. The inspection was unannounced.

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. The registered manager was also the provider of the service and was supported by a deputy manager.

The service provides accommodation with nursing and personal care for up to 24 older people, some of whom are living with dementia. Twenty-four people were living at the home on the day of our inspection, although one person was in hospital.

People felt safe living at New Milton Nursing Home and with the staff who looked after them. Staff understood their responsibilities to challenge poor practice and to raise any concerns about people’s health and wellbeing with the managers. The suitability of staff to deliver personal care was checked during the recruitment process.

There were enough suitably qualified and experienced nurses and care staff to meet the needs of people living in the home. Staff worked well together to make sure people received the care and support they needed and the atmosphere was calm and relaxed.

The provider used a range of assessment tools to identify possible risks associated with people’s health and well-being and included clear guidance for staff on how to mitigate the identified risks. The provider had procedures and policies to ensure the safety of the environment and equipment in the home. People’s medicines were managed, stored and administered safely.

People were confident in the ability of staff to care for them. Staff received appropriate training and support so they could meet people’s needs effectively. Staff were encouraged to develop within their roles and study for nationally recognised care qualifications. New staff shadowed experienced staff until they knew people well and understood how to support them.

The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They had identified people whose care plans contained some restrictions to their liberty and had submitted the appropriate applications to the authorising authority. Staff worked within the principles of the MCA. They offered people choices and supported them to make their own decisions where possible.

Risks around people’s nutritional intake had been identified and people were offered food and drink that was suitable for their individual dietary needs. External health professionals were contacted when people's needs changed and further health involvement was needed to maintain their health. People and their relatives were confident their healthcare needs were met. Appropriate arrangements were made to support people until the end of their life.

Staff had developed positive, caring relationships with people and demonstrated an easy rapport in their communications and interactions. Staff were patient and understanding and sensitive to people’s needs. People were spoken with politely and courteously and told us staff treated them with respect. People’s relatives and friends were able to visit when they wanted to and played an important role within the home.

Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. However, care plans were not always consistently followed. Relatives were kept well informed about their family members’ support needs and where appropriate, actively involved in decisions about their relatives care. People told us that staff were responsive to their requests for assistance.

There was no activities co-ordinator working at the home. Social activities were led by the deputy manager and carried out w

This inspection was completed by one inspector, who spoke with relatives, people who used the service, staff and the deputy manager, observed interactions and looked at relevant records relating to the outcome areas chosen for inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, 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 we spoke with and their relatives told us they were treated with respect and dignity. One person said: "I have been fine since I have been here, I wouldn't stay if I wasn't treated properly". A relative told us: "I have been impressed about the care provided and the efforts made to find out a bit more about my mum's condition".

Staff we spoke with told us: "I have completed safeguarding training and we covered whistleblowing procedures. I know what I should do if I have concerns and how to report them". The deputy manager confirmed that staff had received training in the safeguarding of vulnerable adults.

Medication management arrangements were in place to ensure medication was administered, stored and managed safely.

Is the service effective?

People’s health and care needs were assessed with them and their relatives. A relative confirmed this, they told us: "I have been able to discuss my relatives needs and have seen the care assessment and plans they have produced. Staff talk to me and make me aware of any concern". We saw that specialist dietary, mobility and equipment needs had been identified in care plans where required. People who were at risk of falls had plans in place intended to reduce the assessed risk.

Relatives we spoke with confirmed that they were able to see people who used the service in private and that visiting times were flexible. All relatives we spoke with told us they could visit at any time. One relative said: "I can't always get here at the same time each day so it's good they don't mind when you turn up".

Is the service caring?

We observed that people who used the service were supported by kind and attentive staff. We saw that care staff showed patience, gave encouragement when supporting people and were knowledgeable of their needs. One person we spoke with commented: “I can always rely on the 'girls'. I like to do most things for myself, but they are always there if I need them". A relative said: “I visit regularly. The staff are lovely always welcoming and friendly, that is one of the reasons we chose the home" another told us: "The staff are really lovely to my relative and I've seen them treat other people in the home really well”.

People using the service and their relatives were invited to attend meetings to discuss the service provided and surveys to seek their individual views were circulated. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People we spoke told us they knew how to make a complaint if they wanted to. One person said told us: "I wouldn't hesitate to tell someone if I was unhappy, but I'm not". A relative said: "We had some papers telling us what we needed to do if we had a complaint". We looked at how complaints had been dealt with, records showed very few complaints had been received. The acting manager told us: "We have a complaint at the moment that I'm dealing with. It's never very nice to receive one but the important thing is how you deal with it and learn from it".

Is the service well-led?

The service has a quality monitoring system in place, the deputy manager told us: "I have been carrying out audits and making changes where they have been needed" and: "I've also started to update policies and risk assessments". Records seen by us showed that updates and amendments had been made to ensure information and risk assessments were up to date. The deputy manager was aware of the need to use the information to continually improve the service.

People were happy living at the home. One person told us, “I have settled in better than I thought I would. My social life is second to none and I made some good friends. I am happy.” Another person told us they had been in hospital and other care homes before coming to stay in the home. They said, “This is the best place of the lot.”

During our inspection, there were a number of people being cared for in bed and at high risk of pressure sores. Appropriate risk assessments had been completed and care plans put in place to reduce the risk of pressure sores happening.

At our previous inspection, we identified that the provider was not meeting the expected standards in some of the outcome areas. We set compliance actions, requiring the provider to make the improvements required to ensure the quality and safety of care. There were still no specific care plans in place to provide clear instructions for staff to follow to ensure in case of need medicines were given at the right time. The quality and accuracy of records about people’s care still needed to improve.

There were effective recruitment and selection processes in place to ensure that the right staff were working in the home. The manager and care staff had a good understanding of when concerns with people’s safety and welfare needed to be reported. Staff also had a good understanding of what it meant to act in people’s best interests and the process to follow.

When we carried out our unannounced inspection we spoke with five people living at the home, one relative and five staff. We reviewed care records and other documents, and observed how people were supported to make decisions and choices about how they were cared for.

People living at the nursing home told us that they were happy with life there. One person told us, “There is always a choice in what I do, what I eat, where I go”. People living at the home told us that they felt respected but we found that suitable arrangements were not in place to fully promote people’s choice and dignity at all times.

Another person told us, “I love it here. I came on respite care and did not want to leave”. We observed that all people had care plans in place but these were not always updated to reflect the changing needs of people. There were systems in place to safeguard people living at the home but some staff required further training to ensure proper procedures were followed.

We reviewed staffing and recruitment systems. All staff files and the care plans for people were filed securely and there were recruitment processes in place. We observed that some of the records that we reviewed had gaps in the recruitment process but safeguarding checks on staff were always completed to ensure appropriate staff were working in the home to care for the people.

People told us that they were happy at New Milton Nursing Home. On person told us "The three of us sit together, we chat and do the things that we want to. Staff are good to us, they join in our conversations and we laugh together".

Two people told us that they enjoyed the food and said "We can have anything we like".

A visiting GP told us that he was quite satisfied with the standards of care at New Milton Nursing Home.

We observed good interactions between people using the service and staff

In discussions people told us that their privacy and dignity were respected at all times. This was discussed in the context of personal care giving and hoisting people.

People told us they liked the food, there was a choice and they could have what they wished and when the wanted it. A person having breakfast late morning said that she like to take her time rising, have a bath and have a late breakfast.

A bedfast lady said that she had been at New Milton for a year and was very positive about the care provided. She said “If there is anything you need, they get it for you. I love it here, the staff are so helpful and want to please and make life as good as possible”

People told us that if they felt unwell and asked to see the doctor, this was arranged. One person said that she feels safe at New Milton Nursing Home, she said “staff look after me”

During our inspection visit a resident with memory loss and unable to verbalise her needs, indicated that she was in pain. Analgesics are prescribed ‘as required’ but the person is reluctant to take medication. Her relative was visiting and after intervention by the nurse and with assistance from the relative she ultimately took the required liquid painkillers. This situation was handled very sensitively and ultimately successfully.

People told us that they liked living at New Milton Nursing Home and were happy with the facilities provided for them. Two people showed us their bedroom and said they were comfortable and had adequate space and furniture. One person we spoke with who has been cared for in bed for a year had an adjustable profiling-bed, she was able to change position as required. She has a good view of the patio area with bird-table that she said she enjoys watching with considerable interest. She has a large screen TV with controls at hand and TV programme listings. She was very complimentary about staff saying “they will do anything for you, I have everything I need and am very happy here”.

People told us that they felt safe when using special equipment. We observed staff tell people what actions they were going to take before using moving equipment.

We observed relaxed, friendly and supportive approaches to people who were seen to respond well. This is a small nursing home where relationships between residents and staff are close with mutual respect.

Staff demonstrated in discussions a good understanding of people’ conditions and needs and also peoples’ basic rights and protection needs. Staff members said that they enjoyed the training provided and considered it essential in providing a quality service. They said that they were supported by senior staff and the provider/manager.

When asked if they knew how to make a complaint one person said “I would speak to (the manager) or my daughter who would deal with it”