We inspected Newlands Nursing Care Centre on the 12, 16 and 17 July 2018. Newlands Nursing Care Centre is registered to provide accommodation and personal care to 26 older people some who require nursing care. The service is also registered to provide personal care to people living in their own accommodation, including apartments and cottages based on the grounds of Newlands Care Centre. While we inspect both aspects of the service, we do not inspect people’s own accommodation, therefore evidence in relation to the environment is based on people living in the care home aspect of Newlands.

At the time of our inspection, 12 people were receiving accommodation and nursing or person care. Nine people were receiving personal care in their own accommodation. Newlands is based in Stow on The Wold in the Cotswolds, a rural area of Gloucestershire. The care home is split over three floors with communal spaces on the ground floor, including a dining room, drawing room, restaurant, library, salon and café. Attached to the home is Newlands House with people freely moving from the apartments to the home. A number of cottages are also in the grounds of the service. The service has large gardens for people to enjoy with views overlooking the countryside. This was an unannounced inspection.

We previously inspected the home on 24 May 2017 and inspected the following areas ‘Is the service effective?’ and ‘Is the service responsive’ and rated the service as “Good”. The service had met all of the required regulations at this time.

At this inspection we rated the service as ‘Outstanding’ overall.

There was a registered manager in place at Newlands Nursing Care Centre. 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 service was outstandingly caring. The registered manager and staff were committed to providing the best possible care. There were excellent relationships between staff and people with staff putting people at the centre of their care.

Staff worked creatively to enhance people’s enjoyment of life; including tailoring activities to people’s needs and creating opportunities for people to be involved in their local community. The provider ensured staff had sufficient time to provide compassionate and attentive care and people experienced that they were supported with the things that mattered to them. People were supported to attend family holidays.

The service was outstandingly responsive to people’s changing needs. People were supported by care and nursing staff who were attentive to their needs and knew when they were feeling unwell. The service had worked with healthcare professionals to reduce unnecessary hospital appointments and ensure people’s health and wellbeing were maintained.

People were safe living at Newlands. There were enough staff deployed to ensure people’s needs were being met. People received the support they required to meet their health and wellbeing needs.

People received their medicines as prescribed. The risks associated with people’s care was managed well and people were supported to take positive risks and maintain their independence.

Care staff treated people with dignity and ensured their nutritional needs were met. Hospitality, nursing and care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received. Care staff felt they had all the training and support they required to meet people’s needs.

The service was highly responsive to people's needs. People were supported to live their life to the fullest and enjoyed a wide range of activities and events. People benefitted from engagement and activities which were tailored to their individual

This was an unannounced inspection which took place on 24 May 2017. Newlands Nursing Care Centre forms part of and is within a care village. People who live in the care village can be cared for here on a temporary basis or transfer permanently to the care centre when needed. People from outside of the care village are also admitted to Newlands for short-term or long-term care. The service has 17 rooms which can accommodate can accommodate up to 25 older people. Eight double sized rooms can provide accommodation for couples wishing to live together although the majority of rooms are occupied on a single/suite basis. At the time of the inspection there were 12 people living at Newlands Nursing Care Centre. The service provides nursing care with nurses on site at all times.

There was a registered manager in post. 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 carried out an unannounced comprehensive inspection of this service on 19 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection on 24 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements in relation to a breach of regulation 17. This report only covers our findings in relation to these issues. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Newlands Nursing Care Centre on our website at www.cqc.org.uk”

At our last inspection on 19 April 2016 this service was rated as requires improvement overall. We asked the provider to take action to make improvements to:

• maintaining accurate and relevant care plans to guide staff about people’s care and treatment

and these actions had been met.

We also recommended improvements were made to the way in which people’s capacity to make decisions about their care and support was assessed and recorded. Guidance was also given about ensuring evidence was available in the home with respect to the dealing of complaints. These actions had also been met.

People’s capacity to make decisions about their care and treatment was considered in line with the Mental Capacity Act 2005. Records had been maintained which confirmed when decisions had been made in people’s best interests. People’s care records were personalised and reflected their individual preferences and the way they wished to be cared for. People’s care records were amended, when there were any changes in their needs, to make sure they reflected the care and treatment being provided. People’s complaints were thoroughly investigated and copies of these were kept in the home.

This inspection took place on 19 and 20 April 2016 and was unannounced. Newlands Nursing Care Centre forms part of and is within a care village. People who live in the care village can be cared for here on a temporary basis or transfer permanently to the care centre when needed. People from outside of the care village are also admitted to Newlands for short-term or long-term care. The service can accommodate 25 older people and at the time of the inspection there were 17 people. The service provides nursing care with nurses on site at all times.

The service had a registered manager in position. 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.

During this inspection we found one area of regulation not fully met in relation to the records kept about people’s care and treatment. You can see what action we told the provider to take at the back of the full version of the report. People received support which was tailored to their individual needs and care was delivered with kindness and compassion. People’s end of life care was well planned and their families involved and supported. However, care plans did not always provide staff with accurate and sufficient information about people's care and treatment. The risk to people from this was reduced because care staff received exceptional support and guidance from senior nursing staff. Senior nursing staff were very hands on in the delivery of people’s care and worked alongside care staff so the appropriate care was delivered. However, care plans must accurately reflect and record what care people need and how their care and treatment is to be provided. Shortfalls in accurate and relevant care records can potentially put people at risk of receiving unsafe and inappropriate care.

We also recommended that the service seek appropriate advice with regard to the principles of the Mental Capacity Act 2005 and how better to reflect these were being followed in people's care records. We observed people's care being delivered with their consent, although a desire to protect people from risk had resulted in a decision being taken for one person, which they objected to and which they had not provided consent for. Staff were aware of the need to protect those who were unable to make decisions about their care and treatment independently. However, the process of recording their considerations under the appropriate legislation for another person and the practice of assessing everyone's general capacity on admission required review and improvement.

People’s risks were identified and managed and they were kept safe from harm because staff knew how to report any concerns they may have. There were enough staff to meet people’s needs and robust recruitment practices protected people from those who may be unsuitable. People received their medicines safely and were provided with explanations about these when they asked. Staff had been trained and were well supported. Staff competencies were reviewed and assessed but this process was not recorded. Staff training was on-going.

People were helped to maintain and a healthy diet and when there were concerns about this appropriate monitoring and support was provided. People had a choice of food and drink and there were well appointed restaurants to eat in and to entertain friends and family. People had opportunities to take part in social activities and they were supported to go out. Newlands did not provide transport which was adapted to accommodate wheelchair users however, we were told transport which was adapted could be hired. Arrangements were in place for people to raise a complaint and to have these responded to.

The service was managed well despite the registere

When we inspected there were 18 people living in the home. We spoke with six people who used the service, one relative and five staff. We also made our own observations during the visit.

People who used the service told us they were very satisfied with the service they received. People felt the staff supported them and met their needs. One person who used the service said "I’m very lucky to be here."

People told us that staff treated them with dignity and respect. One person said “I am well respected.” We saw staff speaking and responding to people in a kind and respectful manner.

The care records showed us that people's health needs had been assessed before they came to live in the home. These records included information from health and social care professionals which helped ensure people got the care and treatment they needed.

Recruitment records showed that new staff had been checked to make sure they were suitable to work with vulnerable people. The home trained their staff and had the procedures which protected people from any form of abuse. People told us they did not have any complaints but would speak to the manger or staff if they had any concerns. One person said “I would go and see the managers.”

The service and the building were monitored and risk assessed to ensure they were suitable for the people who used them.

The evidence we collected showed us the service kept people safe and met their care needs.

We spoke to four people who used the service and one person said "they are really marvellous here". Another who could not express a view looked relaxed and their wellbeing appeared good. People told us that their permission was always sought before care was provided. In one person's case, staff did not necessarily agree with decisions one person had made about how they were ending their life, but their decisions were being respected and appropriate care had been provided. For people who lacked mental capacity the requirements under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were considered and followed. Care was being planned and delivered in a very personalised manner with good record keeping in place.

There were arrangements in place to protect people from abuse and staff understood their individual responsibilities in relation to this. There were enough staff on duty to meet people's needs and to allow the service to run smoothly. Staff were provided with appropriate training and support in order to carry out their tasks safely and to professionally develop.

We saw evidence of effective monitoring of services provided and actions being taken to improve them. There were arrangements in place to assess, manage and re-evaluate risks.

People could make complaints and where concerns and dissatisfaction had been expressed this had been taken seriously and acted on.