We undertook an unannounced inspection on 21 June 2016. At our previous inspection on 21 August 2014 the service was meeting the regulations inspected.

Nower house is a non for profit charitable service. They provide accommodation and support for up to 50 adults, some of whom have dementia. At the time of our inspection 44 people were using the service. Nower house is split into two units – Woodcote and Newra. Generally people stayed on their own units, but they were able to mix if they wished to and to participate in activities.

The service had a registered manager. However, they were on annual leave during our inspection. The rest of the management team ensured the service was adequately managed whilst they were on leave. 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 received their medicines as prescribed. However, some of the medicines management processes were not robust and we recommend that the provider reviews their practice in line with good practice guidance for managing medicines in care homes.

People were happy staying at the service and enjoyed the interactions they had with each other and the staff. Staff were knowledgeable about the support people required and provided them with this. However, we identified that one person’s care records did not accurately reflect the support people required or what was delivered.

People were supported to have their health needs met and staff liaised with healthcare professionals as required. Staff accompanied people to hospital appointments if people wanted them to.

Staff supported and encouraged people to manage their nutritional needs. Staff were aware of people’s dietary requirements and supported them appropriately, this included supporting people to put on weight when required and helping those who required a diabetic diet.

Staff treated people with kindness and respect. Staff were patient and polite when supporting people, and respected their decisions. People were given choice about how they spent their time and how they were supported. Staff adhered to the Mental Capacity Act 2005 and best interests decisions were made for people who were unable to make decisions for themselves.

Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by senior staff members and received regular supervision. Knowledge and competency checks were undertaken to ensure staff retained the information they received on training courses.

Staff, people and their relatives were able to feedback their views on the quality of the service. This was achieved through regular meetings, the use of suggestion boxes and completion of satisfaction surveys. A process was in place to acknowledge, investigate and respond to complaints.

Checks were undertaken on the quality of the service. This included regular visits by a board member. Where improvements were required, actions were taken to address these. Systems were in place to record and respond to incidents that occurred, and a member of the management team ensured that notifications of all serious incidents were made to the Care Quality Commission, as required by their registration.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions, is the service safe, effective, caring, responsive and well-led.

As part of this inspection we spoke with six people who used the service, the registered manager and six staff members. we also reviewed records relating to the management of the home which included four care plans, daily care records, staff duty rotas and activity arrangements.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

Some people told us they felt safe living in the home. They said they could talk to the manager and the staff if they felt upset or unsure about anything. Other people were not able to communicate with us because of their poor communication skills. Safeguarding procedures were in place and staff understood their role and responsibility in safeguarding.

We saw staff observed the safety and welfare of people living in the home and saw no negative practices during our visit.

The service was clean and safe and provided people with safe access to all areas of the home.

The staff recruitment practice was thorough.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care plan. Arrangements were in place for people to have visits from GP when appropriate to monitor their individual health care needs. People also had effective support from other health care professionals. For example the chiropodist, district nurse, dentist and the community psychiatric nurse (CPN), and the dietician.

Is the service caring?

People who used the service told us the staff were very caring and always treated them well. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We saw staff explained things to people when they were having difficulty to understand. For example when people asked where they were or when to expect a visit from relatives. We saw people were supported to eat their meals by staff in a sensitive and caring way and they took the time to enable people to be as independent as possible. People who used the service told us that staff always kind and that was why it was a good place to live.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allowed the individual to be as independent as possible. This included the management of people's changing needs for example the provider allocated an additional staff member to night duty to manage an identified need. The service also referred a person for psychiatric support appropriately.

Is the service well led?

The home is well managed by the registered manager who had been in post for several. They had the support of a compliance manage and a general manager who had designated responsibilities for overseeing the effective management of the home. The registered manage also had the support of a well established staff team who had a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment. Complaints and accidents were monitored and lessons learnt from the outcome of these were documented and discussed with staff to further improve quality.

During our visit we spoke with ten people who used the service and two relatives of people who used the service. We also spoke with four staff members two deputy managers the registered manager and the provider.

Some of the people using the service had dementia care needs, which meant they were not always able to describe their experiences of the service. To help us gather evidence of their experiences we used a Short Observational Framework for (SOFI). The tool is used to capture the experiences of people who may have cognitive or communication impairments and cannot verbally give their opinions on the service they have received.

We spent time observing how people spent their time, the support they received from staff and whether or not they had positive experiences.

Our observations of staff practice showed that people were receiving effective, safe and appropriate care, which was designed to meet their specific needs.

We saw people felt comfortable in approaching staff and asking for assistance. People were relaxed and content in their surroundings. Staff engaged positively with people using the service to encourage them to communicate their consent, wishes and choices.

One person who used the service said "The service here is excellent and I have no reason to complain." Another person told us that “The food is nice and staff nice too.”

Where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We met and spoke with five people resident in the home who told us that they were happy and liked living in 'Nower House'.

One person we spoke with commented, "If I want to relax in my own room, I do. I have the choice, but there is always plenty to do if I want to join in with what is going on. That suits me." Another person said that the staff were "always helpful, cheerful, and very kind."

Everyone we spoke with confirmed that they enjoyed their meals and had plenty to eat and drink. They all said they received the care and support they needed and felt safe at 'Nower House' because they could rely on the staff.

We saw that the communal areas of the home, such as the lounges and access corridors, were well maintained, appropriately lit and heated, and were free from odour. The people we spoke with all said 'Nower House' they were comfortable and liked their surroundings.

We saw that furnishings were in good condition and people said they liked the décor. The bedrooms we saw were clean, and each person had personalised their room with their belongings and had arranged their private space the way that suited them.

People told us that they were happy living at Nower Care. They told us that they were given the choice about living in the home and that their wishes and expectations were taken into account when making a choice about living there.

They told us that the care provided was good and that they were well looked after.

Relatives told us that the home had exceeded their expectations regarding the admission process and that the support and reassurance offered to them and people who use the service was exceptional.

There were very good comments about the food and the standard of catering. People told us that the chef meets with them frequently to discuss menus.

People felt that there was sufficient staff employed in the home to meet their needs.