This comprehensive inspection took place on 18 and 21 April 2017. The first day was unannounced.

At the last inspection in January 2016, we told the provider to take action to improve care planning and to comply with the requirements of the Mental Capacity Act 2005. This action has been completed in order to meet the regulations, although improvement is ongoing.

The Retired Nurses National Home is a care home for up to 52 older people. Nursing care is not provided. There were 28 people living there or staying there short term when we inspected. Some people were living with mild or moderate dementia. The service was located in a 1930s purpose-built building. People had individual bedrooms on the ground and first floors, the first floor being accessed by two lifts and three staircases. Communal facilities, such as a lounge, dining room and chapel were located downstairs. There were neatly kept open garden areas to the front and rear of the building, and car parking spaces at the front.

There are eight independent living flats on site and people who live in those are able to participate in activities in the home and have meals. These flats did not form part of our inspection as the service does not provide personal care to people living in them.

As required by the conditions of its registration, the service had a registered manager, who had started in post around the time of the last 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.

People received care and support that met their individual needs. Their independence was promoted. People, and where appropriate their relatives, were involved in decisions about their care.

Staff treated people with compassion and respect, upholding their dignity.

People consented to their care, unless they did not have the mental capacity to give consent. Where they lacked mental capacity in relation to aspects of their care, a best interests decision was made. This took into account the person’s known preferences and there was consultation with the appropriate people, such as relatives and healthcare professionals.

Medicines were managed safely.

People’s nutritional needs were met. There was a choice of meals and snacks were available around the clock. Specialist advice was sought from healthcare professionals where there were concerns about weight loss or swallowing difficulties.

The service had an activities coordinator, who organised a range of group and individual activities for people to take part in if they chose. They had found out about people’s hobbies and interests in order to design the activities programme.

People were protected against the risk of potential abuse because staff understood their responsibility for safeguarding adults.

The premises were regularly maintained, and key checks were undertaken. However, we identified some environmental hazards, which we drew to the attention of the registered manager. Where able to, they took immediate action. Following the inspection the registered manager confirmed that remedial works had been authorised and were being arranged.

People involved in accidents and incidents were supported to remain safe. There were arrangements in place to keep people safe in an emergency. We have made a recommendation regarding the system for identifying treads and patterns in accidents and incidents.

Safe recruitment practices were followed before new staff were employed to work with people. People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. However, a few people said they thought call bells could be answered more quickly, whereas others were satisfied with the response.

People were positive

.This was an unannounced comprehensive inspection carried out by one inspector on 20, 22 and 25 January 2016. We last inspected the home in June 2014 when we found the service was compliant with regulations and the standards required at that time.

There was no registered manager at the home at the time of the inspection, the previous manager ceased their employment at the home on 18 December 2015 before they completed their registration. 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. A new acting manager had been recruited and had started work at the home the week before the inspection. The acting manager was to apply to become registered manager of the home.

The home had also undergone another major change in that Friends of the Elderly took over the control of the Retired National Nurses Home as an organisation in September 2015. As the Retired National Nurses Home remains a separate entity in its own right, both as a company and a registered charity, a new registration was not required.

The Retired Nurses National Home is registered to provide accommodation and personal care for up to 52 people. The home also has eight independent living flats and people who live in those are able to participate in activities in the home and have meals. Nursing care is not provided. At the time of the inspection there were 30 people living at the home.

Improvements were required to make sure the service provided to people was as safe as possible, such as the reviewing of risk assessments to identify actions that could lead to safer outcomes for people.

Staff had been trained in safeguarding adults and were knowledgeable about how to refer any concerns of abuse.

Risks to people’s health concerning the physical environment, had been assessed to make sure that the home provided a safe environment for people.

Accidents and incidents were monitored and audited to see if there were any trends that could make systems and care delivery safer.

The home employed sufficient staff to meet people’s needs.

Robust recruitment procedures were followed to make sure competent and suitable staff were employed to work at the home. The acting manager reviewed staffing files to make sure that all required records were in place and checks completed.

Medicines were managed safely in the home.

The staff team were well-trained and there were systems in place to make sure staff received update training when required.

The home was not meeting the requirements of the Mental Capacity Act 2005 as mental capacity assessments had not all been completed for people living with dementia. Appropriate applications made to the local authority for people at risk of being deprived of their liberty.

People’s consent, where people were able to give this, was gained for how they were cared for and supported.

Staff were not supported through one to one supervision and annual appraisals. In the transition period this level of support to staff had not been provided to the frequency of the home’s policy.

People were provided with a good standard of food and their nutritional needs met.

People were positive about the staff team and the good standards of care provided in the home. People felt their privacy and dignity were respected.

Care planning was in need of improvement. Some care plans did not reflect people’s needs and were not personalised.

The home provided a programme of activities to keep people meaningfully occupied. At the time of inspection there was a vacancy for the post of activities coordinator.

The home had a well-publicised complaints policy and when a complaint was made, these were logged and responded to.

There were systems in place to monito

Retired Nurses National Home is a care home for up to 52 people and 40 people were living or staying at the home when we visited. The home historically cared for retired nurses and associated health care professionals but now also cares for any older person who does not need nursing or dementia care.

People told us they were happy living at the home and staff knew their individual needs and how to meet them. We saw that there were good relationships between people living at the home and staff.

People were involved in developing their care plans, where they wanted to be and people told us they made decisions about their care and support. They told us that staff encouraged and promoted their independence.

People were actively involved and consulted with about the day to day running of the home. People told us they felt respected and that their dignity was maintained.

People were involved in a wide range of activities within the home and were supported to access the community.

Staffing levels were regularly monitored by the registered manager to ensure that there were sufficient staff to meet the assessed needs of people. People told us they did not have to wait when they used their call bells.

Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs.

There was a clear management structure in the home and staff, representatives and people felt comfortable talking to the managers about concerns and ideas for improvements. There were systems in place to monitor the safety and quality of the service provided.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

At our last inspection in August 2013 we found that there had been breach of regulation 17. This was because people or their representatives were not consulted and involved in developing care plans. At this inspection we saw and people told us they were involved in developing their care plans when they chose to. Where they did not wish to be involved their representatives were consulted if they wanted them to be.

We also previously found a breach of  regulation 9 because care plans and risk assessments did not included clear information as to how staff should meet people’s needs. We found that individuals’ risk assessments and care plans had been reviewed and now included all the information staff needed. Staff knew people and their needs well.

At our last inspection we found a breach of regulation 10. This was because the provider did not always follow up on issues identified by people in ‘resident’s meetings’.  At this inspection people told us, and we saw, that action had been taken to follow up on any outstanding issues.

We carried out this unannounced inspection as part of our schedule of inspections. During the inspection we reviewed information relating to safeguarding concerns we had received about medication handling and noted appropriate action had been taken.

We looked at three care plans and spoke with five people that live in the home and four members of staff.

We found that people's privacy and dignity was not consistently respected and they were not fully involved in the assessment and care planning process.

We found that the provider had not taken appropriate steps to ensure that people were protected against the risks of receiving care or treatment that is inappropriate or unsafe. Assessments of need had been carried out and care plans were drawn up, but the information contained in these did not evidence what support people needed and how this should be delivered. There was no evidence that individuals had been involved in the care planning process and their wishes taken into consideration.

People we spoke with considered that staff were “kind and caring”' and they received the appropriate care and support to meet their needs.

The provider was developing systems to assess and monitor the quality of service provision. We found that people were able to comment on service provision, but action was not always taken to address concerns.

We carried out this inspection as part of our planned programme of reviews. Whilst we were at the home we checked on an improvement action made at the inspection in September 2011. At the last inspection people told us they would like better liaison with the Board Of Trustees and to have more influence in the way that the home is managed through the residents' meetings People living in the home told us that trustees now attend the meetings and they considered they were listened to.

We spoke with six people, one visitor and four members of staff during our visit. The visitor we spoke with said: “when I need to be in a care home, I have put my name down for here already and that is because I have seen many and this one is excellent.”

People also said that staff met their needs according to their wishes. We found that care plans accurately reflected people’s needs and had been drawn up with their involvement.

People who lived in the home told us that they had a choice of meals. One person said the portion sizes “were huge”. We observed the lunchtime meal and saw it was relaxed and a social occasion.

People were supported by staff that had been recruited in a safe manner. Examination of staff files evidenced that there was a through recruitment process in place which included all necessary checks.

We found that records were held securely in the home and were up to date and accurate.

At the time of our inspection there were 40 people living at the home. We spoke to 14 of these people about the home and their experiences of the care and services they received. All the people we spoke with were able to give a good account of what it was like to live at the Retired Nurses National Home. We also spoke with the registered manager, the acting head of care, the training and policies manager, a member of the care staff and one of the kitchen assistants.

Generally everyone we spoke to was very positive about the home, how it was managed and the standards that were maintained. Where people did have criticism, they wanted us to put this in context that they would not wish to be in any other home.

The inspection took place between 9.00 AM and 3.15 PM on 16 August 2011.