This inspection took place 5 June 2017 and was unannounced.

Sable Cottage Nursing Home is registered to provide accommodation and nursing care for a maximum of 39 people, of which 15 people were living with dementia. On the day of our inspection 38 people were living at the home.

The home has a registered manager in post. They were present for our 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.

At the last inspection in September 2014, the service was rated Good. At this inspection we found the service remained Good.

People continued to be safe because they were supported by staff who understood how to identify and report potential harm and abuse. Staff were aware of any risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the home.

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. People continued to be supported by staff who had the skills to meet their needs. Staff had received training relevant to their roles and were supported in their roles by the manager and their colleagues. Checks had been completed on new staff to make sure they were suitable to work at the home.

People continued to receive food they enjoyed and were supported to eat and drink enough to keep them healthy. When they needed it, people continued to be supported to access other healthcare professionals to make sure their health needs were met. People's medicines were managed and stored in a safe way, and they had their medicines when they needed them.

People said staff treated them with kindness and compassion and they felt involved in their own care. Staff respected people's dignity and privacy and supported them to keep their independence.

People continued to receive care that was personal to them because staff knew what their individual preferences and needs were. People received their care when they needed it and were not kept waiting by staff.

People lived in a home where they felt confident to express themselves and felt comfortable to speak with staff and managers about concerns and issues that affected them. The provider encouraged people and their relatives to give their opinions of the home through surveys and feedback forms.

The registered manager had developed an established and strong staff team. The registered manager and staff had created an environment that was welcoming and friendly and the home's positive values and culture were seen during our inspection. Staff were clear on their roles and spoke about the people they supported with respect

We saw that systems were in place to monitor and check the quality of care and to make sure the environment was safe. The provider continued to involve people in the running of the home by providing opportunities for them to make suggestions for improvements. People felt their views were respected.

We visited this service on 14 October 2014 and the inspection was unannounced.

The last inspection was carried out in October 2013 and we found that the home was meeting the current regulations.

Sable Cottage is a care home providing personal, nursing and respite care for up to 38 older people, of which 15 people may be living with dementia. A passenger lift and staircases provide access to all levels.

At the time of our visit there were 31 people living at the home.

The registered manager was experienced and had worked at the home for 11 years. She had been the registered manager for 18 months. 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 told us that they were happy living at the home and they felt that the staff understood their care needs. People commented”We have the best care anyone could want”, “Food’s good, good and solid. I eat everything” and “The staff are very good, very nice and treat me very well. I’m very lucky to be here.”

We found that people, where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

We found the home was clean, hygienic and well maintained in all areas seen.

We looked at the care records of three people who lived at the home. We found there was detailed information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were completed and up to date.

We found the provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), safeguarding and staff recruitment. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at Sable Cottage.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people who lived at Sable Cottage could be confident that they were protected from staff who were known to be unsuitable.

We found people were able to express their views, so far as they were able to do so, and were involved in making decisions about their care, treatment, and support. We spoke to five people who used the service. They told us they felt they were listened to and were able to take part in decisions about their care and treatment. Comments included: "The staff are all very pleasant and very kind. They show us respect" and "The girls are lovely." We sat with people who used the service during the lunchtime period. We saw that staff observed people as they had lunch and were on hand to assist where required.

We examined the induction plan and found that all areas of basic training such as safeguarding, moving and handling and fire safety were completed during this process. We found a new buddy system was in place which showed that new members of staff were supported by a senior member of staff during this process. We found there was a lead nurse at the home with other nurses responsible for updating the service with any new information or guidance for areas such as infection control and medication.

We saw the service carried out monthly audits of various aspects of the service’s operations such as medication management, care planning, falls analysis and the environment.

We found that records kept were accurate and fit for purpose. We found that risk assessments and care records were evaluated on a monthly basis or sooner if required.

We found that people experienced care, treatment and support that met their needs and protected their rights. People who used the service told us they felt involved in the care and treatment that was provided to them.

We spoke with seven people who used the service and one relative. Comments from them included “This is a home from home”, “I’m very happy here, there are lots of activities to do” and “I’m very well looked after here”.

We found that people were protected from the risks of inadequate nutrition and dehydration.

We saw that people who use 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.

We spoke with 10 members of staff. We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.

We spoke with three people who were living in Sable Cottage and we met other people throughout the day including three relatives. They told us they enjoyed the food and their lunch that day. They felt that the staff helped with anything they asked for and were always very caring when offering assistance.

Relatives told us that they were very happy with the care and that the standard of care was always very good whenever they visited. They felt that the home was always clean and tidy and never had any unpleasant smells.

They made various comments such as:

“We our very happy with the standard of care”.

“We feel the staff are very genuine and are passionate about the care they give”.

“We have a copy of the complaints procedure and we know we can access the care plans if need be, the staff do keep us up to date”.

“We have no complaints”.

”The staff are very good we are pleased with the care received, they are very attentive”.

We had also contacted the local authority contracts and monitoring team for Cheshire West and Chester before we visited the service. They had no issues of concern to report.