About the service: Sharston House is a detached two storey Victorian property situated one mile from the centre of Knutsford. A large extension has been added to the existing premises to bring the total number of bedrooms to 48. The service had six beds called, ‘Intermediate care’ beds. They were operated with local commissioners to help people receive clinical support following a period of illness and admission in hospital. On the day of the inspection 45 people were living at the service. There is a car park at the front of the building. Assisted bathing facilities are provided on all floors. Staff are on duty twenty-four hours a day to provide nursing care and support for the people who live at the service.

People’s experience of using this service: People who lived at Sharston House were happy about the service being delivered to them and liked living at the service. They shared lots of positive comments about their care, meals and menus provided and activities on offer. People were able to participate in a range of interactive and meaningful activities.

The registered manager and staff were very welcoming and caring about people who lived in Sharston House. There was a friendly and welcoming atmosphere at the service.

Safe care and treatment was consistently provided. People told us that they were happy at the service and they felt safe and secure. People's level of risk was regularly reviewed to keep people safe and comfortable. People’s medications were safely managed.

Staff were supported with training in relation to safeguarding and knew how to report any concerns.

People received support from consistent members of staff who were familiar with their support needs. Staff received training to help develop their skills and knowledge about the people they supported.

Staff understood and respected people's right to make their own decisions and supported people to make choices. People were involved in the decisions that needed to be made and consent was gained in line with the principles of the Mental Capacity Act, 2005.

People's privacy, dignity and independence was promoted. We received positive comments about the quality and range of social activities provided to everyone.

The service had an accessible complaints policy available to everyone. The manager used her reporting tools to reflect and learn from complaints and feedback. Several ways to gather feedback from people was provided by regular ‘resident and relative meetings’ and questionnaires to gather people’s views.

We recommend the service research local advocacy and mediation services to help them with any issues needing support to represent people living at the service.

Rating at last inspection: Good; (The last report was published in December 2017)

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on the 23 October 2017 and was unannounced.

Sharston House Nursing home offers nursing and personal care and accommodation for older people. The service is currently registered for a maximum of 48 people. At the time of the inspection 42 people were using the service.

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.

At our previous inspection in March 2016 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014(the Regulations). These breaches related to recruitment processes, staffing levels, management of medicines, quality assurance and auditing systems, staff supervision and appraisal, treating people with dignity and respect, and meeting people's social needs.

At this inspection we found that significant improvements had been made and most of these matters had been addressed. There was only one breach of the Regulations which related to quality assurance and auditing systems. Audits of care plans and infection control audits had not identified that there was conflicting information in some care plans and that there was a shortage of hands free waste bins and damaged tiled surfaces in some toilets that would make them difficult to clean. You can see what action we told the registered provider to take at the back of the full version of the report.

The interior of the home was comfortable and homely, with people being encouraged to bring their own items and belongings to personalise their rooms.

The registered manager was very welcoming and evidently caring about people who lived in Sharston House. There was a friendly and welcoming atmosphere at the home and people told us that they were happy there and they felt safe and secure.

People were safeguarded from the risk of abuse. Staff knew how to recognise the signs of abuse and how to report concerns.

There were sufficient staff deployed to meet people's needs. Staff had received training, supervision and appraisals and staff meetings were held. Robust recruitment procedures were in place.

Staff sought and obtained people's consent before they provided care or treatment. Staff were aware of the additional requirements of the Mental Capacity Act should they be caring for a person who lacked capacity to make their own decisions.

People said that staff were very caring and kind.

Medicines were stored and administered safely. Staff giving medicines to people had received appropriate training and supervision to support them to do this. Monthly audits of the medicines were carried out.

People knew how to raise a complaint and their views were listened to and responded to in a timely manner, with positive outcomes.

Feedback provided by people was listened to and positive changes to the service were made as a result.

People were able to participate in a range of interactive and stimulating activities.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of food and drink.

This inspection was unannounced and took place on the 10 March 2016.

The service was previously inspected in November 2013 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Sharston House Nursing Home provides personal care and accommodation for up to 48 people with nursing, residential and respite needs, and also offers dementia, convalescence and palliative care.

Sharston House Nursing Home is a detached two storey Victorian property situated one mile from the centre of Knutsford. The home has recently benefited from an extension to bring the total number of bedrooms to 48.

Forty-four people were being accommodated at Sharston House Nursing Home at the time of 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.

The home was going through a period of change following initiatives put in place by the new provider who took ownership of the home late in 2015. At the time of the inspection there was no manager at Sharston House Nursing Home. We were informed by the operations manager that a new manager had recently been appointed and would commence their role on the 14 March 2016. After the inspection the regional director confirmed the new manager had started her role at the home.

The management of the home was being overseen by two operations managers. Both operations managers and the regional director were present during our inspection and engaged positively in the inspection process. The management team were observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors.

During this inspection visit we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to recruitment processes, staffing levels, management of medicines, quality assurance and auditing systems, staff supervision and appraisal, treating people with dignity and respect, and meeting people’s social needs. You can see what action we told the registered provider to take at the back of the full version of the report.

Medicines were ordered, stored, administered and disposed of safely. However we found the registered provider did not record homely remedies. Without any records in place for homely remedies this was open to error and misuse.

Although people told us that staff were caring and kind to them, we saw that staff did not always deliver care to people well.

People’s needs were assessed before they came to live in the home; however we found some assessments were not regularly updated. Care plans were based on the needs identified within the assessment. Some of these had not been reviewed regularly which meant that some of the care plans did not reflect the current needs of people. The care planning system used was in the process of being replaced to reflect a more personalised approach to care needs.

People’s social needs were not being met. People told us they were bored and activities did not occur regularly.

The provider did not have an effective recruitment and selection procedure in place and did not carry out all the required checks when they employed staff.

Staff were provided with induction and regular on-going training. However we found gaps in supervisions and appraisals for staff.

The service lacked governance systems to assess, monitor and improve the quality of the service. For example, effective systems to seek feedback of the experience of service users were not in place and auditing systems were not robust. Record keeping was not always accurate and up to date, in relation to the treatment provided to people living at the home

Staffing levels were not structured

During our inspection we spoke to six people who lived in the home. They were all very complimentary about the care they received and the staff who supported them. One person said; "The staff are lovely. They can't do enough for you. Nothing is too much trouble" Another person said; "It's a different life. The staff are very kind, I can't fault them and I'm being very well looked after."

We looked at the arrangements in place to protect people from harm and abuse. We found that the staff knew what they would do if they had some concerns.

Our observations, documentation we reviewed and the people we spoke to assured us that the people who lived in the home were experiencing care and support that met their needs.

We looked at the procedures for recruitment of new staff and we saw that all the appropriate checks had been made to ensure that staff were suitable to work at the home.

We looked at the home's systems for ensuring that they provided a quality service. We found that these were very good and that the systems relating to monitoring the care provided were completed on a monthly basis.

We spoke to people who live in the home about their experience on being consulted about their care. All said they were happy living in the home. They told us staff always consulted them about their individual needs and involved them in decisions about their care and treatment. One person told us they were always informed and consulted regarding their care. They said “all staff are very kind and will always tell you what’s happening”.

A person visiting the home told us they had a lot of information regarding the home when making their choice and said they were “very happy with the way things were”. They said the staff were always in touch regarding the care of the person they were visiting and said they “couldn’t fault the care”. Another person visiting the home told us that everything was fine and their relative received “good care” and they were always consulted about their relatives care and treatment and everyone working in the home was pleasant and were always ready to listen.

Another person said “I’ve no complaints at all, the staff are lovely”. They also said “I know all the staff’s names and they know mine”. Another person told us that they could always choose where they like to eat their meals, they told us "I sometimes like my lunch in my room or sometimes in the dining area”. One person said “it’s always hard moving house but the staff here have made it easier for me”. Another person we spoke to said they were happy and the staff were “very nice”.

We visited Sharston House and spoke with people who live there. They told us that “the staff are very supportive of me” and “I am looked after with dignity”. “I was shown care and consideration when I moved in here”

One person said that they had been given a lot of information about the home and that they had looked at the homes’ website with their family before deciding to visit and make a decision about living there.

A visitor said that their relative had to be admitted quickly and that the staff did everything they could to make the move easy for all concerned.

Another relative said that “the staff made the whole process effortless at a very stressful time.”

One person living at Sharston House said that “ I like to stay in my room and the staff respect that “.

The people we spoke with all said they received the help they needed. One person said that “ the home is lovely” Other comments made were “ The home is first class”; “food is very appetising, especially the puddings “ and “ this is a lovely place to live.”

We spoke with a visitor whose relative was living in the home. The visitor said that their relative had come to the home for a short stay and liked it so much they had decided to move in.

Most of the people we spoke with said they were well fed and that their individual food preferences were accommodated. A visitor told us “ You couldn’t ask for a better place to care for your relative.”

When we visited we asked people who used the service if they would know how to raise a concern about something that was worrying them. They told us that they knew who to speak to if they were worried and said that if they had a problem they would be able to discuss it with the registered manager and that it would be taken seriously.

When asked did they feel safe in Sharston House people said they did. One person said that “all the staff are approachable and you can speak to them about your worries.” Another said “I can always say if things are not to my liking , which isn’t often, and know that they will deal with matters quickly.”