Our inspection of Steeton Court Nursing Home took place on 3 May 2017 and was unannounced.

Steeton Court Nursing Home is located in the residential area of Steeton. The home is registered to provide care to a total of 71 people and on the day of our inspection there were 54 people living at the service. The home is built on two floors with access to the first floor by means of two passenger lifts and a stair lift. The majority of bedrooms are single rooms with en-suite facilities. The communal areas of the home include lounges, dining rooms and conservatories. There is an enclosed sensory garden to the outside of the property.

A registered manager was in post and had employed in this capacity since 2010. 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 our last inspection in 2015 we rated the service 'good' overall and 'requires improvement' in the well led domain, as we needed assurance that previous concerns were sustained. At this inspection we concluded improvements had been sustained.

People told us they felt safe living at the service and in the company of staff. Staff had received safeguarding training and understood their responsibilities regarding keeping people safe. Appropriate assessments were in place in people's care records to identify and mitigate risk and incidents/accidents documented. However, a more robust audit record of the number of incidents individual people had experienced would assist the service monitor individual trends.

Sufficient staff were deployed to keep people safe and we saw training was up to date or booked. Staff told us the training provided was of a good standard and enabled them to carry out effective care and support. We saw staff were kind and compassionate in their approach and there was a stable staff team which meant staff knew people well. Morale was good amongst staff who felt able to voice any concerns to the management team.

The service was acting in accordance with the Mental Capacity Act (2005) and the requirements of the Deprivation of Liberty Safeguards. People's consent was sought wherever possible and evidence of best interest decisions were in place. People's choice and preferences were respected.

People mostly told us they enjoyed the food provided although some people would like to see a greater variety and choice. Nutritional risk assessments were in place and people found to be at risk referred to the GP or dietician. We saw where people's intake was recorded and nutritionally supplements prescribed and correctly administered.

People were given the choice to participate in a variety of activities on a group or one to one basis.

Complaints were taken seriously and addressed although a low level of complaints had been received.

People's care was planned following needs assessments and kept up to date. We saw and people told us the care provided was in line with people's care plans. People's healthcare needs were effectively supported.

A range of quality audit processes were in place to identify and drive improvements in the service. Meetings and surveys were in place to gauge satisfaction among people who lived at the service and actions taken as a result. Staff attended regular meetings to discuss relevant topics and any issues or service developments.

Steeton Court Nursing Home provides accommodation and nursing care for up to 71 older people at any one time. On the date of the inspection, 21 September 2015, 65 people were living in the service.

A registered manager was in place. 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 and associated Regulations about how the service is run.

At the last inspection on 21 May 2015 we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found care was not consistently delivered to meet people’s individual needs and preferences as some people on the 1st floor were receiving bed baths as early as 4.30am. Staff told us the reason for this was to take pressure off day staff. However this demonstrated a task orientated culture and a lack of a personalised approach to care.

At this inspection we found improvements had been made and ways of working changed to ensure a more person centred approach to the delivery of care and support. People now got up and received assistance with personal care at times that met their individual needs and preferences.

At the last inspection in May 2015, we found pressure relieving mattresses were not always on the correct weight setting increasing the risk they would not be effective. At this inspection we found systems had been put in place to ensure mattress settings were regularly checked. We found these systems had been effective and mattresses were now correctly set.

We found where we had identified gaps in care plans in the May 2015 inspection; these had been addressed through the creation of appropriate and personalised care plans.

Steeton Court Nursing Home provides accommodation and nursing care for up to 71 older people at any one time. On the date of the inspection, 14 May 2015, 68 people were living in the service.

A registered manager was in place. 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 and associated Regulations about how the service is run.

We found medicines were safely managed. Arrangements were in place to ensure people received their medicines at the time that they required them and this was documented by staff.

The premises was safely managed. There were a number of nicely decorated communal areas where people could spend time. Bedrooms were homely and well maintained. The dementia unit was well laid out with a sensory garden which was used in a therapeutic way to help meet people’s needs.

Risks to people’s health, safety and welfare were assessed and a range of relevant risk assessments were in place which covered specific risks such as falls, bed rails and nutrition. This helped to keep people safe.

We found staffing levels were sufficient to ensure people received safe care.

People said they received good quality care from staff who had the appropriate skills and knowledge to undertake their role. We found staff demonstrated a good knowledge of those they were caring for, for example nursing staff were able to confidently describe how to meet people’s nutritional and emotional needs. Staff knowledge is some subjects such as mental capacity act and safeguarding was inconsistent and training updates were overdue in these areas.

Appetising meals were provided by the home and feedback from people about the quality of the food was positive. People’s nutritional intake was monitored and where risks to people were identified, detailed plans of care put in place.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and the service was acting within the requirements of the Mental Capacity Act (MCA).

People told us staff were kind and treated them with dignity and respect. Most of the interactions we observed during the inspection were positive. Staff had developed good relationships with the people they were caring for and demonstrated they knew about their individual needs. This helped staff to provide effective care.

A range of suitable activities were provided by the home. These were delivered by three activities co-ordinators and were well received by people in the home. Specific activities were provided for people living with dementia and we saw the staff delivering activities were dedicated to providing friendly companionship.

We found people’s care needs were assessed and appropriate plans of care were put in place, although two care records we reviewed were missing key assessments.

Prior to the inspection, we received concerns that some people were being bed-bathed as early as 4.30am. We identified that this was occurring in one area of the home. Staff told us that they felt pressured into getting people up early by day staff. Following the inspection the manager told us they had taken immediate action to address this.

This was a breach of the Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of this report.

People spoke positively about the overall quality of the care in the home. We found some systems were in place to assess and monitor the quality of the service which included audits of medication, infection control and finances. However no care plan audits had been carried out since January 2015 despite records stating three would be carried out a month. The service had also not ensured through an appropriate management plan that staff training was provided before it become out-of-date.

There was evidence that best practice guidance such as the National Institute for Health and Care Excellence (NICE) Guidelines were used to inform and improve care practice. This helped ensure the service worked to national standards.

Some staff told us they did not feel well supported by the service and there had not been a care worker staff meeting since May 2014.

One person who used the service said they were "comfortable at the home" and another person said it was like "home from home." One person’s relative said "they had no complaints at all" and "staff were excellent."

We found that people were involved in making decisions about their care and staff treated people with respect and dignity. We found that people's nutritional needs were being met but the choice of food wasn't particularly varied. The environment of the home was clean and also well maintained. There were sufficient numbers of staff to meet the needs of people but on occasion, during meal times in particular, staff could be very busy which meant care duties could be rushed. We found that the provider had appropriate systems and processes for monitoring the quality of care and maintained people's care records in a format that could be easily understood.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the choice of food and drink available. This was because the inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practicing professional. We spoke with seven people who lived in the home, one visiting relative and three staff.

People added that they were able to make choices in their lives and that staff supported this. For example, people were able to lie in bed in a morning. We saw there was a choice of menus available to people and people told us they liked the food in the home. They said “It is very nice, it is hot and well presented. “Additionally the quality assurance system included questions relating to the food provided in the home to ensure that people were satisfied with this.

People told us there had been “no suggestions of anything other than excellent care in the home.”