The inspection was unannounced and took place 27 January 2016.

Stonebridge Nursing home is registered to provide accommodation and personal and nursing care for adults who have a dementia and or mental health related illness for a maximum of 52 people. There were 45 people living at home on the day of the inspection. There were four separate communal lounges, each tailored to people’s mental health and/or dementia related needs.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

People were supported by care and nursing staff to be safe and protected from the risk of abuse. All staff knew each person which helped them to understand and reduced their risk of harm or abuse. Staff consistently helped people with any anxiety or distress immediately and provided reassurance and guidance to support until settled. Staff told us that helping people to live in a calm and relaxed environment reduced the risk of abuse to people living at the home. All staff felt confident in recognised the potential signs of abuse and would report these through the senior staff or management at the home. Where needed the team took steps to prevent further harm and make referral to external agencies as required .

People had care staff that were available on a one to one basis where required and there were sufficient numbers of staff to provide care to all people living at the home without the use of agency staff. Where people had risks identified as part of their daily living staff supported them to reduce those risks. People told us they received their medicines as prescribed and at the correct time. All relatives we spoke with told us there were enough staff to support their relative and did not have to wait for care to be provided.

People were cared for by staff the who told us their training reflected the needs of people who lived at the home. We saw that all staff provided care and support to people in a confident and caring way. Nursing staff had recently discussed how they were recording and evidencing their clinical supervision to maintain their professional registrations, which help to ensure people were receiving the most appropriate care. They told us they wanted to show how their professional discussion prompted a high standard of care and supported to people who lived at the home.

Where people had not been able to consent to certain aspects or decisions about their care records of decisions had been completed. The provider was currently reviewing all care and support records to ensure any changes in people’s capacity and consent to ensure that they made decisions in the person’s best interests.

People had access to snacks and meals throughout the day and night. Where people required support to eat and drink care staff helped them. People had accessed other healthcare professionals to support them and had regular visits from their GP.

Staff developed positive, respectful relationships with people and were very kind and caring in their approach. People’s privacy and dignity was respected and they were supported and empowered to be as independent as possible in all aspects of their lives. Staff anticipated people’s care needs and attended to people quickly in a gentle and unhurried way.

People were involved in the planning of their care and the registered manager ensured that all people were able to be involved. All relatives we spoke with felt they were involved in their family members care and their view and opinions mattered. People’s care plans recorded their care needs in an individual way that reflected their preferences and life histories.

People were happy to raise any concerns or worries directly

The purpose of this inspection was to look at how care and support was provided to people with dementia. On the day of our inspection there were 43 people who lived at the home had varying levels of dementia and mental health needs.

During the day we were able to speak with two people who lived at the home and six family members. We also received seven comment cards where people gave their views about the care and treatment that people received. One person commented: ‘I feel this home offers good quality care and residents are respected and I feel that their needs are met.’

We also spent time observing the care and treatment people received. We looked at six people’s care records, and spoke with three members of staff which included the director of nursing and the registered manager.

Before people came to live at the home their needs were assessed in their own homes, hospitals and other community services. This meant that people only came to live at the home if all their needs could be effectively and safely met.

People and their family members told us that they were happy living at the home and they felt staff understood their needs. One person described life at the home: “Everything is very nice” and a family member said that they were: “Very impressed with staff, they are kind and caring.”

People were involved as much as possible in decisions about their care and treatment. Staff made appropriate referrals to other professionals and services in the community. We saw that staff understood people’s care and support needs were kind and caring and thoughtful towards them and treated people with respect. One staff member told us: “It is all about the residents.”

We saw that the provider had effective systems in place that made sure staff training was planned and delivered. This included person centred dementia care training.

The provider had responsive systems in place to monitor and review people’s experiences and complaints to ensure improvements were made where necessary. The director of nursing commented: 'While our home is far from perfect, it is honest in its self-assessments and utterly committed to providing meaningful, loving care.'

Many of the people living at the home had varying levels of dementia and mental health needs, so not everyone was able to tell us about their experiences of living at the home. Therefore we spoke with two people’s representatives and observed daily life at the home.

We observed that staff treated people as individuals. There were positive interactions between staff and people with lots of laughter and smiling and clear friendships were established. It was clear from what we saw that staff knew people’s needs and provided care and support in a gentle way when people’s behaviour needed to be supported.

People’s representatives told us positive things about the care and support people received whilst living at the home. They told us that they felt involved in any decisions that needed to be made and these were done with their relation’s best interests at heart. One representative told us, “They (staff) are always there for you” and involved them in the planning and delivery of care to meet the person’s needs.

Staff had been recruited in an appropriate way and checks had been undertaken to ensure that they were suitable to care for vulnerable people. Staff understood the needs of people living with dementia and mental health needs.

We saw that people and their representatives had access to a complaints procedure and their concerns had been listened to. People’s representatives told us that they would feel comfortable raising any concerns.

People who use the service experience safe, effective and appropriate care that meets their needs and protects their rights.

Not all of the people who use this service were able to talk to us directly about their care and treatment. We spent time during this visit observing the care and support that people were given. We saw that people were supported safely, they were involved in the planning of their care and treatment.