The inspection took place on 11 April 2017 and was unannounced. The last inspection took place in December 2014 when the service was rated good overall.

Strathmore Nursing Home is registered to provide residential and nursing care for up to 30 people. The home is situated in a residential area close to Bolton town centre. At the time of the inspection there were 25 people receiving a service, three of whom were being nursed in bed.

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 told us they felt safe at the home. Appropriate individual and general risk assessments were in place and updated as required. There were sufficient staff to meet the needs of the people who used the service and staff were recruited safely.

There were appropriate safeguarding and whistle blowing policies in place and staff were aware of the procedures for reporting any issues and confident to follow the procedures.

There were safe systems in place for the management of medicines. Accidents and incidents were recorded and monitored and appropriate health and safety measures were in place.

Staff induction was thorough and there was a programme of on-going and refresher training.

Nutrition and hydration needs were recorded and people’s needs monitored and special dietary requirements adhered to. The meal time experience was unrushed and people were given the assistance they needed and choices of food and drink were available.

Consent forms were used and signed appropriately. The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring. We observed interactions within the home throughout the day and saw that they were friendly and respectful.

Visitors told us they were made welcome and people who used the service and their relatives were involved in all aspects of care planning. Staff were aware of the importance of dignity and people’s dignity and privacy was respected.

People’s wishes for when they were nearing the end of their lives were recorded. Staff had undertaken training in end of life care and the service endeavoured to respect people’s wishes.

Care plans included relevant health and personal information and were person-centred. Activities were offered in the form of group activities or one to one interactions, depending on people’s needs and preferences.

The complaints policy was on display and was outlined in the service user guide. The service had received a number of compliments, but no recent formal complaints.

The registered manager had an ‘open door’ policy and people who used the service, visitors, staff and other professionals found her approachable.

Team meetings were held regularly and there were regular staff supervisions. These helped ensure staff felt fully supported in their roles.

There were a number of audits and checks undertaken to help ensure continual improvement in service delivery. The home linked into a number of local groups to ensure they kept up to date with good practice.

We carried out this unannounced inspection on 1 December. At the previous inspection, in July 2013, the home was found to be meeting all regulatory requirements inspected. Strathmore Nursing Home is registered to provide residential and nursing care for up to 32 people. On the day of the inspection there were 29 people in the home.

There was a registered manager at the home. 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.

We found the home was not completely safe as we witnessed a member of trained staff administering medication in an unsafe manner. This was immediately addressed by the home registered manager. There were a number of potential trip hazards around the home that could have caused injury to people who used the service. We felt this area could be improved.

We found there were sufficient staff to meet the needs of the people who used the service. Recruitment procedures were robust and staff training was comprehensive and on-going. Safeguarding issues were addressed appropriately and staff were aware of how to record and report these matters.

Staff had an understanding of their roles and administered care in a compassionate and friendly manner. They had undertaken training in Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and the home ensured they worked within the legal frameworks.

Care files were complete and up to date. They included a range of health and personal information and were person centred. Other agencies were contacted when specialist advice or guidance was required and the home worked well in partnership with these agencies.

There was a range of activities available to people who used the service. People’s views and opinions were sought via residents’ meetings and questionnaires.

The registered manager was readily available for people to raise any concerns or voice any opinions. Staff felt they were well supported by the management and were listened to and respected. A number of quality assurance audits were carried out at the home, the results analysed and areas where improvements needed to be made were identified and addressed.

We visited Strathmore on 8 July 2013 and found that the home was warm and clean with adequate numbers of staff whom we observed delivering care competently and treating people with respect.

We saw that efforts were made to include people who used the service in decisions around their care.

We looked at four care plans, which included information about health, care needs, background, likes and dislikes. There were appropriate risk assessments and monitoring charts which were reviewed and updated on a monthly basis.

We spoke with two people who used the service. One person told us “The staff are polite and kind”. Another person said “Strathmore have not nursed me back to health, they have loved me back to health.”

We spoke with three visitors at the home. One person told us “Communication is excellent, I’ve been very pleased with the care that X has had.” Another visitor said “I like the homely atmosphere.” A third person told us “Staff are terrific, there isn’t one who isn’t helpful.”

The home had safeguarding procedures which were followed appropriately. Staff had an awareness of safeguarding issues and were confident of recognising, reporting and recording concerns.

We spoke with three staff members who felt they were supported in their employment, learning and development.

We saw the complaints procedure which was clearly displayed within the home. Quality assurance checks were regularly undertaken and issues highlighted and addressed in a timely way.

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 quality and choice of food and drink available. This was because this 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 CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) and a practising professional.

The people we spoke with all said they were treated with respect by care workers who asked for permission before carrying out personal care. They said that they could take part in a variety of daily activities organised by the home, and they also had the opportunity to go on trips out.

The most recent survey carried out for people living at the home and their relatives received positive comments. People said "Staff are always ready to help" and "Staff are friendly and caring". All the relatives who responded to the survey said they felt involved in their relatives care. They said they were offered privacy when they visited, and they felt their views were listened to and taken into account.

All the people we spoke with said that they knew what care they should receive and care workers discussed this with them.