This inspection took place on 31 October and 18 November 2016. Our first visit was unannounced. At our last inspection in July 2014 the provider met the regulations we inspected.

The Old Rectory (Ewhurst) provides nursing care and accommodation for up to 35 older people. There were 32 people using the service at the time of this inspection.

The home had a registered manager in post. 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 felt safe living at the Old Rectory and spoke positively about the care provided to them. Staff knew people well and treated people with kindness, dignity and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. People spoke about the relaxed and homely atmosphere and this was evident on both days we visited.

There were enough staff to meet people’s needs and a consistent established team of staff provided continuity of care to the people staying at the Old Rectory. Individual care and support needs were fully assessed, documented and reviewed at regular intervals.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by senior staff and acted upon.

The service understood and complied with the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood the importance of gaining people’s consent before assisting them.

There was a system in place for dealing with people’s concerns and complaints. The registered manager understood their role and responsibilities and positive feedback was received from people and staff about the senior staff team working at the Old Rectory.

There were systems in place to help ensure the safety and quality of the service provided. We found however that improved arrangements needed to be put in place for the recording, auditing and administration of medicines.

During our inspection we set out to answer five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them, and from looking at records.

For further evidence supporting our summary please read the full report.

Is the service safe?

We saw that people that used the service were treated with respect and in a dignified way by staff. We saw that safeguarding procedures were in place and staff understood their responsibilities in safeguarding the people that they cared for.

The service was clean, hygienic and safe from hazards, providing safe access to all areas of the home.

We looked at staff training arrangements that were in place and saw that the staff were provided with appropriate training to ensure safe and appropriate care was provided for the people that used the service.

We saw that systems were in place to record, report and monitor incidents and complaints. There were policies and procedures in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. This ensured that people were protected from the risk of unlawful restraint.

Is the service effective?

People`s health needs were assessed with them, and included their relatives as part of the process. Arrangements were in place for people to be supported by other health care professionals, and people`s opinions and views were sought as part of the review process.

Is the service caring?

We saw that people were supported by kind and caring staff who spoke to them in a polite and respectful manner. People told us that the "Staff are very good; there is always somebody to help". Another said "There is no better than this, I can`t fault any of them". Another said "It`s marvellous, the staff are friendly, they are very good".

Staff were able to tell us about the people they supported. They knew people`s individual histories and support needs without having to refer to the care records. Staff were seen to take the time and listen to what people said, and they encouraged people to be independent by encouraging them to take part in activities such as going for walks in the garden.

People`s preferences, interests and diverse needs had been acknowledged and recorded in people`s care records. There was care support provided to meet those needs and interests. Family links were maintained and family and friends encouraged to visit.

Is the service responsive?

We saw that people were involved in a variety of activities. We saw people reading in the garden, and going for walks in the garden. We saw that people were involved in choosing their meals and how they spent their day. We noted that the home responded to the majority of people in the home who had expressed a view to not have residents meetings. Instead people wanted to express their views individually, which was respected by the home.

Is the service well led?

The manager had a good understanding of the needs of the people that used the service, as well as managing the requirements of the home. Staff told us that they were clear about their roles and responsibilities, and that they had a good understanding of the values of the home and the organisation that they worked for. Care records were updated regularly to monitor the service that people received. This helped to ensure that people received a good quality service at all times.

You can see our judgement on the front of this report.

The Old Rectory can accommodate up to 35 people. There were 33 people living or staying at the home at the time of the visit, which also included individuals who had come in for respite and short term care at the time of our visit.

We looked around the home which was clean and free from unpleasant odours. All the rooms were single occupancy with ensuite toilet and hand basins and there was a lift so people could access their rooms on the first floor. All the rooms had views and or access in to gardens and grounds. We saw that individuals had personalised their rooms with photographs, books, TV’s and pictures.

During our visit we spoke with four people who used the service, a relative and visitor. We also spoke with five staff including the registered manager. We spent time observing how staff interacted and supported people. We saw staff treat people in a sensitive, respectful and professional manner.

All the people we saw looked happy living at The Old Rectory and the people we spoke with were complimentary about the home. People told us that they “could not fault the place” it was like a “hotel” and that the “staff were marvellous” and that the “staff were lovely and you don’t have to worry about anything”. One relative told us that they eat with their relative regularly and that the “food was good” and another visitor told us that “staff are unobtrusive and pop in regularly to check that people are happy”.

This service provides nursing care for older people with cognitive and physical difficulties. On the day of the site visit there were thirty-two people in residence

The registered manager said, “All of the people who use the service have capacity to make decisions and to sign their care plans". One person said, “The staff consulted with me, and I signed the care plans to show I agree to the care and support in the plans”.

People told us they were very happy with the care and support they received. They told us they “could not fault the nurses”. They said, “The staff, every one of them, including the night staff are just wonderful. They will do anything for us”. One person said, “The staff discuss my care with me. I know what is going on. Nothing is hidden from me”.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care. People had their medicines at the times they needed them from staff qualified to administer medicines. People's comments were considered and responded to appropriately. People and their relatives spoke highly of the care they received. People treated their lunch period as a social occasion. They appeared to enjoy their food and the whole ambience and atmosphere of having a meal. Appropriate recruitment checks were not undertaken before staff began work.

People who use services at The Old Rectory are predominantly older adults. Some of whom have multiple or complex health needs. Those people who spoke with us were very happy and positive about the quality of the care they received at the service.

We observed that people were relaxed and at ease in their surroundings and were involved in meaningful activities. They were supported by staff in a way that demonstrated their rights to respect, dignity and privacy.