This inspection took place on 21 March 2017 and was unannounced. At our last inspection in September 2016 the service was rated as requiring improvement. We found people's risk assessments were not effectively reviewed to ensure they were reflective of people's needs and provided guidance and direction to staff to follow. We also found people's care plans did not always provide direction and guidance for staff about how to meet people's individual needs; and that people's care plans were not effectively reviewed. At this inspection, we found improvements had been made. New systems ensured that risk assessments were in place to help reduce any risks related to people's care and support needs. These were reflective of people's needs and were regularly reviewed. Detailed care plans were in place which guided staff how people wanted their needs met. These were reviewed regularly with people and those important to them.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 27 people were receiving care at the service.

There was a registered manager in post. A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

There were safe practices in place to ensure people received their medications safely and on time. Medications were stored in a designated area of the home and were only given out to people by staff who were trained to do so.

There were recruitment checks in place to ensure that staff were safe to work with vulnerable people.

Staff were able to describe the course of action they would take if they felt someone was being harmed or abused in any way. This included raising and reporting safeguarding concerns. Staff also said the home's whistle blowing procedure was discussed regularly with them, and they would not hesitate to use this procedure if required.

Staff were well supported in their role and had access to training to enhance the skills they required for their role. There were opportunities for staff support and we saw effective teams at work. Staff were happy and motivated with good communication between shifts.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards. (DoLS) The MCA ensures that where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interest according to a structured process. DoLs ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People told us they enjoyed the food. Mealtimes were a positive experience, which people told us they looked forward to. People told us meals were of sufficient quality and quantity and there were always alternatives on offer for them to choose from. People were involved in planning the menus and their feedback on the food was sought.

Care plans, with regard to people's preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Care plans contained a high level of person centred information. By 'person centred' we mean the service was tailored to meet the needs of the person, and not the service.

Complaints had been responded to by the registered manager and appropriately dealt with including any changes which needed to be implemented because of the complaint. There were no

The inspection was unannounced and took place on 23 September 2016. The inspection was undertaken by two adult social care inspectors. At the last inspection in April 2016 the service was given an overall rating of good.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 36 people were receiving the service, including three people receiving respite care.

The home had a registered manager who had been in post since January 2015. 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 and well cared for and staff we met understood people's individual care needs and had received training. However we found that, some staff training, which was required to be updated annually had not been provided in timely way, to ensure people who used the service were safe at all times.

There were good links with health and social care professionals. However, we found a small number of instances when staff had not always acted upon the advice received, so that people's needs were not always met.

Although the registered manager, people and their visitors told us there were enough staff to keep people safe, some staff told us there were busy times during the day when it became difficult to meet everyone’s needs.

Pre recruitment checks were undertaken before staff started work in the service. However, there were occasions when the provider had accepted personal references, rather than pursuing references from applicants’ previous employers.

People and their visitors expressed very positive views about the staff and the care provided. Staff were kind and caring in their approach and interacted with people in a positive way.

People were cared for by staff that demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse.

People told us they enjoyed meal times and were positive about the choice of food they received.

People said their privacy and dignity was maintained and our observations supported this.

People were encouraged to express their views and give feedback about their experience of the service. People said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff spoke highly of the teamwork within the service.

The quality of service provision and care was monitored and actions taken to improve the service where required. However, the quality monitoring system had failed to identify and address the shortfalls we found at this inspection and some issues that had been identified had not been addressed in a timely a way.

The inspection was unannounced and took place on 19 April 2016. The inspection was undertaken by one adult social care inspector.

The Old Rectory Nursing Home provides personal and nursing care and is registered for 36 older people including those living with dementia. On the day of the inspection 33 people were receiving care services from the provider. The home had a registered manager who had been in post since January 2015. 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 had positive views about the staff and the support they were given for their particular care needs. Staff were kind and caring in their approach and people and staff interacted in a positive way. People told us they found the staff to be approachable and relaxed in manner and they could speak to them at any time.

People told us they felt safe and well cared for and staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively to ensure people who used the service were safe. People were cared for by staff that demonstrated knowledge of the different types of potential abuse to people and how to respond to actual or suspected abuse.

The assessments of people's capacity to consent had been completed. People's rights and freedoms were respected by staff. Staff understood people's individual care needs and had received training so they would be able to care for people in the best way for them. There were good links with health and social care professionals and staff sought and acted upon advice received so that people's needs were met.

People using the service were positive in their feedback about the service. People told us they enjoyed meal times and were positive was about the choice of food they received. People said their privacy and dignity was maintained and we made observations that supported this.

People received care that met their individual needs. People were encouraged to express their views and give feedback about their time at the service. People said staff listened to them and they felt confident they could raise any issues should the need arise.

Staff spoke highly of the management team and felt supported. Staff spoke highly of the teamwork within the service. The quality of service provision and care was continually monitored and actions taken where required.

Our inspection looked at our 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 using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff, and staff were given support and guidance to ensure that they cared for people safely. People benefited from named staff to undertake their care. People were cared for in a clean, hygienic and well maintained environment. Systems were in place for managers to monitor the quality of the service and make sure it was run safely.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans contained assessments of people's care and support needs. These assessments described the steps staff should take to ensure each person's needs were met. Staff received appropriate support to meet the needs of people living at the home. Audits and reviews took place to ensure that care was delivered in a way that met people's needs.

Is the service caring?

We observed that staff were caring and respectful towards people. Most care tasks we observed took place in a patient and kind manner. People spoke positively about their experience of receiving care at the home.

Is the service responsive?

Staff acted on people's needs and in accordance with their wishes. Where people needed specific support or care, we saw evidence that this was delivered in accordance with people's needs.

Is the service well-led?

There was a quality assurance system in place, where staff carried out a quality monitoring programme. This was detailed, frequent and thorough. Staff we spoke with believed they were well led and had confidence in the management team.

We carried out this inspection in response to concerns raised by the local authority relating to the provision of end of life care for people who used the service, in particular the management of pain relief and nutrition and hydration.

There were care plans in place to support people at the end of their life. The plans included areas such as people's wishes, pain management, fears and expectations. This ensured staff were aware of people's wishes and decisions relating to their end of life care and treatment. A relative we spoke with raised no concerns about the standard of care being provided. We observed people were being provided with nutrition and hydration and people's intake was being monitored by staff.

During our inspection we spoke with people who used the service and their relatives. People spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. One person said "We all get looked after very well." Relatives we spoke with were also complimentary about the service. One relative told us "The care has been marvellous, any concerns and the staff follow this up."

People were provided with a choice of suitable and nutritious food and drink. People confirmed the food was good and they had plenty of choice. They were supported to be able to eat and drink sufficient amounts to meet their needs.

There were effective systems in place to reduce the risk and spread of infection. We found the home was clean and well maintained.

There were enough qualified, skilled and experienced staff to meet people's needs. During our inspection we observed staff were able to meet people's needs in a timely way.

People were given support by the provider to make a comment or complaint where they needed assistance. People we spoke with confirmed they could raise any concerns with staff and these would be acted on. The service had a system in place to record and analyse all incidents, accidents and complaints. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

During our inspection we spoke with a number of people who used the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. We received comments such as: "We do what we like", "Everyone is great here, I get good care and support" and "It's nice, plenty of company."

People living in the home, confirmed they felt safe and said they liked the staff who looked after them. One person said: "It's very safe; staff are very kind and look after us very well." Another person told us: "Staff are very caring, they sort out problems or concerns quickly."

People who used the service and relatives were very satisfied with the service and staff. They told us staff promoted privacy, dignity and respect throughout their care giving and that communication between staff and others was "fantastic". They praised the staff for being professional, caring and supportive. They said nothing was too much trouble for the staff to do.