Villa Maria Private Nursing Home is a ‘care home’ which provides nursing care and treatment. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 26 people. At the time of our inspection 24 people were living in the service. People had a range of needs including dementia, late stage cancer and physical disabilities.

This unannounced inspection took place on 26 April 2018.

At our last inspection in 17 September 2015 we found the service was ‘Good’ in all the key questions we ask of services and so we rated the service ‘Good’ overall.

The service 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.

The provider did not always ensure bed rails were used safely to protect people from the risk of harm. Pressure relieving mattresses were not always used appropriately to reduce the risk of pressure ulcers, although the service reduced the risk of pressure ulcers in other ways. People received their medicines are required.

The provider did not always follow the Mental Capacity Act (MCA) 2005 in assessing whether people lacked capacity to consent to their care. In addition the provider had not always followed their legal duty when depriving people of their liberty.

Although people received care which met their needs and preferences care plans required improvement to act as suitable guides for staff. Care plans, including end of life care plans, were not always ‘person-centred’ setting out the best ways to care for individuals.

The provider lacked suitable systems to check they were providing care in line with Regulations. The provider had not identified the breaches we found before we inspected the service and so had not taken the necessary action to improve.

The premises met people’s needs in relation to their disabilities. A programme was in place to maintain the safety of the premises.

Systems were in place to safeguarding people from abuse and improper treatment. There were enough staff deployed to care for people and the provider checked staff were suitable to work with people through recruitment checks.

Staff were supported with a programme of supervision and training and were encouraged to do diplomas in health and social care.

The provider consulted with people as part of assessing their needs and also reviewed any professional reports. People were involved in decisions regarding their care. People were supported in relation to their health.

People developed good relationships with staff who were caring. Staff were respectful and understood the people they cared for. Staff treated people with respect and maintained people’s privacy and dignity.

The complaints process was suitable and the provider responded to any concerns raised appropriately.

Leadership was visible and the registered manager acted as a role model to staff, interacting with people and providing personal care to people in their daily work. The directors were also visible in the home and accessible for people, relatives and staff.

The provider gathered feedback from people and relatives regarding the quality of care and the communicated openly with staff and external professionals.

At this inspection we identified some breaches of regulation. You can see the action we asked the provider to take on the back of our full-length report.

This was an unannounced inspection that took place on 17 September 2015.

Villa Maria Private Nursing Home provides accommodation and nursing care for up to 26 people, who have various complex needs. There were 23 people living in the home when we visited.

The home had a registered manager. 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.

In August 2013, our inspection found that the home met the regulations we inspected against. Since then changes had taken place, and in May 2014, a new provider purchased the service.

People and their relatives told us the home had a new owner. They said that it still provided a “great service”, an atmosphere that was enjoyable and they liked living there. Three generations of one family had used the service over the years.

Health and social care professionals told us they felt it was a caring and homely service which met people’s needs effectively. They said people liked the small scale environment and found it a welcoming alternative to larger scale establishments whilst maintaining the high standard of care. A health professional involved with people in the home said there was “good communication and plenty of engagement with professionals.” They also told us staff were proactive in addressing people’s health care needs.

Staff provided good quality care with tenderness and compassion at the end of people’s lives that took their wishes into account. The care records were sufficient detailed and up to date. These provided the correct information for staff to enable them deliver the care and nursing people required.

Referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being. People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, such as GPs as required. People were protected from risks associated with nutrition and hydration. People were positive about the choice and quality of food available, they had a variety of menus to choose from that met their likes, dislikes and preferences.

The home was safely maintained, suitably furnished, clean and fresh smelling. A refurbishment programme was underway to help improve the environment.

Staff engaged with people in a friendly manner and assisted them as required, whilst encouraging them to be as independent as possible. Staff were very knowledgeable about the people they cared for and the field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. Staff said they had access to good support and career advancement.

Staff were supported through an induction support network and on-going training, based on the needs of the people who used the service. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

Good leadership was present in the home. People using the service and staff reported on strong and clear direction given by the manager within the home. Relatives said the manager inspired them with confidence, she was approachable and responsive. The provider consistently monitored and assessed the quality of the service provided to drive improvement.