Westbourne Nursing Home is a ‘care home’. 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. Westbourne Nursing Home accommodates 36 people in one adapted building. At the time of our inspection visit there were 28 people living at the care home.

At our previous inspection in April 2016 the service was rated "Good". At this inspection we found the service remained "Good". At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of our inspection visit Westbourne Nursing Home did not have 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 current manager was planning to apply to be registered with the CQC.

We heard positive comments about the service such as “I’m quite happy here”. “I am very happy we chose Westbourne” and “Very pleased with Westbourne and the caring staff”.

People were protected from harm and abuse through the knowledge of staff and management. Robust staff recruitment procedures were used and staff were supported through training and meetings to maintain their skills and knowledge to support people. Sufficient staff were deployed.

We found the environment of the care home was clean and had been well maintained. People’s medicines were managed safely using a new electronic system.

People received personalised care and support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had opportunities to take part in a variety of activities. People were supported to maintain contact with their relatives. There were arrangements in place for people and their representatives to raise concerns about the service. Care was provided for people at the end of their life.

The provider had informed commissioners of their decision to end provision of nursing. A plan was being followed to end the provision of nursing care at the care home. Effective quality monitoring systems were in operation.

Further information is in the detailed findings below.

This inspection took place on 28 and 29 April 2016 and was unannounced. The care home can provide accommodation and care to up to 36 older people, some who live with dementia. At the time of the inspection there were 31 people living there. The service also provides nursing care with nurses on site at all times.

The service had a registered manager in position. 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 kept safe. Risks to people’s health and welfare were identified and managed well. A shortfall in how windows were restricted was identified during the inspection but addressed immediately. People were protected from abuse because staff knew how to manage this. People’s care was planned and reviewed with them and if they were unable to do this, with their relatives. People were well informed of any changes to their care or treatment, as were their representatives. People’s medicines were managed safely and they received their medicines as prescribed and when they needed them. People who were assessed as lacking mental capacity were protected under the correct legislation. Staff supported people to make decisions and choices where possible. There were enough staff to meet people’s needs. Staff recruitment practices helped to protect people from those who may not be suitable to care for them. People’s care was delivered with kindness and compassion and their dignity and privacy maintained at all times.

People received help to eat their food and drink and they were provided with a choice. People’s levels of nutritional risk were identified and the correct action taken to address this. Staff were well trained and supported to meet people’s needs and manage their risks. People had access to health care professionals when needed. Health care professionals told us they had no concerns about the care or treatment provided to people by the staff. People were provided with very good opportunities to take part in social and meaningful activities. These activities were enjoyed by most who took part in them. For some people the activities and care they had received had had an exceptional impact on their health and quality of life. People and their representatives were able to raise a complaint, have this taken seriously, investigated and responded to. Areas of any dissatisfaction were addressed and resolved quickly.

People benefitted from having a registered manager in place who provided strong leadership and who was respected by the staff. Staff were committed to the registered manager’s visions and values and worked hard to meet their expectations. There were arrangements in place to obtain people’s views and ideas. Relatives also had opportunities to feedback and express their views. Staffs’ feedback and ideas were also valued. Quality monitoring systems were in place to ensure the service performed well and met with various regulations and legislation. This process was used to help improve the service further.

We visited Westbourne House to check one compliance action we made at a previous visit on 3 September 2013. We did not speak to people using the service this time as we were checking medication records. We found that medication record keeping had improved and new additional procedures had been implemented to check recording systems. We found that staff competency had been monitored with regard to safe management of medicines.

On entering Westbourne Nursing Home we found the atmosphere warm and welcoming. We found that there had been improvements at the home since the last inspection with a twelve bedded extension being added.

We spoke with a number of people living at the home and observed staffs understanding of the care and support needed. The people who used the service we spoke with said that all staff "are very nice and friendly" and "everybody is so happy here." One person told us that they had "a lovely view and a nice airy room" and we saw that the rooms were tastefully decorated with their personal belongings.

We looked at people's individual files which incorporated their personal and social profile, care plans and risk assessments and found they encompassed the safety and well-being of people who use the service.

People who used the service told us that they knew how to raise a concern or complaint and felt confident in doing. They said if they had any issues or concerns they could "talk to the manager." There were policies and procedures in place providing guidance and all staff had received safeguarding training which was identified on the training schedule.

We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service.

When we visited the service there were 21 people accommodated as several bedrooms were unavailable due to the building of a 12 bedded extension, which was due to be completed in January 2013. We spoke with five people, three relatives, three members of staff and the manager. People were pleased with the care and treatment they had received and told us, "the staff treat me with respect they are all very good", "the staff help me keep mobile" and "I have seen my care plan and staff writing in it". Activities were provided in the home but some people would have liked to go out in the community more often.

Relatives told us, "the staff always ring me when necessary" and "the care here is brilliant". We looked at peoples' care plans and asked them about their care. One person told us the staff had done everything they wanted and they felt safe.

We found that people were protected from the risk of abuse as the staff had been regularly trained to identify and report any form of abuse.

The staff told us that they had been well trained and supported by the managers and nursing staff and that they all worked together as a team. The manager had asked people monthly about their care and had recorded any changes they had wanted and their satisfaction with the service. People had told the manager they enjoyed the activities in the home and were looking forward to the events planned for Christmas.

People told us the staff treated them with dignity and respect and one person told us "the care provided could not be better".

People living in the home told us about the staff, they said; "the staff are very good, they know what to do", "the staff are respectful", "the staff knock on the door, and always treat me with respect" and "the staff are very good and always treat me with respect".

People told us that the staff asked them what they wanted to do each day, which they liked. One person told us that sometimes she liked a day in bed and a late breakfast. Most people told us they enjoyed the food provided, but additional choice would be welcomed.

One person told us about the support provided by other healthcare professionals outside the home to help ensure that particular needs are well met. Other people told us that their doctor visits them when they feel unwell.

People told us that any concerns they have are shared with the staff directly and they deal with them straight away.

People also told us they were satisfied with the facilities the home provided and they liked their own bedrooms, which were kept clean.