This inspection took place on 17 November 2016 and was unannounced.

Westvilla Nursing Home is located in a pleasant residential area in Retford. The home is purpose-built and is registered to provide accommodation for a maximum of 35 people. On the day of our inspection 32 people were using the service.

The service 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 2008 and associated Regulations about how the service is run

People who used the service and staff at Westvilla knew who to report any concerns to if they felt anything untoward had occurred. People’s care records showed that any risk to their safety had been identified and measures were put in place to reduce these risks. There were enough staff with the right skills and experience to meet people’s needs. People’s medicines were stored and handled safely, but people could not be assured that their medicines were always administered as prescribed. However, the manager was aware of the difficulties and was taking robust action to improve standards with regard to the administration of medicines.

People were supported by staff who had received the training they needed to support people effectively. People had consented to the care that they received. People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

People spoke positively about the food they received. They were able to have choice in what they ate at each meal and received support to eat if required. People had regular access to their GP and also other health care professionals when required.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Staff encouraged people to remain independent wherever possible and where people showed signs of distress or discomfort, staff responded to them quickly. There were no restrictions on friends and relatives visiting their family members.

People received the care they needed in a way that met their needs. We saw staff provide planned care well. Care plans were written with the involvement of each person and their family. They were reviewed regularly to ensure staff responded appropriately to any change in need a person may have. A wide range of group and individual activities were available for people to participate in if they wished. People were also encouraged to maintain their hobbies and interests and a wide range of community based opportunities were used. A complaints procedure was in place and people felt comfortable in making a complaint if needed.

The atmosphere within the home was warm and friendly. People living in the home were asked for their opinions with regard to the service that they received, which meant that their views informed decisions to improve the service. Staff understood the values and aims of the service and spoke highly of the registered manager. The registered manager had clear processes in place to check on the quality of the service and to ensure that any improvements identified were made and sustained

We performed the unannounced inspected at the service on 05 and 06 November 2014. Westvilla Nursing Home is registered to provide accommodation for a maximum of 35 older people. On the day of our inspection 30 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

When we last inspected the service on 07 November 2013 we found there were improvements needed in relation to how people gave consent to their care. The provider sent us an action plan telling us they would make these improvements by January 2014. We found at this inspection that this had been completed and the provider had made improvements in line with the action plan.

We found systems were in place to protect people from the risk of abuse and staff were aware of their roles and responsibilities in this area. The registered manager also shared information with the local authority when needed.

People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were maintained at appropriate levels to support people’s individual needs and people received care and support when needed.

People made decisions and choices where they were able to and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition and dehydration and specialist diets were provided when required. Referrals were made to health care professionals when additional guidance was needed.

People were encouraged to contribute to the development of their care plans and were involved in the planning of their care.

People were treated with dignity and respect. Staff were proactive in promoting people’s choice and were kind and caring when supporting people with their individual needs.

People were encouraged to be involved in decisions about the service and systems were in place to monitor the quality of service provision. People felt they could report any concerns to the management team and they felt their concerns would be responded to and taken seriously.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with five people who used the service and two visitors to the home to establish their views on the quality of service provision. We also spoke with the unit manager, two qualified nurses, the cook and carers. We looked at some of the records held in the service including the care files for three people. We observed the support people were receiving from care staff and carried out a brief tour of the building.

People told us that staff obtained their consent before any interventions were performed. One person told us, “They (care staff) are very respectful. We can do what we want really.” Another person said, “I cannot fault any of the staff. I feel safe and well looked after. They always tell me what they are doing so I can agree.”

We found that improvements were required to ensure that documentary evidence was available to show that people’s plans of care were discussed and explained to them so they could provide informed consent. We also found that where it was suspected that person lacked the capacity to make informed decisions about their care package appropriate assessments had not been undertaken in all instances.

We found that suitable and nutritious food and drink was available in sufficient quantities to meet people’s individual needs and preferences.

People told us they were very satisfied with the staff and found them to be caring and attentive to their needs. One person told us, “All the staff are marvellous and they look after us well.” Another said, “I cannot fault it here the staff are all very kind.”

Systems were in place to manage any concerns and complaints and people felt confident in reporting any issues to the management team.

A relative we spoke with told us “My relative has been here for five years. I’ve never had reason to complain or to worry about them.”

Another person said “My relative has settled really well and is quite content.”

We spoke with three people who were living at the home. One person told us “I’m well looked after and the carers are very nice. The food is lovely and I get plenty to eat. “

We spoke with three members of staff who all said they were happy working at Westvilla. They told us “The training is very good and there is always new training planned.”