This comprehensive inspection took place on 13 June 2018 and was unannounced.

Witnesham nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection of 13 March 2017, we rated the service as ‘Requires improvement’ because the environment did not always meet people’s needs and people were not always offered choices in all aspects of how they lived their daily lives. People’s care plans recorded their preferences but did not always detail how these would be met. The service did provide a variety of activities but these were not always directed towards people’s preferences. Audits to check the quality of the service provided were carried out but had not been in place long enough for to determine if they were effective.

At this inspection of 13 June 2018, we found the service had taken action on the above and we have rated the service as ‘Good’.

At the time of our inspection there were 18 people living at the service. There was a lounge, dining room, conservatory and secluded gardens for people to use and enjoy. The service had changed the service layout since our last inspection so that people could easily view televisions and the garden as they wished. People were supported to make choices of when they got up and when they retired for the day. Activities were focussed upon the interests of the people using the service we saw people making fudge and the day before our inspection people had visited a garden centre and bird sanctuary. The service had audits in place which were acted upon for the smooth running and development of the service.

At the time of this inspection, the service had not had a registered manager in post since April 2018. The service was now being managed by a previous registered manager of the service and they had re-applied to become the 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.

There were arrangements in place to protect people from risks to their safety. Staff had received training regarding the safeguarding of people. Staffing levels of nursing and care staff were appropriate to support people to meet their assessed needs. There was a robust recruitment process in place for employing staff to support the people living at the service. Processes and procedures were in place to receive, record, store and administer medicines safely. Infection control training had been provided for the staff and procedures in operation were designed to keep people safe.

People were cared for by staff who received supervision and on-going training to develop their skills to support people with their assessed needs. Staff encouraged people to eat sufficiently and have drinks of their choice. People were supported promptly as required to see a range of healthcare professionals in order to maintain good health. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Care was delivered in an understanding and empathic way to meet people’s needs. People were supported by staff to make day to day decisions about their care. This included what they chose to eat and the times they got up and went to bed. The staff respected people’s dignity and privacy.

Each person had a care plan which was based on an individual needs assessment and took into account people’s preferences. The care plans were reviewed monthly and more regularly if so required to remain up to dat

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 told us they felt safe living at Witnesham Nursing home and we saw staff worked as a team to help keep people safe. Staff demonstrated they understood how to keep people safe and risks to people's safety and wellbeing were assessed and kept under regular review. People's medicines were managed safely, by staff who had received training. Improvements were needed in the protocols for the administration of medicines prescribed to be given ‘as required’ (PRN).

People’s care plans and risk assessment had been revised since our last inspection. People and their relatives, where appropriate, had been involved in the writing of the new care plans. The new care plans still required further improvement as some did not always identify how people’s needs and preferences were met.

The service provided a variety of activities but these were not always targeted at people’s expressed interests.

People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely. There were recruitment process in place, records demonstrated that the appropriate pre-employment checks had been completed. Staff were supported by the management team and received regular one to one supervision. Staff told us they felt supported by the registered manager and provider.

People received the assistance they needed to eat and drink sufficient amounts to help keep them healthy. They told us that the food was good and we observed people being offered a choice of food for their lunch. People were supported to maintain their overall health and staff made referrals to healthcare professionals when required.

We observed staff to be kind and caring. They staff knew people's individual requirements in relation to their care and support needs and preferences. People and or their relatives had been involved in the planning of their care where they were able to and where this was appropriate.

People and their relatives were positive about the staff and management at the service. There were systems and processes in place to regularly monitor the quality of the care and support provided for people who used the service. However, these now needed to be embedded into the service and had not been in place long enough for us to assess if they were effective.

This inspection took place on 26 July and 16 August, 2016. The first visit was unannounced.

Witnesham Nursing Home provides care and support for up to 30 people. On the day of our inspection there were 29 people living in the service.

There was a registered manager in the service. 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 service was not safe. Inadequate assessment of people’s needs and inadequate risk assessments meant that people were risk of harm or receiving care and support which did not meet their needs.

People did not always receive personalised care that met their needs. Care plans were muddled and did not always show how people’s preferences as to how they received their care and support were met.

Medicines were stored safely. However, where people were prescribed their medicines on an as required basis there were no protocols in place to ensure this was given correctly.

The environment required updating and was cluttered with a lack of space for essential equipment to be stored. This meant that it presented a trip hazard and also increased risks when providing some aspects of people’s care. The design and decoration of the service did not always recognise people’s needs, for example those living with dementia. Plans in place by the provider to improve the environment were superficial and did not show a drive to improve the service.

Staff did not always receive the training they required to provide an effective service particularly with regard to specialist equipment such as hoists. Staff training was not monitored effectively to ensure that all staff were up to date with training.

People received adequate nutrition to meet their needs. However, due to the cluttered nature of the service the dining was not an enjoyable and social experience.

Activities and outings were organised by the service and a group of relatives. The service had recently employed an activities co-ordinator who was working towards ensuring that activities provided were appropriate to the individual and reflected their expressed preferences.

The management of the served was not pro-active in identifying problems. There was significant scope to improve care practices within the service and improve people’s daily experiences

Staff were recruited in a manner which ensured they were suitable to work in this type of environment.

We spoke with three people who used the service, three relatives, three members of staff and looked at six care plans as part of this inspection. People who used the service told us that they were very happy with the care they received, they felt safe and the staff were kind. One relative told us “The care here is A1.”

People told us that they liked the food, one person said “It is very good and a nice selection.”

We found that the service was meeting the personal, emotional and healthcare needs of people using the service. People are encouraged to personalise their rooms with pictures, photographs and personal items.

We found the medication was stored securely as were the care files for people who used the service. Staff training was up to date.

People we spoke with on the day of the review were all happy with the treatment and support they received from the service. They were cared for by a motivated and well trained staff team. Relatives that we spoke with who were visiting on the day of the review all felt happy with the standard of care being provided.