Wyncourt Nursing Home is situated in Timperley, a suburb of Altrincham, Cheshire. It is within walking distance of Timperley village and other local amenities. The Home also has good access to all public transport services. The home is registered to provide care and treatment for up to 35 people who require nursing care. On the day of the inspection there were 34 people resident at the home. The home supports a number of people who are privately funded.

The provider was also the owner and 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.

The registered manager was supported by a deputy manager and a junior deputy manager in the day to day running of the home. There were three floors, the ground floor housing some bedrooms, lounges, conservatory, garden room, bathrooms and dining room. The first floor had more bedrooms and bathrooms and the second floor had the manager’s office, training room and hairdressing room.

At our last inspection in February 2016 we rated the service 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.

.

People felt safe at the home. Safeguarding adults and whistle blowing policies were in place. and staff had undertaken training. Health and safety measures were in place and general and individual risk assessments had been completed appropriately. All risk assessments were regularly reviewed and updated as required.

Staffing levels were high and people said there were always enough staff to meet the needs of the people who used the service. Staff induction was thorough and training was up to date. The recruitment process was robust. Medicines systems were safe and appropriate. Care records included relevant health and support information.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Care was person-centred and people were given choices. Appropriate equipment, was used to help ensure people remained as independent as possible. People said the food was good and there were choices available.

People were treated with the utmost respect and compassion. Relationships between staff and people who used the service were friendly and relaxed. Relevant policies with regard to General Data Protection Regulation (GDPR), confidentiality and privacy were in place.

There were activities occurring throughout the day and people were taken out on trips. Complaints were responded to appropriately.

People we spoke with told us the registered manager was always accessible if they needed to speak with them. Staff we spoke with said they were well supported by management.

Staff supervisions and appraisals were undertaken on a regular basis and staff meetings were held regularly. Quality checks were undertaken regularly and results monitored and analysed to drive improvement to service delivery.

This was an unannounced inspection which took place on 23 February 2016. We had previously carried out an inspection in September 2014 when we found the service to be meeting all the regulations we reviewed.

Wyncourt Nursing Home is registered to provide care and treatment for up to 35 people who require nursing care. On the day of our inspection the home was fully occupied. The home supports a number of people who are privately funded.

The provider was also the owner and 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. The registered manager was responsible for all the services delivered by the provider. They were supported by a deputy manager in the day to day running of the home.

People who used the service told us they felt safe at the home and had a good relationship with the staff that supported them. During the inspection we observed staff were caring and respectful in their interactions with people who used the service.

Recruitment processes were robust and the correct checks had been done to help protect people who used the service from the risk of staff who were unsuitable to work with vulnerable people.

People received their medicine from suitably skilled and qualified staff. Medicine was stored securely and administered safely.

Systems were in place to help ensure the safety and cleanliness of the environment. A dedicated team was employed to make sure the home was kept clean at all times.

Staff told us they received the training and support they needed to carry out their role effectively. There were systems in place to track the training staff had completed and to plan the training required. All the staff we spoke with told us they enjoyed working in the service and felt valued by the deputy manager and each other. Staff said felt able to raise any issues of concern in supervision and in staff meetings.

The registered manager had a good understanding of the Mental Capacity Act 2005. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and support and people were supported appropriately in line with the Act.

People who used the service had support plans in place. Records were stored electronically and were easily accessible by staff. Records reviewed showed that, where necessary, people were provided with support from staff to attend health appointments. People who used the service confirmed they were happy with the level of support they received.

People we spoke with told us they felt able to raise any concerns with the deputy manager and were confident they would be listened to. We noted systems were in place to encourage people who used the service to provide feedback on the care and support they received.

Quality assurance systems in place were used to drive forward improvements in the service and the home was involved in forums within Trafford to improve nursing care and share good practice.

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

We spoke with two people using the service, three relatives, the deputy manager and a nurse, two carers and an activities coordinator. We also reviewed records relating to the management of the home which included care plans for three people, medication administration records, staff training records and quality audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. People said that they felt safe living at the service. Individual assessments for all the people using the service helped staff to identify risks and develop strategies to prevent avoidable harm. During the day most people chose to spend time in one of three communal lounges and we saw that at least one member of staff was present in each area. This meant that staff were close by if people needed assistance and people were less likely to fall.

Equipment available in the home to help people to stand, turn or move had been well maintained and serviced regularly. There was enough equipment available. There was a system in place to ensure that when a hoist was needed to help people move safely, a sling of the appropriate size was used and was only used for one person before being washed. Trained nurses managed medicines safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that if people are deprived of their liberty, it happens in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. While no applications had needed to be submitted, proper policies and procedures were in place. The managers understood recent changes to the law and had met with local authority representatives to discuss the implications for people living at the home. This helped them to understand when an application should be made.

Is the service effective?

The service was effective. People were supported to live the way they chose and experienced care and support that met their needs. People told us that they were happy with the care they or their relative received and felt their needs had been met. One person said the nurses were, “Excellent” and that they always “Answer questions and give information.”

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. A relative said, “They all know him now.” They said that the staff all seemed to know what they were doing. Relatives and a person using the service said they would recommend the home to other people.

Staff had received appropriate training to meet the needs of the people living at the home. Staff acted to protect people from the risk of poor mobility and falls, pressure ulcers and other risks.

The service was actively working towards improving care for people living with dementia and hoped to apply for local authority accreditation of the Dementia Kite Mark. This is evidence that the service provider is committed to delivering the best possible care and support to individuals with dementia as well as evidencing a commitment to service development.

It is a prerequisite of the Trafford Authority that in order for providers to achieve the Dementia Kite Mark they have already been accredited with the Trafford Dignity in Care Award and this was awarded to the service in 2013.

Is the service caring?

The service was caring. All of the people living at the home and relatives that we talked with spoke positively about the caring and friendly attitude of all the staff. The service maintained records about people’s preferences and dislikes and staff knew about them.

People told us they were able to take part in activities that they enjoyed and our observations confirmed this. We spoke with staff who knew people’s needs and we observed them interact with different people in a kind and caring way, using humour when appropriate. We saw that nurses and carers were patient and gentle when helping people. They talked about people with concern and understanding and enthusiasm for the work they did in caring for them.

When appropriate, plans had been discussed and agreed with people and their families about end of life care. This helped staff to know their wishes and to ensure that people had dignity, comfort and respect at the end of life.

Is the service responsive?

The service was responsive to the changing needs of people using the service and invited comments and suggestions. We saw that assessments of people’s needs resulted in care plans that staff read. The care plans helped staff to know the needs and care that individual people required. Care plans were changed if people’s needs changed. People that we spoke with did not remember being involved in reviewing care plans.

Feedback from relatives about the responsiveness of the service was inconsistent. Negative comments concerned the communication they had received from staff about people using the service. Other relatives were happy with the communications they had with all members of staff. All of these people that we spoke with were happy with the overall care that the person using the service received.

People living at the service and relatives told us that carers and nurses were responsive to their everyday needs, requests and choices.

Is the service well led?

The service was led by a registered manager and a deputy manager. A nurse said that the manager, “Leads by example.” A carer described the managers as being very, “People focussed,” and always concerned with what was best for people living at the home. Care staff understood their roles and were happy and motivated. All staff felt that the manager was accessible, approachable and responsive to ideas or suggestions for improvement of the service.

The service had a system in place to monitor and assess the quality of the service. Action plans had been implemented to make improvements to the quality of the home. The atmosphere of the home was described as happy and pleasant by people who lived there and by relatives and other health professionals who had completed a survey.

Records were fit for purpose, held confidentially and securely and disposed of appropriately.

During the inspection, we spoke with one person who used the service and the relative of another person who used the service. They told us the staff asked their permission and that the staff kept them involved in the review of their care.

We found that people were asked for consent and the provider acted in accordance with people’s wishes. People’s health, safety and welfare was protected because the provider worked in co-operation with other health professionals.

We found that the provider had processes in place to ensure people who use the service were protected from the risk of abuse. The people we spoke with told us that they had no concerns about the care they received. They told us that if they had any concerns or complaints, they would speak to the registered manager.

We found there were enough qualified, skilled and experienced staff to meet people’s needs. The people we spoke with told us the staff were friendly and supportive. They told us there were enough staff at the home and they did what was asked of them. There was an effective complaints system available, in case anyone wished to raise a complaint.

During our inspection we spoke with two people living at Wyncourt Nursing Home and the relative of one person.

The people we spoke with were happy with the care they received. One said "I'm in safe hands. There's always a member of staff you know is competent". Another person said "Nurses will do anything for you. They're so helpful". The relative of one person told us "[My relative] is very well looked after and they're happy".

One person said "[The care workers] talk to me like I like to be spoken to, not like I'm an invalid". Another person said "You can tell anyone if you're not happy and I feel comfortable at all times". They said there were always activities to join in if they wanted to, and said "It's up to us when we get up and go to bed, and we can spend whatever time we like in our room".

The results of the most recent satisfaction survey showed that 92% of people and their relatives said staff always knocked on doors and waited to be invited into people's rooms, and 96.9% of people and their relatives said staff respected their dignity at all times. Comments included "I feel [my relative] is well cared for and their disabilities are understood" and "The only comfort in coping with [my relative's] illness is that all the staff at Wyncourt really do care and do their utmost to go the extra mile".