This comprehensive inspection took place on 17 and 20 April 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming.

Amberwood 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.

Amberwood Nursing Home is located in the seaside town of Exmouth. It is a two storey detached building with a passenger lift enabling people to access all areas. There is a main communal lounge and small dining area where people could spend their time as they chose. To the rear of the house is a well maintained secure garden with patio doors leading out and parking to the front. The service is registered to provide personal and nursing care for up to 24 older people. There were 17 people using the service on the first day of our inspection.

We last inspected the service in January 2016, at that inspection the service was rated as 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 this inspection we found the service remained Good.

Why the service is rated good

There was an experienced registered manager who managed Amberwood and the provider’s other service, which is also in Exmouth, Linksways. A registered manager is a person who has registered with CQC to manage the service. Like registered persons, 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. At the time of the inspection, the acting manager was running the service as the registered manager was on leave.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken. There were sufficient number of staff on duty to care for people safely. Where there were any shortfalls the provider used the services of a local care agency to provide care at the home. Staff were up to date with training; Staff had completed additional training courses linked to the needs of the people using the service. Equality and Diversity was part of the provider's mandatory training requirements and people were cared for without discrimination and in a way that respected their differences.

Care records contained detailed risk assessments. People had individual personal emergency evacuation plans in place. The management team recorded and monitored accidents and incidents. Regular maintenance checks and repairs were carried out; all areas of the service were clean and tidy.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The management team had made submitted appropriate Deprivation of Liberties Safeguards DoLS applications. At the time of our inspection there were four applications submitted. Mental capacity assessments were undertaken and best interest decisions were recorded.

Staff felt well supported and participated in regular supervision and appraisals. Staff said regular staff meetings meant they felt involved with the development of the service.

People were supported to maintain their health and wellbeing and had access to health professionals when needed. An external company provided meals at the service with a rolling four week menu which took into account people’s likes and dislikes. People were on the whole happy with the food they received. Snacks and drinks were available when people require

There were 17 people living at Amberwood at the time of our inspection. During this inspection we, the Care Quality Commission (CQC) spoke with five people using the service. We also spoke with six members of staff including the deputy manager and the manager from the other home within the company who was present throughout the morning.

People told us their privacy, dignity and independence were respected.We saw that people were supported to make decisions about their care and how they lived their daily lives. Those whose mental capacity to make decisions was in doubt were supported to be involved indecision making.

Risks to people's health and welfare were identified and their needs were met in a way that was personalised to each person. Health promotion was encouraged through referrals to specialists and through the use of regular dentistry and chiropody services. People told us they felt safe and well cared for.

There were enough qualified, skilled and experienced staff on duty to meet people's needs.

The home was well maintained and clean. All records seen were kept to a satisfactory standard.

People who used the service were positive about the care they received. Each person commented that they were treated with respect and told us they were involved in the planning of their care. They told us they made choices about all aspects of the treatment and support they received. One person told us " we are always being asked for our input and ideas about things".

We observed that staff were respectful and caring and demonstrated an understanding of people's individual needs.

People we spoke with said they felt safe in the home and that there were enough staff to meet their needs. One person told us, "staff are always popping in to see if we are alright".

People we spoke with told us they would be able to approach the manager or a member of the staff team with any concerns or suggestions they may have. We saw that people were involved in regular meetings about the home and services provided and that written information was circulated detailing actions taken.

We saw that there was a programme of activities available for people living in the home which included time set aside for individual requests.

We conducted an unannounced visit to Amberwood on 25 August 2011. We met at least 11 of the 15 people who lived there on the day we visited, 10 of who were able to give us their views to varying degrees, and also spoke with a visitor.

We met someone whose sight was impaired. This person told us that staff always knocked and identified themselves before coming into the room. They said the staff also explained in detail what they were planning to do and sought the person’s agreement before proceeding. We heard people being offered choices about what time they would like to get up, what to wear, when they would like to go to the lounge, and about food and drink they wanted. They told us they were regularly involved in discussions about their care.

People told us that the food was very good, with lots of choice. We saw that, for someone who was no longer to express themselves verbally, their lunch was provided in line with information on their dietary dislikes in their care records. Another person told us the cook had found out that they particularly liked a certain type of food and had agreed to make it twice a week for them.

One person told us there were lots of things to do, going on to describe a recent trip to the seaside where they enjoyed afternoon tea. They also told us they enjoyed the visits from a local donkey sanctuary. We saw a member of staff involving people in a word quiz activity. We met someone who could no longer clearly express themselves verbally, but who responded with a smile when we spoke with them. Their radio was playing music that their care records stated they liked, and their care records also reflected that staff spoke with them about interests that the person had held prior to the deterioration in their health.

People were happy with the support they received, and this was appropriate care that met their individual needs. However, we noted that their care records were not always sufficiently detailed to ensure they would continue to receive care they needed.

Several people told us about a recent fete held in the home’s garden for people living at the home and their visitors. Someone was enabled to go home to visit family locally because staff took them and fetched them back again. Another person said they were being supported by the home to get a mobility scooter, so they could go out independently. People were thus able to be part of the community surrounding the home.

Five people we spoke with said they felt safe and were well cared for at Amberwood. We spoke with a visitor about their relative living at the home who lacked capacity to make decisions about their own care and welfare. They told us that family members were consulted and involved in making decisions about this person's care and welfare, to promote the person's best interests.

People who could express their views were positive about the staff team and the support they provided. We saw people received polite, sensitive support. Those who were more dependent seemed reassured or cheered up by staff interactions with them and other forms of support provided.

Two people and a relative told us that if they had any concerns they could raise it with the manager and were confident it would be dealt with. A director made monthly visits to the home, on behalf of the provider, specifically to review the quality of the service provided. This was done by speaking with some of the people who lived there and checking on other aspects of life at the home. The most recent report of these visits included that someone was to be consulted about the forthcoming redecoration of their bedroom. The Activities coordinator was beginning to carry out monthly surveys with each person. This showed the home obtained people’s views on the service in various ways.

We carried out an unannounced comprehensive inspection on 30 December 2015 and 5 January 2016. Amberwood Nursing Home is registered to provide personal and nursing care for up to 24 older people. There were 18 people using the service on the first day of our inspection. We last inspected the service in November 2013, at that inspection the service was meeting all of the regulations inspected.

A registered manager was in post who is also registered with the Care Quality Commission (CQC) to manage another home which is qwned by the same provider. 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 said that they had been mentoring the acting manager who would be applying to the Care Quality Commission (CQC) for registration as a joint registered manager in 2016.

Everyone was positive about the registered manager and acting manager and felt they were approachable and caring. The registered manager and acting manager were very visible at the service, undertook nursing shifts and were very positive role models to the staff.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. There were sufficient and suitable staff to keep people safe and meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had the skills and knowledge to meet people’s needs.

People were supported to eat and drink enough and maintain a balanced diet. People and visitors were very positive about the food at the service.

People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

Staff supported people to follow their interests and take part in social activities. A designated activity person was employed by the provider and implemented activities at the service.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives, staff and health professionals. There was a complaints procedure in place and the registered manager had responded to a concern appropriately.

The premises and equipment were managed to keep people safe.