The inspection was carried out on 02 May 2017, and was an unannounced inspection.

Balgowan Nursing Home provides accommodation, nursing and personal care for up to 40 older people. Accommodation is provided in an old detached building with two newer purpose-built wings. At this inspection, there were 38 people living in the home.

At the last Care Quality Commission (CQC) inspection in 07 October 2014, the service was rated Good in four domains, outstanding on Caring domain and Good overall.

At this inspection we found the service remained Good overall.

People continued to be safe at Balgowan Nursing Home. People were protected against the risk of abuse. We observed that people felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. Medicines were managed safely and people received them as prescribed.

Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Members of staff felt supported by the registered manager, however one to one formal supervisions had not regularly taken place. Not all staff had received training in such areas like diabetes and safeguarding, which would enable them to meet people's needs effectively. We have made a recommendation about this.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services. Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. The policies and systems in the service supported this practice.

The registered manager ensured the complaints procedure was made available to people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Further information is in the detailed findings below.

The inspection visit was unannounced. The previous inspection was carried out in September 2013, and there were no concerns.

The premises are an old detached building with two newer purpose-built wings. The service provides general nursing care and accommodation for up to 33 older people. There were no vacancies on the day of the inspection.

The service is run by a registered manager, who was present on the day of the inspection visit. 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.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Two of the people in the home had been assessed as lacking mental capacity, and there were clear records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

All staff had been trained in safeguarding adults, and discussions with them confirmed that they knew the action to take in the event of any suspicion of abuse. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the manager or outside agencies if indicated.

There were clear risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People spoke highly of the manager and the staff throughout the day, with comments such as, “The manager and staff are kind, caring and helpful”; and “The staff are always here to help. When I call, they come quickly.” We saw that staff were in evidence throughout the day, and responded quickly to people’s requests for help. Staff interacted well with people, and supported them in carrying out their preferences. There were effective systems in place for ongoing staff training; and for staff supervision and support.

Staff files that we viewed contained the required recruitment information. New staff were taken through a comprehensive staff induction programme which included basic training subjects. They worked alongside other staff until they had been assessed as being competent to work on their own.

Medicines were managed and administered safely. People received their medicines on time.

People were supported in having a nutritious diet. The chef was considerate and caring in ensuring that people had dishes that they enjoyed; and in providing individual dishes for people to meet their specific choices.

People and their relatives told us that they were involved in their care planning, and that staff supported them in making arrangements to meet their health needs. Care plans were amended to show any changes, and care plans were routinely reviewed and audited to check that they were up to date.

Staff were informed about people’s individual lifestyles, and supported them in retaining their independence. People said that the staff were kind and caring ,and treated them with dignity and respect.

People were given individual support to carry out their preferred hobbies and interests, such as knitting, playing games and doing crosswords. The home had been modernised to provide suitable living accommodation, and there were plans in place for on-going improvements. The premises included a garden space which was available for wheelchair users.

The registered manager maintained good links with the local community; and invited local groups into the home to provide focal points of interest and entertainment.

There were systems in place to obtain people’s views. These included formal and informal meetings; events; questionnaires; and daily contact with the manager and nursing staff. People said that the registered manager was “Always available” and she was “Friendly and approachable.” One person said “I would not hesitate to ask the manager about any concerns; and I know she would deal with anything I was worried about.”

Staff were fully aware of the ethos of the home, in that they were there to work together for the good of the people in their care. People told us that the home ran just the same at night time and at weekends; and whether the registered manager was in the building or not. This demonstrated how the registered manager fostered a positive culture within the service, and ensured that staff knew the importance of putting people who used services first.

There were systems in place for record keeping and auditing records. The audits were generally well maintained, and showed how the registered manager initiated improvements as the result of their findings. There was a culture of continuous improvement, so that people would feel increasingly well cared for; and staff would develop their own roles to the maximum of their potential. The manager had started to meet with other managers in the company’s group of homes, so that they could discuss best practice and continually look for ways to improve the services.

At the time of our inspection, there were 32 people living at the home.

We spoke with four people who used the service, and three visiting relatives. People we spoke with who used the service told us that they were happy with the care and support they received. They told us that they were involved in how their care and support was provided by the staff. One person told us "It’s a wonderful place, couldn’t be better" and another person commented “it’s great here”. A visiting relative told us “I can’t praise this place enough; they are above and beyond helpful”.

We looked at people's care plans and saw that they were individualised and contained people's choices and preferences. Risk assessments were in place to identify and minimise risks as far as possible to people who used the service.

We spoke with people who told us they felt that staff had the right skills to care for them and support their needs appropriately. We found that staff had supervision and support from their manager and that they undertook relevant training to keep their skills and knowledge up to date. A visiting relative told us “the staff are wonderful here; always willing to help”.

We found that the home had a range of checks and audits in place to monitor cleanliness and to help prevent cross-infection in the home.

We found that the home kept accurate records and stored them safely and appropriately, to ensure people's details and information was protected.

People we spoke with told us they liked living at Balgowan. One person told us “I like living here it is nice, the staff are good they help whenever they can”.

People told us that they felt safe and we observed that people living in the home were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and who encouraged their independence.

People told us that they were well cared for in the home. They said that they felt safe and liked the staff and manager. One person said “The staff are good to me”, another person said “Staff are very kind”.

Relatives of people that used the service told us they had no complaints with the service. One person said “I think it is lovely, the best care home in Hythe”.