Bethshan Nursing home provides support for up to 34 people who may require nursing and personal care and may also be living with dementia. Accommodation is provided on two floors and there is a passenger lift to help people to access the lower floor. The home has a range of equipment suitable to meet the needs of people living there. The home mainly provides support to older people. All bedrooms are ensuite and each floor has a communal lounge and kitchen area for snacks.

At our last inspection, 14 September 2015, 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. At this inspection we found the service remained Good.

Why the service is rated Good:

People continued to be safe living in the home. Hazards to people’s safety had been identify and managed. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks.

Robust systems were used when new staff were employed to ensure they were suitable to work in the home.

The staff received training and support to ensure they had the skills to provide people’s support in a safe way. The staff knew how to identify and report abuse.

Care was assessed, planned and delivered to meet people’s needs. People who lived in the home, and others who knew them well, were included in planning their support.

People continued to receive the support they required to maintain good health. They had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

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 supported this practice.

We saw a positive dining experience was provided to people who used the service. Meals were of a good quality, varied and people were given choices. The staff were knowledgeable about the support people required to enjoy their meals and drinks safely and this was provided.

People and relatives said staff were kind and caring. Staff had time to interact and engage with people and not just when they carried out tasks. The staff promptly identified if people were unwell or anxious and provided assistance as individuals required.

People were provided with activities and entertainment of their choosing and regularly accessed activities within the community. Technology was used to enhance people's lives such as access to the internet for leisure and for keeping people safe by means of sensor mats and beams.

People had the opportunity to give their views about the service and feedback was acted upon in order to ensure improvements were made to the service when required. A complaints procedure was available.

The provider had systems in place to ensure the delivery of good quality care. The home was well maintained and had an on-going programme of improvements for the benefit of people living in the home.

This inspection took place on the 14 September 2015 and was unannounced. We last inspected this service on 5 February 2014. At that inspection we found that the provider was meeting all of the regulations that we assessed.

Bethshan Nursing Home is located on the outskirts of Whitehaven in a residential area. The service provides support for up to 33 people who may require nursing care and may also be living with dementia. Accommodation is provided on two floors and there is a passenger lift to help people to access the first floor. The home has a range of equipment suitable to meet the needs of people living there. The home mainly provides support to older people. All bedrooms are ensuite.

The general nursing unit is on the first floor and the lower ground floor is designated for the care of people with dementia.

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.

Everyone we spoke with told us people were safe and well cared for in this home. People knew how they could raise a concern about their safety or the quality of the service they received.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff to provide the support that people needed. People received their care from staff who they knew and who knew how they wanted to be supported. Medicines were ordered, stored, administered and disposed of correctly.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care. The staff knew how people communicated and gave people the time they needed to make choices about their lives and to communicate their decisions.

The staff knew how to identify abuse and protect people from it.

The staff spent time with people and understood that this was an essential part of their role. The staff were trained and supported to provide people with the care they required. Support plans were based on thorough assessments and were written using a person centred approach.

People were provided with meals and drinks that they enjoyed. They were supported to take a good diet that was based on an assessment of their nutritional needs. People who required support to eat or drink received this in a patient and kind way.

The manager of the home was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

The atmosphere in the home was open and inclusive. People who lived there and their visitors were asked for their views and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

The service had sufficient staff to meet people’s needs.

The registered manager provided good leadership.

The provider had systems in place to ensure the delivery of good quality care.

We spoke to people who lived in the home and to their relatives who were visiting on the day of our inspection. Here are some of their comments:

"I'm quite happy here… We all have a laugh together!"

"I like living here as you get a bit of fun in this house."

A visitor told us:

"My relative has settled well here and we enjoy still being part of their life. We can't praise the staff highly enough. Where they sometimes fall down is in relation to activities. I think they could do more."

We observed the way care was given to people who lived in the home and we looked at individual files. We judged that people were getting suitable levels of personal care and support. We had evidence to show that people were given help to get the right kind of health care.

We checked on the management of medicines in the home and found that this was being done appropriately. People received suitable medication to deal with their health needs.

The home was fresh and clean on the day of our visit. We had evidence to show that maintenance, upkeep and replacement of furniture, fittings and equipment was ongoing.

We met all of the staff on duty and we heard from them that they were suitably recruited, inducted, supervised and trained. We also had evidence to show that any poor performance in the team was dealt with appropriately.

We looked at a wide range of records including those related to monitoring quality and we found these to be easily accessed and appropriate.

We observed that people's privacy and dignity were upheld and staff sought their views to influence the care, treatment and support offered. People we spoke with understood the care and treatment choices available to them and said they were involved in making decisions about their care and support.

We found the home to be appropriately staffed for the needs of the people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with dementia.

One person living in the home said, “The staff are all brilliant, we are spoilt here. The food is very good.” And another said, “We are always asked about what we would like to do, you can please yourself about joining in the activities that’s on offer.”

A relative told us, “We spent a long time in choosing this home and have been very pleased with the level of care, support and consideration my relative receives. We are kept up to date and included in any important decisions.”

We saw that the provider had an effective system in place to identify, assess and manage the quality of the care and the environment. This meant the home was clean, tidy and well maintained. It also meant people’s care was regularly checked to make sure the support offered was still meeting their needs.

We had positive responses from the people we saw in the home:

"Quite happy - have no concerns - I am kept fully informed and involved."

"Very nice dinners here...no complaints."

"She is a grand lass (the manager)".

"The staff are nice and I am settled here."

"Have enjoyed my stay and I am going to a meeting as I want to go back home for a while...They are good people and if I need to come in it would be here or their other home".

One person who has problems with speech was able to convey her approval of the way staff have helped her to become more mobile.

We spoke to a number of people who live in the service and to some relatives. These are some of the things they told us:

"The end of life care was excellent. The night staff were very good...as a family we were very impressed."

" I am happy living here and glad I moved."

"I like it here and I like the staff and can go out with my family"

"No complaints ...its fine and I am quite settled."

"The owners dealt with some things I wasn't happy with and things are OK now."

"I feel safe here now".