Country View 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. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Country View Nursing Home is located in a small village in Northamptonshire and is registered to provide accommodation and personal care to older people who may or may not have nursing care needs. They provide care for older people and people with a physical disability. The provider can accommodate up to 29 people at the home in 10 double bedrooms and 9 single bedrooms. When we visited there were 29 people living at the home.

At our last inspection in June 2016, this service was rated overall as good. At this inspection, we found that the service had deteriorated and has been rated as requires improvement.

The inspection took place on the 17 September 2018 and was unannounced.

A registered manager was in post. 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 were treated with warmth and kindness by the staff and management team, and by staff that had taken time to get to know them. People had choice and control over their lives and could access a range of activities tailored to meet their individual needs. People’s privacy and dignity was protected and promoted and they received personalised and compassionate care at the end of their lives.

People were assisted to maintain relationships with their families, people’s relatives could visit them at the home at any time.

People told us they felt safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risk assessments were in place. There was sufficient staff available to meet people’s needs.

People using the service and their relatives knew how to raise a concern or make a complaint and felt confident that these would be addressed.

People were supported to access relevant health and social care professionals and there were systems in place to manage medicines safely. People received their medicines as prescribed.

The provider did not have an effective quality assurance system in place to identify areas of concern and to improve and innovate. Safe recruitment processes were not always followed and the provider did not prioritise maintenance work required to the décor.

People were not always supported by staff that had the skills and knowledge to meet their needs. Staff had not received effective and regular supervisions or appraisals to enable them to carry out their roles effectively.

The provider had not always consistently submitted legally required notifications for incidents such as abuse and those involving the police.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

This unannounced inspection took place on the 7 June 2016. Country View Nursing Home provides accommodation for up to 29 people who require nursing care. There were 29 people in residence during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were safeguarded from harm as the provider had systems in place to prevent, recognise and report concerns to the relevant authorities. Senior staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People’s care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People had been involved in planning and reviewing their care when they wanted to.

People were supported to have sufficient to eat and drink to maintain a balanced diet. Staff monitored people’s health and well-being and ensured people had access to healthcare professionals when required.

Staff understood the importance of obtaining people’s consent when supporting them with their daily living needs. People experienced caring relationships with the staff that provided good interaction by taking the time to listen and understand what people needed.

People’s needs were met in line with their individual care plans and assessed needs. Staff took time to get to know people and ensured that people’s care was tailored to their individual needs.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the manager and by the provider.

The inspection of Country View Nursing Home was carried out by an inspector who gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that people’s needs had been appropriately assessed before they were admitted to Country View Nursing Home. After admission to the home we saw that their needs were regularly reassessed to ensure they received safe care. This meant that staff had the information they needed to minimise identified risks to people’s safety and welfare.

We saw that people were cared for in an environment that was clean and hygienic. We found that the equipment in place for staff to use was appropriately serviced. This meant that people were cared for in a safe, well maintained environment.

There were sufficient numbers of experienced and competent staff on duty to safely meet people’s personal and healthcare needs. We saw that staff had been appropriately trained and received the managerial support they needed to do their job. Staff had received training in the protection of vulnerable adults and the staff that we spoke with knew how to report concerns. We saw evidence that incidents or accidents had been appropriately reported to the Local Authority and the Care Quality Commission (CQC). This meant that people were protected from the risk of neglect or unsafe care.

Suitable arrangements were in place to respond to emergencies, with the manager or provider always being available ‘on call’ to support staff to manage the situation safely and in a timely way.

Is the service effective?

Staff had received the information, training and managerial support they needed to do their job effectively. There were arrangements in place that ensured staff had the most up-to-date information about people’s needs. This included ‘handovers’ of pertinent information when staff arrived for duty. We spoke with staff and observed them going about their duties in an unhurried, purposeful way.

They were able to tell us about people’s individual needs and how they delivered their care. This meant that because staff had a good knowledge of each person’s care needs and preferences they were able to provide effective care.

Is the service caring?

When we saw staff interact with people their manner of approach was patient, kind, and gentle. One visitor we spoke with said, "All the nurses and carers are kind. They look after people so nicely.”

The staff presented as friendly and helpful. We heard staff encourage people to do things for themselves but they made sure people were safe and provided them with timely assistance whenever that was appropriate. People were offered support at a level which encouraged independence and ensured their individual needs were met.

We saw that when staff assisted people with personal care such as toileting or bathing they made sure doors were closed to protect people’s dignity and privacy. We heard people addressing people by their preferred name. We found that people were encouraged to spend private time with their visitors as they chose, either in a quiet lounge area or in the privacy of their room.

We saw that people nearing the end of their life were treated with compassion and sensitivity so that their final days were as comfortable and pain free as possible.

Is the service responsive to people’s needs?

We saw that there was enough staff on duty to meet people's nursing and personal care needs. This was also confirmed by the five staff, three visitors, and people in residence we spoke with. People said they never had to wait for long if they needed assistance. We heard that call bells were always answered in a timely way, with people rarely kept waiting. The system used also enabled staff to differentiate between emergency and routine alerts.

All the staff we spoke with had a good understanding of how to support people in a way that respected each person as an individual, each with their own needs and preferences for how they wished to receive their care and support.

Is the service well-led?

There was a registered manager in post. Staff were aware of their roles and responsibilities and were supported by the manager and by the provider.

Staff said they received a good level of practical day-to-day managerial support to enable them to carry out their duties. The provider had ensured there were robust quality assurance processes in place. This meant that people were assured of receiving the care they needed in a way that suited them.

The staff we spoke with told us said that the manager and provider had an ‘open door’ approach so that staff could readily express any concerns or ask for guidance whenever they needed to.

We spoke with six people who used the service. One person told us “I have no complaints”. Another said “staff couldn’t be better”. We saw that staff spoke with people in a kind and respectful manner.

We saw that there were limited records to show that people’s capacity to make specific decisions had been assessed or how decisions made on people’s behalf were assessed as being in their best interests. We looked at care files for six people. We saw that only one person had been assessed for their capacity to consent to receiving care and treatment.

We found that although people were happy with the service, care records did not always contain all the information staff needed to care for people appropriately.

We found care plans contained the basic information staff needed to meet people’s care and nursing needs but contained limited information about people’s preferences, preferred routines and life histories.

We found that most of the required checks were carried out before staff began working in the home.

The provider did not have a consistently effective system to regularly assess and monitor the quality of service that people receive.

The people we spoke with told us that they enjoyed living at the home and had lots of different activities. They told us that the food was nice and they had different choices of meals. One person told us if they were not happy, they would tell the staff or their relative. The people said that the staff were “very nice and listened to them”. They also helped them with their personal care needs and maintained their privacy and dignity.

We observed staff talking to the people and helping them in a dignified manner. They told us that they enjoyed working at the home. One staff told us “we work well as a team and meet people’s needs well”.

The families we spoke with told us that the care provided by all staff was very good. They said their relatives were happy and safe living at the home. They told us that they were always made welcomed at the home by staff on duty.