Craven Nursing Home is situated in a semi-rural setting on the outskirts of the market town of Skipton. The home is registered to provide nursing care and accommodation for up to 68 people. The home is separated into three units. One of these units cares specifically for people living with dementia. At the time of our inspection there were 54 people at the service.

This comprehensive inspection took place over two days. 24 February 2017 was unannounced and 9 March 2017 was announced. At the last inspection in December 2014 the service was rated as Good.

There was a registered manager in place. 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 told us they felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were appropriate systems in place to make sure that people were supported to take medicines safely and as prescribed. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background.

Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). 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.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account, although the information about this in care plans sometimes lacked detail. Care plans gave directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.

People received good care at the end of their lives. Staff were well trained in this area and sensitive to the needs of people, their friends and relatives.

People’s needs were regularly reviewed and appropriate changes were made to the support people received. People had opportunities to make comments about the service and how it could be improved.

The registered manager had good oversight of the service and there was a clear ethos of care. The registered manager had made improvements at the service since they started in post. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

This inspection was carried out on 16 December 2014 and was unannounced. At our last visit to Craven Nursing Home in June 2013 we did not ask for any improvements to be made.

Craven Nursing Home is situated in a semi-rural setting on the outskirts of the market town of Skipton. The home is registered to provide nursing care for up to sixty eight people, some of whom may have a mental disorder or dementia. The home is separated into three separate units. One of these units cares specifically for people with dementia.

There was a registered manager at this service who had been appointed recently by the registered provider and was registered in November 2014 with the Care Quality Commission. 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.

The service was safe and people told us they felt safe.

Staff were recruited safely with appropriate checks carried out to ensure staff were suitable to work in a care setting.

Staff were able to describe how they would identify and report abuse and knew how to alert the appropriate person if necessary. Staff had been trained to meet the needs of people who used this service. They were supported by the registered manager and received regular supervision.

We saw that staff were caring and spoke respectfully to people.

People, who used the service, and their relatives, knew how to make a complaint or raise concerns. They told us they had regular contact with the registered manager and the registered provider and that they felt able to discuss any matters with them. People also told us they felt comfortable with staff.

There was an effective quality assurance system in place at this service.

The provider had systems in place to help people make decisions about their care and support. This included group meetings to discuss what happened in the home and individual meetings.

People who used the service told us they were happy with the care and support they received. People told us care was “Excellent”, “Extremely good” and “Just what you need”.

There was enough equipment to promote the independence and comfort of people who used the service. People were protected from unsafe or unsuitable equipment.

There were effective recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were referred to in positive ways; they were described as “Kind” and “Thoughtful.” People told us they felt well looked after. One person told us, "They go out of their way to make sure I am comfortable." Without exception, people gave us the impression that their experiences at The Craven were positive and that they received a good standard of care.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

Our inspection of 2 October 2012 found there was a lack of clear administration and auditing of medication and that staff were not supported in their work. The provider wrote to us and told us that a full audit had been carried out by a local pharmacist and that supervisions had been arranged. We found at this visit that improvements had been made and this was confirmed by the staff we spoke with.

Subsequent to our inspection in October 2012, we had also received information of concern on 28 January 2013. We were told that people were not being provided with adequate food provision and that there was little choice at mealtimes. We were also told that the weekend staffing levels fell below the required numbers, resulting in people not receiving proper care and attention.

We therefore also reviewed the food provision and staffing levels at this visit. We found that the food provision was good. We also found that staffing levels were consistent over a 24 hour, seven day cycle. The staffing levels were found to be adequate and that peoples needs were being met.

People using the service talked with us about the food and the staffing levels. One person told us, “The meals are very good.” Another person said, “The quality of the food is variable, but overall it is alright.” Everyone we spoke with told us the staffing levels were good and that they did not have to wait for attention.

We spoke with eleven people who used the service and four visitors. Three people told us that they had been involved in planning their care, along with their relative. One person told us, “I am very happy here.” Another person told us, "I am waited on hand and foot, they do everything for me." When talking about the way staff assisted with personal care, one person said, "I don't feel embarrassed at all, they are very sensitive to the way they help you, keep you covered if you are undressed or give you time to do things for yourself."

People also told us, "The lasses are lovely, they are a lovely crew." One person said, "The staff make me feel like a person." People said that the manager was good at listening to any concerns or complaints and that staff did their best to put things right.

We were not able to ask some people about their experiences due to their complex communication needs. Due to this we used a formal way to observe people in this review to help us understand how their needs were supported. We call this the ‘Short Observational Framework for Inspection (SOFI). Through those observations we saw that people appeared relaxed and comfortable with the staff and were well supported.

People who were able to talk to us told us that they had been consulted about their care and treatment and advised about the support options available to them.

People confirmed that the care at the home was consistent and supportive. They felt that staff attended to their needs in a dignified and sensitive way. People said, “The staff are very thoughtful and always ask me if I need something and if I am alright”. “They come quickly when I call I don’t wait, they don’t rush me either”

People also explained that they knew how to raise concerns and said they were confident issues raised with the staff or manager would be sorted out straight away.