The inspection visit at Delaheys Nursing Home took place on 06 December 2016 and was unannounced.

Delaheys is a care home with nursing registered to offer personal and nursing care for up to 28 people. The home is a detached property with accommodation located on the ground, first and second floors. A passenger lift is in place for ease of access. The property is surrounded by garden areas and there is a large conservatory at the front of the building. Accommodation is in single and shared rooms, some with en-suite facilities. At the time of our inspection there were 24 people residing at the home.

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.

At the last inspection visit carried in January 2016, we found the registered provider had not met the fundamental standards. We identified concerns in relation to medicines management, consent to care, safeguarding and assessment of risk. We asked the registered provider to submit an action plan to demonstrate what improvements they were going to make. We used this inspection visit in December 2016 to check the required improvements had been made

During this inspection, we found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

We have made a recommendation about the introduction of formal supervision for staff.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

The provider had ensured risks to individuals had been assessed and measures put in place to minimise such risks. A comprehensive plan was in place in case of emergencies which included detail about how each person should be supported in the event of an evacuation.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at Delaheys Nursing Home. This was confirmed from discussions with staff.

Staff responsible for administering medicines were trained to ensure they were competent and had the required skills. There were appropriate arrangements for storing medicines safely.

People and their representatives told us they were involved in their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who were able to speak with us told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the management team had responded promptly when people had experienced health problems.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support t

This inspection took place on 14 January 2016. The inspection was unannounced. The last inspection of Delaheys Nursing Home took place on 29 April 2013. At that time we found that the provider was fully compliant with all the regulations assessed.

Delaheys is a Care Home with nursing registered to offer personal and nursing care for up to 28 people. The home is a detached property with accommodation located on the ground, first and second floor. A passenger lift is in place for ease of access. The property is surrounded by garden areas and there is a large conservatory at the front of the building. Accommodation is in single and shared rooms, some with en-suite facilities. The home is furnished to a high standard.

The registered manager was available and received feedback throughout the inspection. The registered manager was also the nurse on duty during our inspection.

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.

We found that the service provided a good standard of person centred care. Feedback from people who lived at the service was positive in regards to the care and support from staff. People told us that they felt safe and well cared for.

We found that the service had a safeguarding policy and procedure. However this was not easily accessible for people who lived at the service and or their relatives. We found that staff lacked knowledge about types of abuse and referral procedures. Some staff had undertaken training for safeguarding vulnerable adults as part of their health and social care diploma; however we found that service specific training has not been undertaken. Training should identify internal procedures and the local safeguarding authority referral process to enable staff to identify and report abuse.

The environment was clean, safe and well maintained. A very high standard of interior was maintained throughout the service and the providers prided themselves on maintaining this.

We looked at care records and found that staff worked positively with community professionals such as dieticians and speech and language specialists to ensure that people’s needs were met.

Care plans were being developed to move from a medical model to person centred. Care plans showed that people were encouraged to participate in the care planning process. However we found that this was not always in line with the Mental Capacity Act 2005.

Records showed that mental capacity assessments were not always undertaken prior to making a decision on the person’s behalf. We found the manager and care workers lacked knowledge about the Mental Capacity Act 2005 (MCA 2005) and the related Deprivation of Liberty Safeguards (DoLS). This meant that people were not always provided care and support that had been assessed in line with the MCA 2005.

We found that staff training and development required improvement. Staff told us that they felt confident in their roles and supported.

We looked at how the service protected people from avoidable harm and injury. We found that people who lived at the service had been assessed for risks associated with clinical care, such as skin integrity and malnutrition. However we found that personal emergency evacuation plans were not in place to enable emergency evacuation at the service should it be needed.

We discussed this with the providers who agreed to take immediate action.

We found shortfalls in medicines management that placed people at risk of not receiving their medicines as prescribed. Shortfalls included inaccurate recording on medicine charts, unsafe administration and ineffective care planning around people’s medicine regimes and preferences.

We found that people were supported to maintain a healthy and

During the course of the inspection we spoke individually with the senior nurse on duty, two member of the care staff team, four people who lived at the home and two relatives that were visiting. However the conversation with some people was restricted because of the effects of their dementia.

People told us that they were very pleased with the level of care and support received and that they liked the staff team. One person said, “The staff are all very nice, all good, there is nothing bad to say”. A relative explained, “They are so helpful and caring and interested. We are well pleased”.

Although people living at the home could not really remember whether they had seen their care plan or whether this had been discussed with them, comments were all positive. One person told us, “I cannot remember whether I know anything about my care plan but it does not really matter. I am very happy with the care. They always try their best”.

We looked at the internal and external environment of the home that was well maintained and furnished and decorated to a high standard. People told us that they were comfortable in their bedroom accommodation, could have their own things around them and that the home was kept, “Very clean”.

One person explained that she had been asked if everything was to her satisfaction. We were told, “Overall it’s a pretty good place, and everything seems to be really quite good”.

Nobody expressed any concerns only compliments.

We saw that staff were respectful and considerate to people living at the home and explained what they were doing and why, allowing time for the person to understand, such as when supporting people into the dining room for lunch. Staff were patient when offering choices such as what an individual would like to drink and did not rush for a quick reply.

We spoke with a group of two residents and a relative in the conservatory area of the home, who told us that they were extremely pleased with the level of care and support provided by the staff team describing them as, “Perfect, they are so good and so thoughtful and put themselves out”.

It was clearly observed that there was positive relationships and interaction between the staff team, the people they supported and the relatives that visited. One relative told us, I have my eye on everything but everything is always good, it is always very calm and never rushed”.

Those people living at the home provided positive feedback about the service provided. People felt confident that staff understood their individual needs and requirements and were able to meet them very well.

One resident commented, “The care is excellent, privacy and dignity is respected and they (the staff) do it with love.” A relative told us, “The nursing care here is much better than any hospital, there are never any smells and the staff overcome any problems.

We were repeatedly told by residents that staff treated people with care and respect and protected them from harm. People said that they felt comfortable and safe living at the home and knew who they would speak with if they did have any concerns. The people spoken with were however very clear in telling us that they had no concerns what so ever about the home or the staff team that supported them.

We spoke to those living at the home about the staff and the availability of staff. We also observed staff going about their duties and saw that staff had time to sit and talk to individuals, meal times were not rushed and the atmosphere remained calm, relaxed and very comfortable. We noted that call bells were responded to in a timely manner, indicating that staffing arrangements were adequate.

People using the service spoke very highly of the staff team. Comments included, “There are always enough staff, we are so well cared for it is untrue.” Another person said, “Everybody is so friendly and thoughtful. They make you feel at home, I feel as though I don’t want to go home now it is so comfortable and nice. It’s very homely, everybody gets good attention.” A third person said, “I am very happy with the care and everything.”

Residents we spoke with gave us excellent feedback about the Matron and all members of staff team describing them as understanding, approachable and very good. One person said, “Everybody is very helpful and kind. They always do their best and it is very, very good.”