The inspection took place on the 22, 23 and 24 March 2017 and was unannounced.

Dunwood Manor Nursing Home provides accommodation and nursing care for up to 55 older people, some of whom may also be living with dementia or have a physical disability. At the time of our inspection 39 people were living at the home. The home is in a rural location in Sherfield English, near Romsey.

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.

There were sufficient numbers of staff deployed to meet people's individual needs. New staff had been employed following robust recruitment and selection procedures and this ensured that only people considered suitable to work with vulnerable people were working at Dunwood Manor Nursing Home.

People received end of life care to a good standard and the staff had strong working relationships with external healthcare professionals.

People told us that they felt safe living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns.

The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff were supported by the registered provider and registered manager, and felt that they were valued.

Staff had received induction training when they were new in post and told us they were happy with the training provided for them.

Medicines were stored, recorded and administered safely.

People told us that staff were caring and that their privacy and dignity was respected. They said that they received the support they required from staff.

People's nutritional needs had been assessed and people told us they were very happy with the food provided. People’s individual food and drink requirements were met.

Complaints made to the home had been thoroughly investigated and people had been provided with details of the investigation and outcome.

There were systems in place to seek feedback from people who lived at the home, relatives and staff.

Staff, people who lived at the home, relatives and a social care professional told us that the home was well managed. Quality audits undertaken by the registered provider and registered manager were designed to identify any areas of improvement to staff practice that would promote people’s safety.

The inspection took place on 10 December 2014 and was unannounced.

Dunwood Manor Nursing Home provides accommodation and nursing care for up to 55 older people, some of whom may also be living with dementia or have a physical disability. The home is in a rural location in Sherfield English, near Romsey. There is access to gardens and a hydrotherapy centre. Hydrotherapy is the use of water in the treatment of different conditions, including arthritis and related rheumatic complaints.

Dunwood Manor has a registered manager 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.

At the last inspection on 10 February 2014, we asked the provider to take action to make improvements in respect of acting in accordance with the Mental Capacity Act 2005. This was because staff had a lack of understanding of the principles of the Act and because mental capacity assessments and best interest decisions had not been correctly documented. The registered manager submitted an action plan which stated that the home would be compliant by 30 April 2014. This action has now been completed.

People told us they felt safe in the home. Staff had completed safeguarding training and were able to explain to us how they protected people from abuse. Staff told us they were aware that they could report safeguarding concerns to outside agencies such as the police, the local authority and the Care Quality Commission.

Specific risk assessments were in place for each person in relation to falls, bed rails, safeguarding and mental wellbeing. Support plans were written in relation to each identified risk. Staff described how they learnt about people’s individual risks from handovers and care plans. The daily handover sheet included information about people’s individual risks in relation to their health, risk of falls, dietary needs and behaviours.

There were sufficient staff on duty in the home to meet people’s needs. Staff commented on how well the permanent staff worked together but stated that agency staff were usually less effective. Sometimes permanent staff felt pressured but did not feel there were not enough staff to meet people’s needs. On the day of the inspection, it was clear that staff were busy all day; however we noticed that call bells were answered within a reasonable time (approximately two minutes).

Recruitment and induction practices were safe.

Medicines were stored and administered safely. We checked records in relation to controlled drugs and found them to be accurate. Medication administration records (MAR) were kept for each person. We reviewed a sample of the records from the day of the inspection, which showed that medicines had been administered as prescribed.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as infection control, fire training, moving and handling, food hygiene and health and safety.

Training had taken place and some had been booked for nurses in respect of clinical competencies.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with residents appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

Mental capacity assessments had been undertaken which were decision specific, where relevant. Where a care plan was required in relation to mental capacity, this was reviewed on a monthly basis to ensure the most up to date assessment was in place. This was important because people’s capacity can fluctuate. People made their own decisions where it was established, they had the capacity to do this, and their decision was respected.

We found that the registered manager had made appropriate Deprivation of Liberty (DoLS) applications and staff were aware of which people were subject to a DoLS and the restrictions these authorised. Handover notes included information on whether a DoLS was in place or whether an application had been submitted.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day. A tea trolley came round during the morning serving tea, coffee, fruit squash, biscuits and yogurts. The meals offered were home cooked, freshly prepared and nicely presented.

People were supported to maintain good health through access to ongoing health support. Following the inspection we received feedback from several health professionals who regularly visited the service. A dental officer told us they were always contacted appropriately and in a timely fashion. Two GPs and a pharmacist told us they regularly visited the home and were complimentary about the care. People using the service had access to an onsite hydrotherapy pool. Health needs were closely monitored within the home.

Staff were cheerful and attentive and had taken time to get to know people individually. One person told us about their interest in garden birds. Staff had ensured they were sat by a window so they could see the birds. One person said “The cleaner watered my plants for me this morning; I never asked for this, I thought it was considerate.” Relatives were complimentary about the home; one relative said “They’re so wonderful here.”

People were involved in decisions about their care and were offered choices in all aspects of their daily life. Privacy and dignity was protected and staff were able to respond appropriately to people’s needs due to the detailed and accurate care plans, risk assessments, daily records and handovers. Care plans contained information about people’s abilities, their desired outcomes and the support they required to achieve them, including any identified risks. People were encouraged to join in activities as much as they would like to. Detailed records were kept of activities with a sheet for each person recording the activity they had partaken, how much they had been involved and whether they had enjoyed it.

The provider had a complaints procedure which detailed how informal and formal complaints should be dealt with including. Complaints had been appropriately responded to, in a timely way.

There was a positive and open culture within the home. Staff said they felt able to raise concerns at any level of management, and were confident they would be responded to. Staff said they were actively encouraged through meetings and appraisal to give feedback about the service.

Improvements since the last inspection included the recruitment of a new registered manager, new care plans, a training pack for care workers and a clinical training booklet for care workers. Policies and management arrangements meant there was a clear structure within the home which ensured the service was effectively run and closely monitored. The quality of the service was closely monitored through a series of audits. A business continuity plan was in place to ensure the continuing care to people in the event of an emergency.

On the day of our inspection, the manager had been working for the provider for a few weeks and had not yet completed an application to be registered manager. We used a number of different methods to help us understand the experiences of people using the service because some people had complex needs which meant that they were not able to tell us their experiences. During our inspection we spoke with four people who used the service, relatives of two people, eight members of staff, the manager, a GP and observed interactions between staff and people living at the home. We looked at care records in relation to eight people who used the service.

The documentation we reviewed showed that staff had a lack of understanding in respect of the legal requirements in relation to the Mental Capacity Act 2005. There were no relevant mental capacity assessments or best interest decisions recorded on care plans where appropriate.

All care plans showed people’s needs were assessed and reviewed monthly. We saw that initial assessments were made prior to admission, and included assessments relating to people’s medical history, social history, personal care, mobility needs, skin integrity, psychological needs, wound mapping and continence requirements.

During our visit, we spoke with care staff and they could recall attending annual training in safeguarding vulnerable adults and demonstrated a good understanding of what this meant.

People were protected from unsafe or unsuitable equipment because the provider carried out regular maintenance and checks.

People who use the service and a relative told us there were always enough staff to meet their needs, and that call bells were answered in a timely way. A care worker told us “It is a really friendly team, we all work together.”

An annual survey was carried out which included comments from people who use the service, their family and friends. The last survey was carried out during June 2013. As a result of feedback from this survey an action plan had been drawn up and actions completed appropriately.

People using the service told us staff checked with them whether they were happy to receive care. One person told us: “Staff bring in a chair to weigh me, I sometimes don’t want to be weighed.” They confirmed that staff respected their wishes and that they could refuse care if they wanted to and said: “They (staff) always ask my permission.”

Each person’s care needs had been reviewed monthly by nursing staff. All the relatives we spoke with told us that they were kept informed about their family member’s care, especially if their needs changed. One relative told us: “They consult with me at every opportunity.”

We saw that there were systems in place to ensure that, as well as day to day cleaning, there were schedules in place for the decontamination of equipment used in the home. For example, hoists, stand aids and drug trolleys.

The service had a comprehensive system of staff supervision and appraisal. We saw records that showed staff received supervisions from senior staff at least twice a month. All staff took part in an annual appraisal. People we spoke with said that staff appeared to be well trained and carried out their duties professionally. Comments we received included: “They are jolly good” and “I know good staff when I see them.”

One of the people we spoke with said they had, in the past, had to make a complaint. They said it had been dealt with appropriately and they had not needed to complain again.

People told us they were happy living at the home. They received the care and support they needed in a way they preferred because staff listened to their wishes and involved them in care planning processes. People told us they felt safe at the home because they believed staff had the skills and knowledge to provide care and support for them. They commented that the home arranged for them to see health care professionals such as General Practitioners (GP's) when they needed to.

People living at the home confirmed that they were able to influence the running of the home in a variety of ways that included discussions with the manager and care staff, meetings and care plan reviews.