This inspection took place on 14 and 20 March 2017 and was unannounced. The previous inspection was completed on 28 November 2014 where we rated all areas as good with no requirements.

Eastleigh Raleigh Mead is registered to provide nursing and personal care for up to 60 people. The home is divided into three units; the ground and second floor provide nursing care for older people living with dementia. The first floor unit supports people with higher physical nursing needs. There were 58 people living at Eastleigh Raleigh Mead at the time of the inspection.

The service had 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.

People received care, treatment and support which was really effective. This was because the registered manager and provider had a real commitment to ensuring staff at all levels had the right training and support to do their job well. This included specialist dementia training, end of life care and national training in care. Staff were encouraged to use reflective learning to develop their skills and areas of interest.

People benefitted from a service which was extremely well run. The registered manager, director and provider all operated an open and inclusive approach. They listened to people and staff to help improve the service. They showed commitment to learning from audits and feedback. One relative said ‘‘From the moment I spoke with the provider and met with the manager and lead nurse, I knew I had made the right decision. They were so caring and understanding. Nothing was too much trouble. I can’t praise them enough. They were outstanding- all of them and each staff member.’’

The service had used innovative assistive technology to promote the most effective way to support people. For example, using blue tooth technology to ensure people’s personal playlists of music which was important to them could be played at any time and in any area of the home.

The design, layout and furnishing of the service had fully considered the needs of people and staff to provide the most effective care. For example, a lighting system had been installed in all communal areas which mimicked natural light and was turned down after lunch to allow a rest period then turned back up as afternoon tea was being served.

Care and support was well planned. Risks had been assessed and measures put in place to mitigate those risks. People’s healthcare needs were well met and staff understood how to support people with changing healthcare needs. Staff understood people’s needs and knew what their preferred routines and wishes were. This helped them to plan care in a person centred way.

Medicines were well managed and kept secure. People received their medicines in a timely way and where errors were noted, staff acted quickly to ensure people were not at risk. People were offered pain relief and received their medicines on time.

There were enough staff with the right skills, training and support to meet the number and needs of people living at the service. Staff said they felt valued and were encouraged to contribute to how the service was run and how care and support was being delivered

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, capacity relatives, friends and relevant professionals were involved in best interest decision making.

People and relatives said the staff were car

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

We completed this responsive inspection as we had received some anonymous concerns about how care and support was being delivered on the ground floor dementia care unit. This inspection therefore only relates to this one unit and covers two main areas. These were; ensuring people had safe and effective care and ensuring staff had the right skills and new staff had the right checks in place to ensure they were suitable to work with vulnerable people.

On the days of our inspection there were 15 people living on the ground floor dementia care unit at Eastleigh. The summary is based on conversations with three relatives of people living at the service, nine staff including senior staff working for the provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service was safe because there were sufficient staff with the right skills and experience to meet the needs of people they supported. The service had robust recruitment processes in place to ensure only staff who were suitable to work with vulnerable people had been employed.

Is the service effective?

We found the service was effective because they had planned people's care and support in line with their assessed needs. Where people had increased needs due to their dementia, this had been clearly identified and risk assessed to ensure staff had the right information to support people effectively. We saw staff had training and further training had been planned to ensure staff had the right skills to work with people with complex needs. This included understanding the Mental Capacity Act and restraint techniques.

Is the service caring?

Our observations of how staff interacted with people on the dementia unit showed they provided care and support in a kind and respectful way. Staff were conscious of ensuring people's dignity and respect was upheld throughout the day. Relatives of people we spoke with confirmed that in their view staff were ''Kind and respectful''.

Is the service responsive?

We found the service was responsive because it had ensured people's needs were continually reviewed and where needs had changed their care plan had bee updated to inform staff about how they should address any increased needs. We saw where people had showed signs of distress but were unable to say why, their general health was considered and GPs and CPN's were regularly consulted.

Is the service well led?

We found the service was being well led because we saw evidence of people, their relatives and staff being consulted about various aspects of the service. We saw that senior management had responded positively to our last inspection report and had made some improvements to staff training and support to ensure their team were well equipped to do their job.

When we inspected this service on 22 October 2013, we found non-compliance in five of the seven outcomes we checked. Following this inspection we asked the provider to send us an action plan to show how they intended to achieve compliance. We received an action plan with stated timescales of actions to be taken. The provider said they would be fully compliant in all outcomes by 31 January 2014.

This inspection was a follow up inspection to check on whether the provider had achieved compliance in five outcome areas. Two inspectors spent 7 hours at the service, speaking to people living at the home. We also spent time observing how care and support was being delivered. We looked at some key records. These included care plans and risk assessments, staff rotas and accidents and incident records. We also received some further information following the inspection, which included quality audits and staff training matrix. This helped us judged how well the home was being managed.

We spoke with 10 people who lived at the home and with six relatives. Overall their views were positive. Comments we received included ''very good'' and ''caring and helpful''. One person’s relative who had a bad experience in another home said '‘its works extremely well here, staff know how to diffuse situations’'. They said they liked the spacious floor areas which gave people space to move around without being cramped.

We also spoke with a range of staff including the registered manager, three nurses, director of human resources, group support manager, eight care staff and two housekeeping staff. We heard how since the last inspection, more time and resources had been agreed and used to update and review all care plans and risk assessments. We also heard a review of staffing levels had taken place and more nursing time had been allocated. In particular the middle floor, which has people with complex nursing needs, now had two nurses on duty for the main parts of the day. This enabled the team to ensure medications were delivered in a timely way and that nursing staff could work with care staff to ensure good care was being delivered.

We heard from staff how safeguarding training and workshops had been provided since the last inspection. We also saw how care plans and risk assessments included more detail about how people should be supported when they were resistive to their needs being met. This meant they were protected from unsafe or inappropriate care being delivered, as instructions and training for staff were now in place.

We heard how more time and resources were being implemented to ensure there were robust quality monitoring systems in place, which checked and reviewed accident and incidents so care plans and delivery of care was more responsive to people's changing needs.

As a result of concerns received by us we conducted this responsive inspection. Prior to the inspection we spoke with NHS continuing health care colleagues who commissioned placements at this service. We were told that the care of people funded by the NHS continuing health care were to be reviewed to ensure they were receiving the care they required. During this inspection we found that the provider was non-compliant with five of the seven outcomes we inspected.

Three inspectors each spent time on each of the three separate units that form Eastleigh nursing home. The ‘top’ floor provided care for people with nursing needs and mild to moderate dementia; the ‘middle’ floor provided nursing care for people with complex needs and the ground floor dementia suite provided nursing care for 15 people with advanced dementia. We spent time talking to people who lived at the home, to staff and to visiting relatives and friends. We looked at some key documents, including electronic care files, risk assessments and daily records.

We asked the provider to send us some additional information. This included records about staff training completed, staff rotas and any audits or records of systems relating to how they reviewed their quality of care provided.

People who lived at the home, who were able to give an informed view, said they were happy with the care and support. One person told us ‘‘Of course I would prefer to be in my own home, but the staff here are marvellous, I couldn’t ask for better.’’

Most relatives also gave us a positive view, particularly on the top floor. One family visitor told us ‘’this is quite a drive for me, but I know x is getting the best care possible. I wouldn’t want him to go anywhere else’’. One relative with family member using the dementia suite service told us staff were kind and regular staff understood the person’s needs and ways. Another relative was concerned about communication with them and aspects of the care provided.

We found staff understood the needs and wishes of the people they cared for. However we found care was not always being well planned. This placed people at risk of not receiving the right care.

Staff had training, but lacked support via formal supervisions. We found there were not always sufficient qualified and competent staff available on the middle floor.

Although the provider had done some work to improve the systems in place to review the quality of care, there was not an effective system in place to consistently monitor the quality of the service.

This inspection was unannounced and took place on 24 and 28 November 2014.

Eastleigh Ralleigh Mead is registered to provide nursing and personal care for up to 60 people. The home is divided into three units, the ground and second floor provide nursing care for older people living with dementia with the first floor unit supports people with higher physical nursing needs. There were 59 people living at Eastleigh Ralleigh Mead at the time of the inspection.

At the time of the inspection the long standing registered manager had just de registered with CQC and an application for a new manager was being processed by CQC. The new manager intends to work with the previous registered manager who is staying on at the service to be part of the clinical lead team. 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.

Care was well planned and being delivered by a staff group who understood people’s needs. Risks were being managed and reviewed in line with people’s changing needs. People living at the home felt safe and well cared for. There was a variety of planned activities for people to participate in. These included accessing the local community where possible.

Staff were available in sufficient numbers and had the experience and competencies to work with people with complex needs. The provider had ensured for example, that all staff had up to date training in working with people who may become distressed or anxious and may require safe holding. Where people had been deprived of their liberty, this had been recorded and was in line with The Mental Capacity Act (2005) to fully protect people.

Staff understood people’s needs and could describe their preferred routines. They worked as a team to provide personalised care and support for people. Health care needs were closely monitored and advice sought from GPs, community psychiatric nurses and other allied health care professionals as needed. The service had introduced a new electronic recording system for their medicines management. Staff had received training and support to manage this change and reported the new system was working well, with less chance of error.

The home was clean and free from odour. Staff understood the processes for ensuring good infection control procedures and there was a ready supply of personal protection equipment such as gloves, aprons and hand sanitizers to help reduce the risk of cross infection.

Staff reported that they felt well supported and had confidence in the management team. Staff felt their concerns, ideas and suggestions were listened to and acted upon. There was a planned training programme covering all aspects of health and safety and some more specialised areas such as working with people with dementia care needs and care of the dying. Staff had regular opportunities to discuss their work and receive support and supervision.

Systems were in place to ensure people and their family had opportunities to have their views heard both formally and informally. Relatives reported they were made to feel welcome and had opportunities to talk to staff and management about any concerns or ideas they had in relation to any aspect of the running of the service.