This comprehensive inspection took place on the 11 and 19 January 2018, the first day was unannounced. At the last inspection, in August 2015 we rated the service as ‘Good’ overall and in the Safe, Effective, Responsive and Well led domains and as Outstanding in Caring. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Halsdown Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Halsdown Nursing Home provides nursing care for older people, some of whom are living with dementia. It is a two storey adapted building with 14 rooms, three of which can accommodate couples who wish to share a room.

The registered provider is also the registered manager of the service. A registered manager is a person who has registered with 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.

At this inspection we found the service remained Good.

Why the service is rated Good.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. Staff were highly motivated and found ways to value each person’s contribution and treat them with the utmost dignity and respect. The home was organised around people’s needs, by staff who knew what was important to each person.

People were supported at the end of their life to have a comfortable, dignified and pain-free death. The service worked with hospice staff to improve end of life care for people. Staff followed national best practice guidance such as 'One chance to get it right' and NICE guidelines for end of life care (2015) and were working towards The Gold Standards Framework (GSF). This helped staff have the skills and confidence to help people have a good death.

Staff undertook 'Dementia Friends' training to understand various types of dementia affected people, they encouraged and supported people living with dementia to live well. Dignity training was provided in innovative ways to promote best practice. Staff sought out opportunities to praise and value people.

Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. People's risk assessments were comprehensive with actions taken to reduce the risks as much as possible. We found the hot water supply to hand wash basins in people’s rooms and in bathrooms was too hot. We made the deputy manager aware of this risk. They took immediate action to address and arranged for thermostatically controlled valves to be fitted in all rooms the next day. This meant hot water temperatures were reduced to within safe recommended limits.

Staff understood the signs of abuse and knew how to report concerns, including reporting to external agencies. A detailed recruitment process was in place to ensure people were cared for by suitable staff. People received their medicines safely and on time from staff that were trained and assessed to manage medicines safely. People received their prescribed medicines on time and in a safe way.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People were supported by staff who were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were

During this inspection we the Care Quality Commission (CQC) spoke with five people using the service and one relative. We also spoke with five members of staff, the home owners and the deputy manager.

Risks to people's health and welfare were identified and their needs were met in a way that was personalised to each person. Health promotion was encouraged through referrals to specialists and through the use of regular dentistry and chiropody services. People told us they felt safe and well cared for.

We saw people had a choice of suitable and nutritious food and drink available in sufficient quantities. People said the food was good. People were cared for in an environment that was suitably designed and well maintained.The home was clean and comfortable.

There were enough qualified, skilled and experienced staff on duty to meet people's needs. Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.

The inspection took place on the 5 and 11 August 2015 and was unannounced. We last inspected the service in January 2013 and did not identify any concerns or breaches of regulations.

Halsdown Nursing Home provides accommodation for up to 17 older people who may require nursing or personal care. The home has a registered manager, referred to as ‘Matron'. 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, relatives and health and social care professionals were overwhelmingly positive about their experiences of the home. They spoke about how friendly and welcoming staff were, the homely atmosphere and said the home was well organised and run.

Staff were kind and compassionate towards people, and had warm and caring relationships with them. They were highly motivated and used innovative ways to respect each person’s dignity and maintain their privacy. The home was organised around people’s needs, and they were supported by staff who knew what mattered to them.

People were actively involved in making decisions about their care. They were offered day to day choices and staff sought people’s consent for care and treatment. Where people lacked capacity, staff demonstrated a good understanding of their responsibilities under the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty safeguards (DoLs). Mental capacity assessments were undertaken for people who lacked capacity, relatives and health and social care professionals were consulted and involved in decision making in people’s ‘best interest’.

People were supported to receive ongoing health care support. Staff were knowledgeable about people’s care needs, and any risks. Detailed care plans showed each person's care and treatment needs. Care records were up to date and showed accurate records were kept about each person, which were regularly reviewed and updated as people’s needs changed.

People were supported to remain active, and be as independent as possible. They were encouraged to mobilise and a regular exercise class was provided. People were assisted to maintain their interests and hobbies and to try new things, and accessed the community regularly.

People and relatives felt safe at the home, although some minor health and safety risks related to the premises were identified. The registered manager addressed most of these during our visit.

The culture of the home was open and friendly. There was clear leadership from the registered manager, and staff had clear roles and responsibilities. The provider had a range of quality monitoring systems in place which were used to continually review and improve the service.

The provider participated in a number of good practice initiatives to encourage high standards of care and keep staff up to date with practice. This included schemes such as Dignity in Care, the Social Care Commitment and the Alzheimer's society’s 'Dementia Friends'. There was evidence of continuous improvements being made in response to these initiatives and from people’s feedback.