Hay House Nursing Home is nursing and residential home for 35 people, the majority of people living with dementia or a cognitive impairment. The service is a large, older style building with a secure garden and well maintained grounds in a rural setting.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

We carried out an unannounced inspection of Hay House Nursing Home on 19 February 2018. At the time of the inspection 32 people were living at Hay House Nursing Home.

There was a registered manager employed at the home who were clearly passionate about providing a high quality, individualised service. They had worked at the service for many years. 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 provider, Chartbeech Ltd had recently been bought by new owners who owned another service in the South East.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. Most people were not able to comment directly on their experiences due to living with dementia. One relative said, "They’re amazing! Mum is seen as an individual and since she has been here we have seen her [personality] coming through again. They care deeply. She had the best care here.” Another relative told us, “They are brilliant. It’s such a nice home, relaxed. They know [person’s name]’s habits, people do their own thing.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and also enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people. They looked comfortable and happy to spend time in the lounges, their rooms or the conservatory and diner.

People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or watched television. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance or were engaged with sensory activities.

People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.

People and relatives said the home was a safe place for them to live. One relative said, “It’s such a relief. I can have a break and not worry about coming in.” Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team.

Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living wit

Our inspection was unannounced and lasted approximately nine hours. We were accompanied by an expert by experience. Prior to this inspection, we had been contacted by a person, who raised concerns, these related to one person not being treated with dignity, poor moving and handling practice, a lack of stimulation for people and poor standard of meals in the evening. We asked the home to investigate these concerns and they provided us with a report, which showed the concerns had not been upheld, apart from an issue regarding keys being made available to staff. During this visit, we inspected five outcome areas, four of which related to the concerns; all five outcomes were compliant.

There were 33 people living at the home. We spoke with nine people living at Hay House. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We spoke with seven visitors. We also spoke with three staff members and the manager. We looked at a selection of records; we focussed on how people’s care, nutritional needs and medication were managed. We also looked at how staff were supported to carry out their role.

Staff offered people choice, and treated people with kindness and respect. Care and support was offered to people in a friendly, cheerful and professional manner. We saw people generally looked relaxed and at ease with staff. When people felt anxious, staff were quick to recognise the need to change their approach, such as sitting with them to reassure them. People’s health and well-being was assessed, and care was provided in a way that suited people's individual needs. There was a range of meals and drinks to suit people’s individual needs and tastes. Medication was well managed and administered in a person centred manner. Staff were provided with training to help them support people in an appropriate manner to help maintain their well-being.

There were 32 people living at the home when we visited. We spoke with six people and four visitors and asked them about the care and treatment provided. We looked in detail at three people's records which included personalised information about people, as well as care plans and risk assessments. We spoke with eight staff and asked about people’s care needs. We looked at staff recruitment files, records of servicing and maintenance of equipment as well as the homes quality assurance processes. We followed up improvements in relation to compliance actions set following a previous inspection.

One person said “the team is really good, I feel well supported”. A relative said “staff give time to all the residents” and another said “staff are very good, well meaning, will do anything for you”. We found that people's needs were met and risks were well managed. On the day we visited we saw how much people enjoyed singing along during the musical entertainment. Staff engaged quietly and respectfully with people using helpful body language, for example crouching down to someone's level to speak to them and praising the achievements of others. When people were distressed or anxious, we saw staff immediately went to support them in calm and measured manner.

We found all six standards we inspected were fully compliant.

We had identified concerns about respecting and involving people in their care, treatment and support, and cleanliness and infection control at the home in our report of December 2010. At our return visit on 27 June 2011 we found that improvements had not been made. This had resulted in people not receiving support in a dignified way that respected privacy. People were also not being protected against the infection risks associated with poor cleanliness at the home. On 14 July 2011 the Care Quality Commission issued formal warnings to Chartbeech Limited that it must make urgent improvements with regard to respecting and involving people who use services, and improvements to cleanliness and infection control at Hay House.

We made an unannounced visit to the home on 20 September 2011 to check that suitable action had been taken to address areas of concern highlighted in the warning notices. We found that it now complied with the essential standard of quality when respecting and involving people in their care, treatment and support, and in the management of cleanliness and infection at the home.

Many of the people living at the home have difficulty in evaluating and expressing their thoughts and ideas because of dementia or other illnesses. This meant that where people could not tell us how they were treated at the home we relied upon observation of care and support staff provided to people to assess how well people were cared for and valued as individuals. Some people told us that Hay House was a good place to live and that staff treated them well. We observed the staff working well as a team in order to provide attentive care. The staff interactions we observed or heard were kind and respectful toward people. There has been a change of management of housekeeping at the home since our last visit and a review of housekeeping systems and practices has taken place. We found people living in a home that was clean and people were protected from the risk of any infection spreading in the home.

During our visit we were unable to speak with people in depth due to their communication disabilities. However, we spoke with 3 relatives of people living here. These people told us that their relatives are not being treated as individuals or with respect to their privacy and dignity. For example, one person said their relative has been left wearing only a vest or naked with a duvet over their lap for long periods of time.

Another person told us that their relative is losing the skills they had when admitted to the home because staff do not have the time or information they need to support them to maintain these skills and their independence. They say that people have to fit into the homes routines and are ‘done to’.

Another person told us that people do not always have the right cutlery to eat and have seen their relative eating trifle with a fork.

We were told that on one occasion, information about someone’s medical condition given to staff by a relative was forgotten and a visit from the doctor was delayed.

Visitors to the home also say this home is clean and that the staff are lovely.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Hay House Nursing Home is registered to provide accommodation and nursing care for up to 35 older people. It provides a service for people with dementia as well as other mental health conditions. On the day of our inspection 30 people were living at the home. The home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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, and associated regulations, about how the service is run.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People appeared relaxed and happy. People, their relatives and health care professionals all spoke highly about the care and support Hay House Nursing Home provided. One person living with dementia who had been dozing in a chair after breakfast was relaxed and smiling and said “I like it here." Another person told us; “It’s nice here. I’ve always liked it. The people are nice.”

The environment encouraged people to be independent if able. The décor of the building had been carefully thought out and took account of people’s needs. For example, people living with dementia were enabled to access bathrooms using pictorial signs and plain flooring to facilitate independent mobility. People who were able, moved feely around the building and its grounds as they chose. Staff actively supported people in meaningful activities and to access the grounds. People were involved in decisions about proposed changes, to further enhance their day to day lives.

Information we requested was supplied promptly. Care records were comprehensive. We discussed the format with the registered manager, as there was a lot of unnecessary information making it more difficult to find details about how to provide care. The provider had already noted this and they were discussing adding summaries and simplifying the format to make it more person centred. However, plans contained detailed person centred information about how individuals wished to be supported. People’s preferred method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe. People had choice and control over their lives and were supported to take part in a varied range of activities both inside the home and outside in the community. Activities were meaningful and reflected people’s interests and hobbies.

Staff put people at the heart of their work, they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. The home’s philosophy was about providing care for people with dementia which was person centred and individualised. Staff told us that focussing on this philosophy had really “opened their eyes” and changed their understanding of people and the way they worked with them. They said the home had become “more homely and relaxed” and there was less of a routine.

The service had an open door policy, relatives and friends were always welcomed and people were supported to maintain relationships with those who matter to them. During the inspection people frequently came in to join the responsible manager and provider in their office. They were welcomed in, sat in an armchair and made themselves at home.

Staff were well supported through induction and ongoing training. Staff were encouraged to enhance their skills and professional development was promoted. Staff felt that the general training they received equipped them for the job. They could ask for specific training as the need arose, for example related to pressure area care and tissue viability. They emphasised that much of the care they provided was very individual according to the needs and preferences of the person, so the knowledge they needed was very specific.

Staff understood their role with regards the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made and advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. People told us they felt safe.

People knew how to raise concerns and make complaints. People told us concerns raised had been dealt with promptly and satisfactorily. Any complaints made were thoroughly investigated and recorded in line with Hay House’s own policy. Learning from incidents had occurred and been used to drive improvements.

The service had a very open and transparent culture. Staff described the management as very supportive and approachable. Staff talked positively about their jobs. Staff told us that they had a “lot of confidence in the registered manager.” They described her as “very supportive”, a “good listener” and said they could go to her with any issues. She was caring towards the staff and understood they needed to be well supported in order to care effectively for people at the home. One member of staff told us, “The home is like my family. I want to put all my energy into it.” Staff were encouraged to come up with innovative ways to improve the quality of care people received. Staff felt listened to and empowered to communicate ways they felt the service could raise its standards and were confident to challenge practice when they felt more appropriate methods could be used to drive quality.

People’s opinions were sought and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents and accidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the home.