This inspection took place on 12 and 13 March 2018 and was unannounced. During our previous inspection on 21 and 23 June 2016, we found one breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This was regarding the provider not having completed all of the required staff pre employment checks. We asked the provider to submit an action plan to show how they would address this breach and the provider supplied evidence on 13 September 2016 that the required action had been completed. During this inspection, we checked whether the provider had maintained the improvements they had made. We found the provider had made and sustained the required improvements.

High Hurlands Nursing Home is a care home for people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

High Hurlands Nursing Home provides care to a maximum of 22 people who live with a learning disability, autism and/or associated health needs in a small village on the outskirts of Liphook in Hampshire. At the time of the inspection there were 22 people living at the home.

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.

There was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally.

The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting.

Risks to people were assessed and action was taken to minimise any avoidable harm to people. Staff were trained to support people who experienced behaviour that may challenge others, in line with recognised best practice.

The provider used an electronic system to manage people's medicines. The system ordered, recorded the administration of and managed people's medicines stocks. Nurses had undertaken training to enable them to use the system and ensured that they administered people's medicines safely.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual’s complex needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

Risks to people with complex needs were identified and managed to ensure they were supported to eat and drink safely. The registered manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, family atmosphere at the home. People were relaxed and comfortable in the presence

We carried out an unannounced inspection of High Hurlands Nursing Home on 21 and 23 June 2016. High Hurlands Nursing Home is a residential nursing home providing accommodation and support for up to twenty two people with learning disabilities in a small village on the outskirts of Liphook in Hampshire. It is located alongside the provider’s other separately registered service, High Hurlands Community Homes which are set in the grounds of the nursing home. At the time of our inspection twenty people were living at the nursing home.

High Hurlands Nursing Home had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

During the inspection we saw that there were sufficient staff to meet people’s needs. Where shortfalls were identified, for example, through sickness, the provider managed these internally by deploying staff flexibly across the nursing home and community homes.

The provider had not always ensured that all the relevant recruitment checks were carried out for newly employed staff. This meant that people were not always protected from the risk of receiving care from staff who were not suitable for their role.

Risks to people had been assessed and measures were in place to manage them. All incidents were recorded and reviewed in detail at monthly management meetings in order to identify any potential risks to people and in order to take any required actions to keep people safe.

Staff had undertaken training in safeguarding adults and understood their role in relation to keeping people safe from the risk of abuse. Where safeguarding incidents had occurred these had been dealt with appropriately, including being correctly reported to the relevant authorities and action taken to minimise the risk of re-occurrence.

The provider used an electronic system to manage people’s medicines. The system ordered, recorded the administration of, and managed the stock of people’s medicines. Nurses had undertaken training to enable them to use the system and ensure that they administered people’s medicines safely.

Staff received an appropriate induction and continued to receive regular supervision and relevant training in their role. People were cared for by well trained and well supported staff.

People’s records demonstrated they were supported by staff to see a range of health care professionals both on a routine basis and when they needed additional support.

Deprivation of Liberty Safeguards (DoLS) applications had been made for all people who lacked capacity to make decisions for themselves. Mental Capacity Assessments and Best Interest decisions had been carried out for people on some areas such as implementation of their care plans and use of specialist beds. We have made a recommendation that the provider ensures that appropriate mental capacity assessments and best interest decisions are clearly documented for some specific decisions taken on a person’s behalf, for example around other types of restraint, in order to demonstrate that the least restrictive outcomes for people were always in place.

People were supported to eat and drink enough to maintain a balanced diet. Meals were provided in the form of nutritionally balanced ready meals, cooked from frozen, which many people ate and enjoyed. However some staff and relatives told us they would prefer people to have freshly prepared meals. People’s mealtime experience varied on occasion. People didn’t tend to eat at the same time or together which sometimes impacted on the scope for mealtimes to be a social occasion. Some staff were very good at interacting wi

People who lived at High Hurlands had complex needs and were not able to comment on the quality of the care and support provided. However we observed a high number of positive interactions between staff and people who lived at the service. Staff provided sensitive and appropriate care that was in line with people's assessed health and support needs.

People were protected against the risk of abuse because staff had been trained in adult protection procedures and were encouraged by the management team to express any concerns about people's wellbeing.

People were supported by sufficient numbers of well trained staff, most of whom knew them well. This helped to contribute to the high quality of interactions we witnessed.

The service was well led by an experienced manager and a competent and efficient senior management team who ensured that there were robust monitoring systems in place, to review all aspects of the service, for example infection control. This helped to maintain the high quality of the service.

People who lived at High Hurlands had complex needs and most were not able to comment on the care and support provided. We spoke with one person who said that staff were "nice"

There were very clear systems in place to ensure that staff acted appropriately in people's best interests when they assisted them with their health and care needs. Staff were given detailed guidance, which was regularly reviewed to help them to support people appropriately and consistently. Relatives were regularly informed about people's wellbeing. Healthcare professionals were consulted when the need arose and their advice was followed.

There were thorough processes in place to ensure that medicines were managed safely and regular audits took place to review medication procedures.

Effective recruitment procedures helped to ensure that staff employed were fit and appropriately qualified to do their job. People were supported by well trained staff who demonstrated a good understanding of people's needs.

Staff were regularly assessed to ensure that they had, and continued to have the necessary skills and knowledge .

There was a clear system in place to manage complaints and staff had a lot of guidance and knowledge about how to recognise when people were unhappy. Staff were encouraged to express their views during regular supervision sessions and said that managers were receptive to their opinions.

People who lived at High Hurlands had complex needs and were generally not able to tell us what they thought about the care and support they received. We used a specific way of observing care to help to understand the experience of people who could not talk with us. We observed that staff were friendly and respectful towards people and that they were quick to respond if anyone appeared unhappy or distressed.