We inspected this service on the 5 & 6 December 2016. This was an unannounced inspection.

Highcroft nursing home provides care for older people with nursing and personal care needs. At the time of the inspection there were 22 people living at the home. Accommodation is arranged over three floors. It has a lounge, a dining area, manager’s office, nurse’s station, the ground floor had an additional lounge, kitchen and admin office. There is a drive way at the front and a patio area.

There was a registered manager in post who was also the provider. 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’s medicines were not always kept secure. We found although the medicines trolley was kept secure and locked in between administering medicines. Whilst people were being administered their medicines the trolley was left open and unlocked meaning people's medicines were left unsafe and could be access by anyone within the building. People’s medicines administration charts (MARs) were being signed before the person had been administered the medicines. This meant if the person chose not to take their medicines then the chart would need to be altered to accurately reflect that the medicines had not been administered.

People’s care plans contained detailed, accurate and informative risk assessments in relation to their individual needs.

People felt safe in the home and received support from staff who had appropriate checks in place prior to commencing their employment.

People were supported by adequate staffing levels and staff supported people in a kind and caring manner.

Staff received regular supervision and training to ensure they were competent and skilled to meet people’s individual care needs.

Staff felt happy and supported but the management of the home.

People were happy with the meals and had various choices each meal time.

People’s care plans confirmed if people were unable to make decisions relating to their care and treatment although people’s records could be improved with the information being in one part of the persons care plan. The principles of The Mental Capacity Act were being followed.

People were supported to maintain relationships with friends and family.

The home had a separate dining area that people could use if they wished and people booked it to have meals and parties with their friends and family.

People were supported by staff who gave people choice and control in their care and support.

People could access a range of activities each week and people were positive about what was available to them. Activities such as singing, exercise classes and aromatherapy were offered and people could have daily newspapers delivered to the home which was organised by the home.

People felt able to make a complaint to the registered manager should they need to do so.

People and relatives were involved in planning their care.

The provider had quality assurance systems in place that identified areas for improvement so that areas of improvement could be identified and planned for the forthcoming year.

People, relatives and professionals views were sought so that improvements could be identified feedback received was overall positive about the care provided and received.

On entering Highcroft Nursing Home we found the atmosphere warm and welcoming with good interaction between staff and people who used the service. We observed staff being respectful and sensitive to people's needs. Giving people time to make decisions and gently encouraged to do things.

We noted some people were unable to communicate with us and we observed staffs understanding of the care and support needed. We spoke with people who used the service and a family member who said that they "can't fault staff" and they are "very very nice." People told us they liked their bedroom which were tastefully decorated with their personal belongings for example "family photographs."

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found that they encompassed the safety and well-being of people who used the service.

People who used the service told us that they knew how to raise a concern or complaints and felt confident in doing. They said if they had any issues or concerns they could "tell staff" or speak to the manager.

Staff told us they were supported by management and had received all relevant training. We saw staff were supervised regularly and were appraised annually. The quality of the service was monitored through regular audits. People who used the service, family and their representatives were given the opportunity to give feedback regarding the running of the service.

Some people we met were unable to communicate with us and we observed their care to help to understand their experience of living in the home. We spoke to six staff about how they were supported to meet people's needs.

We observed staff being respectful and sensitive to people’s needs. Giving people time to make decisions and gently encouraged to do things. One person told us that they are “very good staff, we just have to ring and they come straight away” and another “It’s wonderful here staff are always ready to help you”.

We saw comprehensive and detailed care plans and risk assessments that were regularly reviewed and up to date policies and procedures.

We observed people at lunch time. People we spoke with told us that the food is “good”. One person told us that we have “good food, we have a choice of food and I can ask for something else if I don’t like the choice on the menu”. We saw that people have a choice of where they would like to eat and staff are sensitive to individual preferences.

During lunch time we observed people given their medication. The medication and dosage was explained to the person and they were encouraged to take this when they were ready.

Staff told us that they have regular training and supervision and they received good support from the manager.

People told us how well supported they were by staff team at Highcroft. We were told “The home is very good, it must be the discipline from the top”. “It is wonderful here I couldn’t be in a better place”. “You get better treatment here then you do in the hospital, they are very very good”. “The staff are all brilliant they are all well trained, I don’t think matron would have them here if they were not”.

People were being effectively supported by staff with their range of nursing and personal care needs. We saw that care plans properly supported care practises and contained up to date information to guide staff to give people the care they needed.

People benefited because there was a commitment by the providers to ensure there was a comprehensive training programme for the staff team. People were cared for by staff who had a good understanding of their range of nursing and personal care needs.

People felt safe and properly treated living at Highcroft. There were effective systems in place to ensure staff were competent with the right information available to guide them, so that people were kept safe in the home.

We saw that people were regularly asked their views of the care and support they were receiving at Highcroft. There were effective methods being used to check, monitor and improve even further the quality of the service people received.

There were systems to review and learn from all critical incidents and occurrences that may have impacted on people's health and wellbeing.