The inspection took place on 10 October 2016 and was unannounced.

The home provides residential and nursing care for up to 91 people. Some of the people at the home were living with a dementia. The home was purpose built and is set over two floors with the upstairs being a secure dementia area. There is a main lounge and dining area on each floor as well as smaller areas with comfortable seating. There were 85 people living at the home when we inspected.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager had implemented new care plans to improve the recording of person centred care. These had not been fully completed and therefore people’s risks and care needs were not fully documented. However, staff’s knowledge of people’s needs meant that the care provided met people’s needs and kept them safe from most harm. Though a number of people were left sitting in their hoist slings which was not good practice and increased risks.

Staff were kind, caring and compassionate and supported people’s dignity and independence.

There was a monthly programme of activities and people were able to choose what activities they wanted to undertake. People were also supported to continue to enjoy hobbies and activities they had taken part in all their lives.

There were enough staff to ensure that people’s needs were met in a timely manner. In addition staff received training and support from managers which meant that the care provided was safe and effective. Recruitment processes ensured that staff were safe to work with people living at the home. Staff had received training in keeping people safe from abuse and knew how to raise concerns. The registered manager investigated any concerns raised and took appropriate action to protect people.

Medicines were safely administered to people. However, delays in receiving medicines meant they were not always available for people when needed. The registered manager was working to resolve this issue. Mealtimes were a pleasant experience for people and they were offered a choice of food and drink. Dietary needs were catered for and appropriate equipment was available for people. Staff monitored people’s weight and supported them to remain at a healthy weight. People were supported to have access to healthcare professionals.

People’s rights under the Mental Capacity Act 2005 were respected and where people had capacity they were supported to make decisions which may put them at risk. Where people were unable to consent to living at the home and were under constant supervision appropriate referrals had been made to the Deprivation of Liberty Safeguards supervisory authority. People were able to make choices about their everyday lives and these were supported by staff.

People knew how to complain and the registered manager investigated complaints and took action to stop the issues reoccurring. The registered manager was approachable and supportive of staff and took account of good practice guidance to improve the care that people received. People living at the home and their relatives had their views of the home gathered and the registered manager took action to address any issues highlighted. People were supported to be involved in the running of the home.

We visited Hunters Creek Care Home with nursing to see if they had made improvements in planning people’s care to meet their needs and to reduce the risks to people’s health safety and welfare. We looked at four care records and spoke with two members of staff.

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

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service effective?

People’s needs were assessed and they were involved in discussions about their care. We saw care plans reflected people’s needs and abilities to make their own decisions. We saw where risks had been identified; care plans identified how the risk to people could be reduced.

On the day of our inspection there were 82 people living at Hunters Creek Nursing Home. The home is split over two floors with the upstairs providing a secure unit for people with dementia. During our inspection we spoke with five people who lived in the home, two relatives, eight members of staff and the manager. We also spoke with a social worker who was visiting a person who lived at the home.

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

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS) although no applications had needed to be submitted.

The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

We found there were good infection control processes in the home. We saw there was ongoing monitoring and improvement of the systems to keep people safe from infection. Staff had access to appropriate protective equipment such as gloves and aprons. We saw the home was kept clean and hygienic.

Is the service effective?

People’s health needs were assessed and they were involved in discussions about their care. However, we saw care plans did not always fully reflect people’s needs and abilities to make their own decisions. We saw where risks had been identified there was not always plan in place to identify how the risk to people could be reduced. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to planning care to meet people’s needs and ensure their safety.

We saw people were supported to have a choice of food and drinks. Where people were required to follow a special diet they received food appropriate to their needs. We found people’s nutrition was assessed and people were monitored to ensure they were not at risk of malnutrition.

Is the service caring?

People told us they were happy with the care they received. One person said, “I find it’s ok. It’s just like home, it is my home.” We saw there was a warm and caring relationship between people who used the service and staff. Care workers spoke politely to people and we saw they always knocked on the door before entering a person’s room.

People using the service, their relatives, friends and other professionals involved in their care were asked about the quality of the service they received. Shortfalls and concerns had been identified.

Is the service responsive?

People told us they knew how to make a complaint. We found information on how to make a complaint was available to people in their room.

We found where people were not well the provider arranged to them to see an appropriate health care professional.

Is the service well-led?

We found the provider did not have a manager in place who was registered with the care quality commission. We spoke with the manager who confirmed they were in the process of applying for registration with the CQC.

We saw the manager and senior staff were responsible for completing a comprehensive suite of audits which identified concerns about care and the environment. The provider mostly took action about any concerns identified. We have reminded the provider they need to take action in all cases.

During our visit we raised a few concerns with the manager about issues we had identified. In each case the manager had already identified the same concerns. This meant the manager was aware of the problems in the home and was taking action to improve the service.

People told us they were involved in decisions about their care. One person told us, "Staff ask me each day what I would like to do." Relatives told us they were kept informed about their family member's care needs. There was evidence in the care records that consent to treatment was sought from people prior to treatment taking place.

People we spoke with told us their physical needs had been attended to but their emotional needs had not been. One person said, "I would like staff to come and chat with me." Activities took place on most days covering a range of events such as quizzes and crafts. One person said, "I could join in but it is my choice not to." Another person showed us the flower arrangement they had completed. The care plans recorded daily events in peoples lives and when staff had sought the assistance of other health and social care professionals.

The storage areas for medicines were clean and tidy. Staff had received training to ensure they were safe to administer medicines and we observed two members of staff giving out prescribed medicines.

People told us their care needs were sometimes delayed due to some new staff working slower than others. They told us the skill was not good at times. One person said, "They (new staff) do things so quickly.." Staff told us some staff had left and new staff were completing their induction. The rotas confirmed where agency staff had been used. There was no record of a staffin level needs analysis being completed.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Roberta Berry's name appears as they were still on our register at the time.

When we visited the home we spoke with six people who lived there. On the day of the visit there was an outbreak of diarrhoea and vomiting. People who lived there had been advised to stay in their bedroom in order to prevent the spread of the virus. Some staff were on sick leave, however people told us the care they received had not been affected.

The people we spoke with told us they were being well looked after, no one expressed any concerns. One person told us, “The staff are very good, they look after us alright.” Another person said, “I certainly am being well looked after. I do like it here, they are very good.”

We spoke with a relative who was visiting. They told us, “My relative is being very well looked after. They do lots of activities such as bingo, a quiz, knitting and they had someone bring a dog in for people to pat. The communication is good. I have no complaints."

We also spoke with a visiting GP. They told us, “The clinical procedures are good, the nurses discuss any problems people may have. The thing I am impressed with is that not many people are taking food supplements. The staff encourage people to eat their meals and are offered other alternatives to keep up nutritional intake.”