Iden Manor provides accommodation, personal care and nursing care for up to 51 older people including people living with dementia. The ground floor and upper floors accommodate people with residential needs, and the lower ground floor accommodates people living with dementia and more complex needs. On the day of our inspection, 44 people lived in the service, 24 of whom lived with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good. We have made recommendations regarding some aspects of the management of medicines.

Medicines were administered safely, although we identified improvements needing to be made regarding the documentation and administration of medicines prescribed ‘as required’ and of topical creams; and of the monitoring of temperature where some medicines were stored.

Risk assessments were centred on the needs of the individual. Each individual risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks of falls for people.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role.

Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records help staff deliver care that met people’s individual needs.

People were supported to have choice and their independence was promoted by staff who understood the needs of people living with dementia. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. The activities provided were suitable for people living with memory loss and were in the process of being enhanced.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. The registered manager acted on the results of these checks to improve the quality of the service and care, although their checks had not identified the shortfalls in respect of some aspects of medicines management.

Further information is in the detailed findings below.

At the time of this inspection there were 43 people using the service. We were informed by the deputy manager that the service was divided into two units. One unit was primarily for those with a diagnosis of a dementia and the other unit specifically provided nursing care. The deputy manager confirmed that approximately half of the people across the service had a diagnosis of dementia.

During the inspection we spoke with 13 people that used the service, three staff members and three relatives to seek their feedback about the service provided. We did not receive any completed comment cards after the inspection. People that used the service told us they were very happy with the care they were receiving. One person commented “I like it here and the staff are so kind, caring and thoughtful. I especially like playing bingo and reading the newspaper with the staff”.

Relatives of people using the service told us that they were involved in their relatives care and were satisfied that they were given the care and support they needed. One person commented “[My relative] is happy here, X has put on weight and the staff are very kind. We as a family were consulted about their needs, likes and dislikes before they came here”. Another relative commented “I am completely satisfied with the care X receives here and I find the staff excellent”.

We found that people had detailed assessments of their needs and care plans that ensured these needs were met. Their preferences were taken into account and staff provided care that promoted people’s dignity and treated them with respect. The service worked well with other agencies to meet all areas of people’s health and social care needs.

There were effective systems in place for checking and improving the quality of care people with dementia received. This included asking the people that used the service, and their relatives, what they thought of the care provided. Risks were carefully monitored and action taken to reduce these.

This inspection was carried out on 27 and 30 January 2015 by one inspector, a specialist advisor and an expert by experience.

Iden Manor Nursing home provides accommodation, personal care and nursing care to up to 51 older people including people who are living with dementia. At the time of this inspection 41 people were living at Iden Manor Nursing Home. There are two units one for people living with dementia and the other provides nursing care. The building is a period property, accommodation is over four floors and rooms are of individual shapes and sizes. There is a through floor lift allowing access to each floor. Each unit has its own lounge and dining room and a quiet lounge. There are extensive grounds and well-maintained gardens that are accessible to people and have seating and paved areas. There is a large safe patio garden area for the use of people living with dementia.

There was a registered manager at the service. 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.

The provider had taken reasonable steps to make sure people were safe. Staff had undertaken training so that they understood how to protect people from abuse and harm. The home had safeguarding and whistleblowing policies and procedures that staff could access. People told us that they felt safe and visitors told us the service promoted people’s safety. One person told us, “They are good people and I feel safe. “ A relative told us, “There are enough staff and it is safe”.

The provider had assessed individual and environmental risks to people’s safety and put measures in place to minimise these. Staff had been trained so that they knew how to support and care for people living with dementia.

The service had a welcoming and calm atmosphere. People had access to a choice of seating area. Accommodation for people living with dementia contained items to stimulate people’s interest and aid reminiscence. People living with dementia had their own items that signified important events in their lives in their rooms or beside their doors to help them identify their rooms.

The service was clean and staff understood the action they needed to take to prevent the risk of cross infection.

There were safe systems for the storage and administration of medicines and people received their medicines when they needed them.

Systems were in place for the management of emergencies at the service. These included the assessment of the support each person would require in the event of an emergency at the service. Information for staff about how to manage emergencies was easily accessible to them. Staff checked equipment that was for use in the event of an emergency to make sure it worked properly.

The provider operated safe recruitment systems that included checking that applicants were suitable to work at the service. There were sufficient numbers of staff on duty and staff were clear about their roles and responsibilities.

Staff received the training they needed for their role and additional training so that they understood people’s needs. Staff undertook Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) training. The Care Quality Commission monitors the operation of the Derivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the service was currently subject to a Dols, we found the manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement that widened and clarified the definition of a deprivation of liberty.

The service promoted partnership working with other agencies, such as a hospice and other healthcare and social care professionals.

Staff asked people, or their relatives for their consent to the care and treatment they received. People had access to information about advocacy services if they needed them.

People told us staff understood their individual needs and were kind, caring and patient. People said staff had time to listen to them. A member of staff told us that, “There is time for the nice things as well”. A relative told us that staff were “Tender and caring”. A visitor told us that staff did not “Keep you hanging about” in relation to people using call bells to request assistance.

We saw that staff mostly treated people with respect and dignity; they called them by their names, explained what they were doing and respected their privacy. However, at lunchtime on both days of our inspection domestic staff cleaned the nursing unit lounge where people were taking lunch whilst some people were still eating.

It is recommended that best practice guidance is sought and followed relating to protected meal times and the need for people to be able to eat meals without disruption.

Staff told us they were well supported, they received regular supervision, annual appraisals and attended meetings to offer this support and ensure they were working to the expected standards and sharing best practices.

People were provided with meals that were well cooked and presented and there was plenty of choice available. People told us they liked the food and one person told us “They feed me so well I am putting on weight”. Staff supporting people who needed assistance with eating and drinking did so sensitively and respectfully, and offered people food choices in ways that they could understand. People on both units in the service could choose to eat their meals where they wished.

People’s health needs were well met. Staff recorded information about people’s health. People and relatives told us that staff sought advice from health professionals when they needed to..

The service offered people a variety of planned activities and celebrated special events and days throughout the year. Staff were employed to plan and provide activities that met people’s needs and choices.

There was a complaints procedure, people and relatives told us they felt confident that any concerns would be, and had been, listened to and addressed.

People, staff, and health and social care professionals felt the service was managed well. One person to us “It is well led, they are all homely people”. Staff told us they felt the manager and senior staff “Had time to listen” and were approachable.

There were systems to monitor the quality of the service, such as surveys for people and relatives to complete, informal meetings and events at which people and relatives could offer their views. The provider made a range of audits and checks to make sure staff followed correct working practices and that the service was safe. These included medicine, training, and health and safety audits. Action had been taken when necessary to make improvements to the service as a result of these checks.