About the service:

Kineton Manor Nursing Home provides accommodation, nursing and personal care for up to 51 older people, who may have dementia. There were 51 people living at the home at the time of our inspection.

People’s experience of using this service:

At our last inspection in May 2016, the service was rated requires outstanding overall. The key questions for safe, effective and responsive were rated good and the key questions caring and well-led were rated outstanding. At this inspection we found the evidence continued to support the rating of outstanding. The continuous improvement in the service had resulted in a further outstanding rating for the responsive key question.

People told us that they were extremely happy with the service they received. They praised the atmosphere within the home and spoke of the dedication of both managers and the wider staff team.

The service was led by a highly motivated and compassionate registered manager who continued to explore ways to improve the service to ensure people received high quality care. Staff were proud to work at Kineton Manor and spoke very positively about the guidance and motivation provided by the registered manager and the senior staff team.

There were enough highly trained and skilled staff to meet people’s needs. There was a strong commitment to providing staff with the opportunities to develop in their role and take extra qualifications.

Staff spoke about people in a very compassionate manner, were knowledgeable about people’s history and background and valued them as individuals. People were respected for who they were and staff understood the importance of protecting people's rights in line with equality legislation.

The service offered people opportunities to meet their individual cultural, psychological, spiritual, emotional and social needs, whatever their abilities. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff worked in partnership with a multi-disciplinary team to enable people to live healthier lives or to manage long term medical conditions. The registered manager and staff continued to demonstrate an extremely strong commitment to supporting people and their relatives before and after death.

The provider’s policies and procedures protected people’s rights and enabled them to live safely, free from abuse, neglect and discrimination. Risks to people in their daily lives were assessed and plans were in place to reduce these. People’s medicines were managed safely and infection control procedures protected people from the risks of cross infection.

People were supported to maintain a healthy diet. Meal times were social occasions and people had a choice of meals.

The provider used a range of strategies to check people and their relatives were satisfied and confident in the standard of care provided within the home. The service had systems to continuously monitor, assess and improve the service provided.

The provider was a member of several good practice initiatives and research projects where they worked in partnership with other organisations to make sure they were following current best practice. Knowledge was shared to improve outcomes for people in the wider care sector.

Rating at last inspection:

At our last inspection which was published 19 July 2016, the service was rated outstanding.

Why we inspected:

This inspection took place as part of our planned programme of inspections, based on the rating of outstanding made at our last inspection.

Follow up:

We will continue to monitor this service according to our inspection schedule.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 25 and 26 May 2016 and was unannounced. The service was last inspected on 8 May 2014, when we found they were meeting the regulations.

The registered manager had been in post for thirteen 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 2008 and associated Regulations about how the service is run.

The service provides accommodation, nursing and personal care for up to 51 older people, who may have dementia. Fifty people were living at the home at the time of our inspection.

People were at the heart of the service. People, relatives and staff told us they felt like family because of the love and care they all felt from, and for, each other.

People were cared for and supported by kind and caring staff, which made them feel special. Relatives were inspired to become volunteers at the home so they could give back some of the kindness and support they had received.

Relatives felt welcomed at the home and shared in caring for their relations. Staff were valued for their contribution to making people’s experience of the service the best it could be. Staff were proud to work at the home and pleased with the thanks and compliments they received.

The end-of–life care people received was as personalised, caring and supportive as a specialist hospice service. Health professionals and relatives complimented the service on the end–of-life care that the whole staff team delivered.

The provider’s philosophy, vision and values were understood and shared across the staff team. People’s opinions and suggestions were respected and used to improve the quality of the service.

The registered manager was a role model for staff who were all inspired and motivated to deliver the highest quality service. The provider, staff and relatives respected the registered manager’s professionalism and recognised their leadership was inspirational.

The registered manager shared their professional knowledge and experience with staff and implemented innovative methods to ensure all staff understood how they contributed to people’s experience of the service.

The registered manager worked with educational and research organisations to improve the quality of people’s treatment. The quality of care and treatment at the home was sufficiently well recognised that it was a university approved training establishment for nurses.

People received effective care, support and treatment because staff had training, skills and knowledge that was relevant to people’s needs. Healthcare professionals were complimentary about the quality of care and praised the effectiveness of people’s treatment. The staff worked as a team to support people with their health and social needs and staff understood how to improve people’s sense of well-being.

All the staff were supported to maintain their professional development by the registered manager. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their families, legal representatives and healthcare professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and staff supported people to maintain a balanced diet.

Staff monitored people’s appetites, moods and behaviours and

The registered manager was on leave when we visited the home on 19 May 2014. We spoke with the deputy manager, the head of housekeeping, a housekeeper, one nurse and two care assistants. We talked with people who lived at the home, observed people being cared for and reviewed records to answer the five key questions: is the service safe, effective, caring, responsive and well-led?

Forty-nine people were living at the home on the day of our inspection. Many of them were not able to describe how they were cared for and supported because of their complex diagnoses. We observed how care was delivered and talked with 13 people, two relatives and a visiting specialist nurse about what it was like to live at the home.

We reviewed four staff files, two volunteers’ files and three care plans. We looked at records of complaints, accidents and quality assurance audits. We saw the results of surveys undertaken by the provider of people who lived at the home, their relatives, the staff and of allied health professionals.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

The care plans we looked at showed that risks to people’s health and well-being were assessed. Care plans described the actions staff should take to minimise the identified risks.

People were cared for in an environment that was safe, clean and hygienic.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider checked that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who lived at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications had needed to be submitted according to the local authority policies and procedures. The deputy manager knew about a recent judgement by the Supreme Court in relation to (DoLS), and was taking action to ensure they complied with any changes in the local authority’s policy and procedures.

Is the service effective?

People told us they were happy with the care they received and their needs were met. It was clear from our observations and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us, "I am very happy. You can’t fault it”, “The staff are very good. What more can you ask for?” and “We are well looked after.”

Is the service caring?

People were supported by kind and attentive staff. People told us they were able to get up and go to bed when they wanted to, and always had a choice of meals. Relatives told us, “It’s the best nursing home” and “If we asked X if she wanted to move, she would say ‘no’.”

We saw that care workers were patient and encouraged people to make their own decisions. A nurse told us, “For people with dementia, we learn what their gestures and body language mean.”

Is the service responsive?

People’s needs and abilities were assessed before they moved into the home. The records we looked at confirmed that people had been asked about their likes, dislikes, preferences and interests. We saw people were supported to follow their own interests and join in group activities if they wanted to. People told us they went out to places that interested them.

Is the service is well led?

Staff had a good understanding of their role and responsibilities for delivering a quality service. Staff told us they were informed of the outcome of the quality assurance audits and knew about any actions they should take to improve. A nurse told us, “We are in a very good place. I am very proud to work here.”

The provider conducted internal quality reviews and actively consulted with people, their relatives, the staff and external health professionals through surveys and meetings. We saw that complaints were investigated thoroughly and actions taken to provide a satisfactory resolution.

We spoke with six people who lived at the home and four relatives. They told us that staff knew and understood their needs. One person said, “The staff are lovely. It’s like a family home. We are one big family." We saw that people, or their representatives, signed to consent to their care and treatment.

In the four care plans we looked at, we saw that people’s care was planned according to their needs and dependencies. A relative we spoke with told us they felt well informed about their relation’s care, treatment, and their changing needs. One person we spoke with told us, “Staff came and helped me very quickly when I rang my buzzer. I feel altogether very safe, the staff are very efficient.”

We found the provider had a system for managing medicines safely. All the staff we spoke with were clear about their responsibilities for administering medicines.

The two care staff we spoke with told us they felt well prepared to work with people because they had a comprehensive induction when they started working at the home. They told us they were supported in their day to day practice by the nurses and manager. The two staff files we looked at included records of their induction and training and of their regular meetings with the manager.

The manager had a system for monitoring the quality of the service, which included regular audits by staff and external professionals. The manager responded to people’s feedback and took actions to improve the quality of the service.