The inspection took place on the 8 and 9 May 2017 and was unannounced.

Kingfisher’s is registered to provide accommodation for people who require nursing or personal care for up to 60 older people some of who may be living with dementia. All rooms are single occupancy with on-suite facilities. The home is located a short walk from the town of Milford on Sea in Hampshire.

The service had a registered manager. 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 continued to receive outstanding end of life care and people experienced a comfortable and dignified death. People, relatives and professionals consistently told us about the excellent care they received from well trained staff who demonstrated the knowledge and skills required which had a very positive impact on people's health and wellbeing.

There was a proactive support system in place to enable staff to develop their knowledge and skills and motivated them to provide a quality service. The provider continued to seek to improve people’s care, treatment and support by working in partnership with health and social care specialists to implement best practice.

The home had developed excellent links with the local community, schools and charities and had a strong ongoing relationship that worked together in supporting the home and charities and involved the people living at Kingfishers.

The culture of the home was based on core values which related to promoting people's independence, recognising their individuality and providing the care and support in a way that embraced people's culture and diversity.

The calibre and knowledge of the nursing and care staff was consistently high as was the housekeeping and kitchen staff who all contributed towards providing a high standard of care to people.

Staff sought people's consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff were knowledgeable of and confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives, friends and relevant professionals were involved in best interest’s decision making.

Staff understood their responsibilities in respect of protecting people from the risk of harm.

People were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were updated to show any changes, and care plans were routinely reviewed to check they were up to date.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies’ in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff developed positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to individuals in a compassionate way.

People's privacy and dignity was maintained at all times during the inspection.

Mealtimes were positive and sociable experiences. Staff supported people

Kingfisher’s is registered to provide accommodation for people who require nursing or personal care for up to 60 older people. The ground floor accommodates 12 people with residential care needs, the middle floor provides 30 beds for people with nursing needs, and the top floor is for 18 people who are living with dementia. The home was purpose built and opened in 2009. All rooms are single occupancy with on-suite facilities. The home is located a short walk from the town of Barton on Sea in Hampshire.

On the day of our inspection visit 60 people were living at the home.

The registered manager was on maternity leave on the day of our inspection. In her absence the service was being overseen by the Head of Care in the role of acting manager. 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 and associated Regulations about how the service is run.

People were very happy living at the home. Staff met their needs and were kind and caring. Staff knew people well; they supported people, and communicated with them according to their individual needs.

Staff understood and responded to people’s care and support needs, were kind and friendly towards them, and treated people with dignity and respect.

Care plans reflected people’s individual needs and were up to date. People and their relatives were involved in care planning and in decisions about their care. Staff involved other health and social care professionals where appropriate.

Staff were appropriately trained and skilled to ensure the care delivered to people was safe and effective. They all received a thorough induction when they started work at and fully understood their roles and responsibilities.

The acting manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs. Each person and relative told us they were continually asked for feedback and encouraged to voice their opinions about the quality of care provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. People’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. A visiting health care professional told us, “I have no concerns at all about people living at the home. The staff are very good at the care they provide. If I ever need to be cared for then this will be the place for me. It is a wonderful place”.

The service provided outstanding end of life care. All relevant specialist and specialist equipment was provided to make people comfortable at this time. In February 2015 the home received accreditation to the Gold Standards Framework (GSF) quality hallmark award in End of Life care. The home had an open and realistic approach with people for End of Live care and were positively life affirming.

Kingfishers is a nursing home for 60 older people. The ground floor accommodates 12 people with residential care needs, the middle floor provides 30 beds for people with nursing needs, and the top floor is for 18 people who are living with dementia. On the day of our inspection visit there were 59 people living at the home.

There was a registered manager in post who was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law like the provider. The registered manager is also referred to as ‘the manager’ throughout this report.

People told us they were happy living at the home, the staff met their needs and were kind and caring. Staff knew people well; they supported people, and communicated with them according to their individual needs.

Care plans reflected people’s individual needs and were up to date. People were involved in care planning and in decisions about their care. The home’s staff involved other professionals and families where appropriate. We saw that staff understood and responded to people’s care and support needs, were kind and friendly towards them, and treated people with dignity and respect.

We found that a range of activities were offered to people either in a group setting or on an individual basis. During our inspection we saw people involved in activities. People were given the opportunity to provide feedback on the activities and were happy with the range of activities provided.

The service was meeting the requirements of the Deprivation of Liberty Safeguards. The manager was reviewing whether any applications needed to be made in response to recent changes in relation to the Deprivation of Liberty Safeguards.

There were suitable procedures in place to ensure that medicines were stored, handled and administered safely.

The home was well run and the manager encouraged people, staff and relatives to express their views about the home. Staff and people living in the home spoke very highly of the manager. People said it was well led and they felt involved in the running of the home. They said they were able to raise concerns and felt listened to.

We spoke with five people who used the service, one relative, and seven members of staff. We reviewed the care records of six people.

People were involved in making decisions about the care and support they received. One relative said “[they] always listen to me if I have concerns, and keep me totally informed”.

When a person was not able to make a decision independently due to their physical and mental frailty, arrangements had been made in line with current legislation. This included 'best interest' decisions which involved representatives and other health professionals.

People's needs were assessed and a plan of care developed for these. Any identified risks to the person's health and welfare had a plan in place to reduce and minimise the risk of harm.

People were protected from the risk of abuse by the processes and policies the home had in place. Staff were aware of how to safeguard people and had received training.

Staff received appropriate professional development and supervision to carry out their role. This was carried out at regular intervals and training was planned in accordance with mandatory requirements and the need to update staff.

The provider had suitable systems in place to monitor the quality of the service provision. This included audits of medications, care records and the environment. An analysis of any accidents and incidents was carried out and changes implemented to minimise risk to individuals.