The inspection took place on the 25 and 30 October 2018 and was unannounced.

Kite Hill Nursing Home is registered to provide accommodation for up to 30 older people. There were 28 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over two floors. All bedrooms were for single occupancy and many had ensuite facilities. Bathrooms and toilets were provided on both floors. There was a lift and stairs available to access the first floor. There was also an external lift to facilitate access to a patio and rear garden area.

Kite Hill Nursing Home is a ‘care home’. People in care homes receive accommodation, nursing and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. We found the home to be clean and well maintained throughout the inspection.

A registered manager was in place. 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.

Quality assurance process had not identified areas for improvement found during this inspection, including around the safe management of all medicines, risk management systems, wound care and inconsistencies in care plans. When we identified concerns to the provider’s nominated individual and the registered manager took action or committed to consider how things could be improved.

The premises and equipment were safely maintained. Incidents or accidents were reviewed and action taken to reduce the likelihood of any reoccurrence.

Sufficient numbers of care and ancillary staff were deployed to meet people's needs. Checks were made to ensure staff were suitable to work in a care setting. Staff were trained and felt supported and valued.

People's nutritional needs were assessed and people were supported to eat and drink. There was a choice of food. People’s health care needs were monitored and referrals were made to other services appropriately to ensure there was a coordinated approach to people's care.

People were treated with kindness, respect and compassion. People's privacy and dignity were promoted. People were supported to have choice and control of their lives and staff promoted independence where possible.

Care and support were centred on the individual needs of each person and staff responded promptly when people's needs changed. People and external health professionals were positive about the service people received.

Staff supported people to receive end of life care that helped ensure their comfort and their dignity.

Activities were provided seven days per week offering a range of mental and physical stimulation.

There was an effective complaints procedure in place. People and their relatives confirmed they were listened to and changes were made when requested.

Staff were organised, motivated and worked well as a team. They felt supported and valued by the management team.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection took place on 23 February 2016 and was unannounced. The home provides accommodation for up to 30 older people with nursing care needs. There were 27 people living at the home when we visited. All areas of the home were accessible via lifts and there was a lounge dining room and accessible outdoor space. All bedrooms were for single occupancy and had en-suite facilities.

There was a registered manager in place. 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 and relatives were positive about the service they received. They praised the staff and care provided. People felt safe at the home. Care staff knew how to prevent, identify and report abuse.

Staff followed legislation designed to protect people’s rights and freedom to help make sure decisions were only taken in the best interests of people, although this was not always documented.

People received personalised care from staff who understood their needs and they were supported to make choices. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death. Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. Individual risks to people were managed effectively.

People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly. Staff recognised that people’s needs varied from day to day and responded effectively. The provider had identified a need to increase activities staff and was recruiting to these posts.

Suitable arrangements were in place for managing medicines administered by nurses. Although However, self-administration procedures were not sufficiently robust.

People were also positive about meals and the support they received to ensure they had a nutritious diet.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program in progress.

The provider had identified a need for additional staff at busy times of the day due to an increase in people’s needs; they were taking action to provide this. Safe recruitment practices were followed. Staff provided effective care; they were suitably trained and appropriately supported in their role.

Staff treated people with kindness and compassion and formed caring relationships with them and their relatives. Staff protected people’s privacy, promoted their independence and involved them in planning the care and support they received.

People liked living at the home and felt it was run well. There was a clear management structure in place. Staff understood their roles, were happy in their work and worked well as a team.

There was an open and transparent culture. The provider encouraged staff feedback and visitors were welcomed. Complaints, when received, were investigated and responded to. Quality assurance processes were in place to assess key aspects of the service. Where these had identified a need for improvement action had or was being taken.

We spoke with three people who used the service and the families of four others. They all said they were very happy with the level of care provided and staff understood their needs and sought their consent before providing any care. One person said “the staff here are lovely, they are very kind and have a joke. They know what to do and understand my needs. I am very happy here”. A family member told us “they ask [their relative] for their consent before they do anything, like changing their pads”. They added “I am very satisfied with how things are”.

We looked at six care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were reviewed on a regular basis. We observed care in the communal areas of the home and saw staff interacting with people in a positive way. One member of staff said “Staffing at the moment is fine. You have time to chat to people when you are with them doing personal care for example”. We also saw there were two members of staff dedicated to helping people to engage in both individual and group activities.

We found the home had effective systems in place to protect people from abuse. One of the people we spoke with told us “my wife knows I am safe when I am in here”. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We found the provider had an effective quality assurance system and they sought the views of people who used the service and their families through regular surveys.

We used a number of different methods such as reviewing records, we observed staff supporting people, we talked to staff, the manager and we talked to one person’s family to help us understand the experiences of people using the service. This helped us to review the care and support as people using the service had complex needs and limited communication.

People experienced care, treatment and support that met their needs and protected their rights. Care plans were person centred and documented people's wishes in relation to how their care was provided.

The provider did not have an effective system in place to assess and monitor the quality provision of the service. We looked at incident records; these had not been completed in full and did not show us that the provider had looked at lessons learnt from incidents.

We spoke with a person’s family, who told us that they thought care was good and that they felt listened to and involved in their relatives care.

People said that they were very happy with the way their health and care needs were met. People said that they had been involved in planning their care and that their individual wishes were met. People had no concerns about their privacy and dignity.

People were also very happy with the staff who they said worked hard and were aware of how to meet their needs. People said staff were available when they needed them.

We also spoke with some health professionals who were positive about the home and said they had no concerns.

We spoke with some people who live at Kite Hill Nursing Home. We were unable to speak with all people due to the level of their disability.

People were unsure about their care plans and risk assessments but were happy with the way their health and personal care needs were met. People said they had no concerns about privacy or dignity stating that staff knock on their doors before entering and are considerate of privacy when providing personal care.

People confirmed that a range of activities are provided. However some said that they choose not to take part in organised activities preferring to remain in their bedrooms reading or listening to the radio.

People also said that they are able to make decisions about what time they get up or go to bed and about how and where they spend their time or what they have to eat. People said that they were happy with the meals the home provided and that they received plenty of hot or cold drinks. People gave examples of when alternatives were provided if they did not like what was on the menu. A relative who visits the home on a regular basis stated that meals looked good.

An external professional stated that they had advised that the home purchase a specific piece of equipment and the home had done this.