About the service: Linksway is a nursing home that was providing personal and nursing care to 17 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Everyone said the service was well led by the registered managers. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were systems in place to monitor the quality of care provided. Audits had not identified some of the issues found at our inspection the management team were responsive and proactive when areas for improvement were highlighted to them.

People remained safe at the service. People said they felt safe and cared for living at Linksway. People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met. Where concerns were identified during the inspection the registered managers took immediate action to remedy the concerns.

There were sufficient and suitable staff to keep people safe and meet their needs. Thorough recruitment checks were carried out. New staff received an induction that gave them the skills and confidence to carry out their role and responsibilities effectively.

Linksway supported people who require palliative care. The registered managers and staff were very committed to ensuring people experienced end of life care in an individualised and dignified way.

The provider recognised the importance of social activities. People were encouraged to engage in meaningful activity to aid both their physical and emotional well-being.

Staff told us they were well supported. They commented on the availability of the registered managers for support, advice and guidance at all times. Training covered a wide range of areas and was regularly refreshed. Staff were able to request additional training to meet people’s specific needs. Staff were encouraged to develop their skills and contribute to the running of the service.

People had a varied and nutritious diet. There was a designated enabling staff member to support people to engage in activities they were interested in, on an individual and group basis.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to lead a healthy lifestyle and have access to healthcare services. Staff recognised any deterioration in people's health, sought professional advice appropriately and followed it. People received their medicines on time and in a safe way.

Rating at last inspection: Good (report published September 2016).

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We carried out an unannounced comprehensive inspection on 9 and 11 August 2016. Linksway is a nursing home providing personal care to a maximum of 24 people. The home is a detached house located in the coastal town of Exmouth in East Devon. On the first day of the inspection there were 17 people staying at the service.

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.

Everyone was positive about the registered manager and the management team and felt they were approachable and caring. The registered manager was very visible at the service. The provider and registered manager demonstrated they had a clear vision and values for the service.

There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary and agency staff had been used to ensure adequate staffing levels were maintained.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had the skills and knowledge to meet people’s needs.

People were supported to eat and drink enough and maintain a balanced diet.

People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their prescribed medicines on time and in a safe way.

A designated enabling person was in the process of being employed by the provider to support people so they did not become socially isolated.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The provider had a quality monitoring system at the service. The provider actively sought the views of people and staff. There was a complaints procedure in place and the registered manager was aware of how to respond to complaints appropriately.

The premises and equipment were managed to keep people safe.

On the day of our inspection 16 people were living at the home and receiving care from the service. We, the CQC, spoke with five people, the manager, a registered nurse, three care workers and the person in charge of maintenance. We looked at three care plans. One person described the home as a "very good indeed" and said “the care we get is wonderful”.

We found that staff were well supported and had completed appropriate training. They knew people as individuals and were aware of each person's needs. They were assisted by care plans which contained clear assessments of needs and the strategies to meet those needs. Care records were reviewed and updated regularly. The service had good relations with health care professionals and acted upon their advice.

We saw people had a choice of suitable and nutritious food and drink available in sufficient quantities. People said the food was good. One person said “the food is marvellous and I always get a choice.”

Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.

People told us they were very happy living at the home and felt that they received a high standard of care. People described staff as “wonderful”

We found that people were being involved in making decisions about their lives. We saw people were supported well and that the home were working well with other agencies involved with people's care.

We found that people's healthcare needs were being assessed and supported well. We found that the home's staff and management understood people's needs, including communication needs where they were impaired. We found that they understood people's rights and supported them.

The home was clean and comfortable.

People using this service felt safe and were confident that staff had the skills needed to safeguard them and to meet their needs. Staff training, supervision and annual appraisals were linked to ensuring that staff had the skills to meet people’s needs.

People said they felt safe living at the home and knew how to raise any concerns or complaints.