The inspection took place on the 7 November 2017 and was unannounced.

Maplehurst Nursing Home is a nursing home. People in nursing homes receive accommodation for nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Maplehurst Nursing Home is registered to accommodate up to 38 people in one adapted building. The service currently operates from 29 rooms. On the day of our inspection there were 26 people using the service with a range of support and nursing needs including older people and older people living with dementia. The home is a large detached property spread over three floors.

The home 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 were safe because a safety culture was embedded at the service.

Staff had exceptional skills in managing and reducing risk and keeping people safe whilst promoting people to lead fulfilling lives and minimise restrictions on their freedom. People’s comments included “I feel much safer since coming to live at the home, particularly at night, the amount of staff on duty is unbelievable”.

People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Staff were trained to be aware of signs of abuse and were encouraged to report concerns, which were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to. The service had a written complaints process. Any concerns or complaints were investigated with actions identified to make improvements.

The service was inspirational in the approach to ensure that staff put their learning into practice to deliver care that meets people’s individual needs. This was around consistent mind-sets and behaviours. On an annual basis each staff member was asked to provide quantitative feedback on each of their peers on five criteria's. These five criteria's were aligned to the CQC’s five key questions. Is the service safe, effective, caring, responsive and well led?

People received exceptionally effective care, based on best practice by staff with an in-depth knowledge of their care and treatment needs, who were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. The service used innovative and creative ways to train and develop staff to put their learning into practice to provide outstanding care that met people's individual needs.

People mattered and the care was exceptionally personalised. Staff paid attention to detail and demonstrated pride, passion and enthusiasm for the people they supported. Each person had a trusted member of staff, known as a keyworker, who took a lead role in each person's care and wellbeing. They continuously looked for ways to ensure people had positive experiences and led fulfilling lives. Staff knew about people's lives, their interests and talents and encouraged them to share them with others.

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

There was a strong emphasis on the importance of eating and drinking well for people living with dementia. The provider was creative in looking at ways

The inspection took place on the 1 July 2015 and was unannounced.

Maplehurst Nursing Home is registered to provide care and nursing for up to 38 older people and older people living with dementia. The service currently operates from 29 single rooms. On the day of our inspection there were 26 people using the service with a range of support and nursing needs. The home is a large detached property spread over three floors with a well maintained garden and patio.

The home 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.

This is the first inspection under the new provider of Maplehurst Nursing home who registered in October 2013.

The experiences of people were very positive. People told us they felt safe living at the service, staff were kind and compassionate and the care they received was good. One person told us “Oh I am absolutely safe here, I’ve no worries about speaking up about anything”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The registered manager made sure there was enough staff on duty at all times to meet people’s needs. When the provider employed new staff at the home they followed safe recruitment practices.

There was a strong emphasis on the importance of eating and drinking well for people living with dementia. People had sufficient to eat and drink throughout the day. The provider was innovative in looking at ways people were supported to eat and drink, sufficient to their needs. People’s nutritional needs were met and people reported that they had a good choice of food and drink. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to activities in line with their individual interests and hobbies. These included light exercise, painting and arts and crafts.

The provider was passionate and creative to ensure staff were kept up to date with training and had links with external organisations that guide best practice. There were named champions in various areas such as infection control and moving and handling within the service who actively motivated and supported staff to ensure people were provided with a quality service.

The home considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. Peoples healthcare needs were monitored and they had access to health care professionals when they needed.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it.

There were clear lines of accountability. The service had outstanding leadership and direction from the registered manager and provider. Staff felt fully supported to undertake their roles. Staff were given regular training updates, supervision and development opportunities. For example staff were offered to undertake additional training and development courses to increase their understanding of needs of the people living at the home.

Resident and staff meetings regularly took place which provided an opportunity for staff and people to feedback on the quality of the service. Staff and people told us they liked having regular meetings and felt them to be beneficial. The provider took action in response to feedback received. Feedback was also sought by the provider via surveys which were sent to people at the home and relatives. Surveys results were positive and any issues identified were acted upon. People and relatives were aware how to make a complaint and all felt they would have no problem raising any issues. The provider responded to complaints in a timely manner with details of any action taken

There was strong emphasis on continual improvement and best practice which benefited people and staff. There were robust systems to assure quality and identify any potential improvements to the service. This meant people benefited from a constantly improving service that they were at the heart of.

The provider and registered manager promoted strong values and a person centred culture. Staff were proud to work for the service and were supported in understanding the values.