The unannounced inspection took place on 10 and 11 November 2016. A previous inspection, on 22 May 2014 found that the standards we looked at were met.

Nashley House Retirement Home provides accommodation and personal care for up to 52 older people.

There was 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 treated with kindness and respect by staff that had made caring relationships with them. People’s views and opinions were sought toward improving the service and making their lives better. Privacy and dignity were upheld.

There was a strong emphasis on risk management and there was a low incidence of accidents as a consequence. The premises and equipment was maintained in a safe state.

Robust recruitment practice protected people from staff who might be unsafe or unsuitable to work with older people. People were protected from abuse because the staff had a good understanding of how to respond if they had any concerns and the registered manager met their responsibilities.

There were sufficient staff to meet the needs of the people using the service and some flexibility should those needs change.

Medicines were handled for people by staff that were trained and supervised to do this safely. There were measures in place to maintain those safe standards.

Staff were very happy with the level of training they received, which they said had improved. Staff received supervision of their work, a yearly appraisal and felt able to take any questions to senior staff or the management.

Staff responded quickly to any change in people’s health and involved external health care professionals where advice or treatment was required. The standard of care provided was very high. One person said, “I feel confident in the care I receive from the staff and the staff are very supportive and they take care of me“.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was upholding people’s legal rights.

People’s needs and wishes were assessed and each person had a detailed plan to inform staff how the care they required was to be delivered. People were involved in regular reviews of their care plan.

There was a broad programme of activities available for people but some people said these did not suit their interests. Activities included arts and crafts, a pantomime, quizzes and visits to local attractions. People who preferred to stay in their room were provided with one to one attention. One person said they go to the lounge where there is “company if you need it”. One male resident said they wanted more activities of interest to men. There were examples of where personal interests had been supported, including visits to a ‘do-it-yourself’ store.

People’s dietary needs were met, there were several choices of meal, but there were some negative comments about the food provided. The registered manager had regularly consulted people about the menu and the activities on offer.

People and their family members felt confident that they could take any concern or complaint to the registered manager and it would be dealt with appropriately. The registered manager said, “A complaint is an opportunity for us to learn.”

The registered manager had been in post for one year. They said the culture of the home since their arrival was “moving forwards”. In that time they had formed a str

This inspection was carried out by an adult social care inspector. We set out to answer these five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. This is based on our visit to the home when we spoke with ten people who used the service, four of their relatives, and five staff members. We also made observations and looked at a number of records. Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

The service was safe because risks to people, for example in relation to poor nutrition and a lack of mobility, were being identified. Staff then followed procedures which reduced the risks and helped to ensure people's safety. Medication was being kept securely. People appreciated the support that they received with their medication and felt it was safer for staff to be involved.

Facilities and equipment in the home were being checked to ensure they were safe and working correctly. Aids were being used to assist people with their mobility; staff had received training so that they knew how to use these safely with people.

Is the service effective?

The service was effective because people felt that the home was meeting their needs. Care plans had been produced which set out the support that each person was to receive. The plans provided guidance for staff and helped to ensure a consistent approach. Staff provided support in ways which helped people to maintain their independence.

Staff followed procedures for monitoring people's health and wellbeing. This meant that any concerns, such as a loss of weight, could be followed up in a timely way. People were supported with seeing healthcare professionals so that their healthcare needs were met.

Is the service caring?

The service was caring because of the way that staff approached their work and treated people. People described the care staff as “very kind”; one person commented "the staff are very keen on keeping us warm and comfortable”. The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff talked to people in a respectful way. They took time to explain what they were doing, for example when administering medicines.

Relatives we met with said they were made to feel welcome when visiting the home and they were happy with the care being provided.

Is the service responsive?

The service was responsive because risks were being assessed and action was being taken to protect people’s health and welfare. People were asked about their choice of meals, which were prepared in ways which met their individual needs.

Surveys were being used to gain the views of the people who used the service, their relatives and staff. The feedback provided information about what was working well and how the service could be improved. People who used the service had the opportunity to pass on their views at other times. One person told us “They come round every month asking if we have any complaints, it's like a meeting and we can say what we want.”

Is the service well-led?

The service was well led because there were procedures in place for monitoring the service and making improvements. People who used the service, and relatives we spoke with, had confidence in the home’s manager and how the service was being run.

The manager was registered with the Commission and had support from senior staff who had been delegated specific areas of responsibility. Staff commented positively about the training they received; one care worker described this as “fantastic”.

We saw care planning had been improved so that care plans reflected an individualised approach to providing care. There were comprehensive risk assessments in place. They provided guidance to care staff about how to support people in managing risks to their health and welfare.

We found substantial changes had been made in how delivery of care was recorded. Individualised records of the delivery of care had been completed. They evidenced the care and treatment provided to people using the service. There were good arrangements for the secure storage of confidential information.

People told us that they felt they were treated with respect. One person said how friendly and helpful staff were. People told us they had an opportunity to discuss the care they received. We saw that staff interacted in a positive, enabling way and we observed friendly and warm interaction between staff and people living in the home. People told us they had regular resident's meetings which were used to improve the quality of care provided in the home.

People we spoke with were satisfied with the care they received. There was a range of activities available for people. Staff told us they did not participate as much as they would have liked in activities people in the service undertook. There was no person centred guidance to staff about how to respond to risk. We found there were not robust arrangements to protect and support people with their health needs.

People told us they felt safe living in the home. Staff demonstrated a good understanding of the nature of abuse and their responsibility to report any concerns about possible abuse.

There were robust arrangements in place for the recruitment of staff which included the required checks to make sure people were suitable to be employed in the home.

There was a lack of personalised records providing information about the care provided to people living in the home. We found that information about people was not readily accessible or kept in a safe confidential way. Individualised risk assessments had not been completed.

People who spoke with us were able to discuss their life at the home and what they enjoyed about living there.

People said that they appreciate having their own rooms, and being able to choose how they are decorated. People told us that they liked living at the home. One person said “the girls look after us very well. If you call them they are here on the dot”.

People told us that they made decisions about what they did during the evening. One person told us “we can choose where we go during the day. I choose to stay in my own room. I like my own company”. People who use the service told us that they felt safe at the home and that staff are “always willing to help”.

People told us that the food was “really good” and that there was plenty to eat at times that suited them. One person said “if we don’t like what is on the menu then the staff will make us something else. I really like the food here”.

People told us that there was assistance for them to maintain their personal hygiene if required and that their privacy and dignity was respected. One person said “I wouldn’t change anything about living here its lovely. If I want a quiet word with the staff then I can. They are busy but always have time to chat”.

People had positive comments to make about the home and we found that all the essential standards were met.