Newquay nursing home is a nursing home that can accommodate up to 41 older people, some of whom have a diagnosis of dementia. On the day of the inspection there were 27 people using the service.

We carried out this inspection on 16 June 2017. At the last inspection, in March 2015, the service was rated Good. At this inspection we found the service remained Good.

People who were able to talk to us about their view of the service told us they were happy with the care they received and believed it was a safe environment. People commented, “The staff are wonderful, I am looked after very well, I am very happy”. A relative commented “We are very happy with the home” and “I am really fussy and I cannot find fault here.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Comments from people about staff included, “Staff are great” and “Staff are kind.” Relatives commented “Staff are just as caring towards me as they are to (family member’s name). Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

People were able to take part in a range of activities of their choice. Where people stayed in their rooms, either through their choice or because they were cared for in bed, staff spent one-to-one time with them. This helped to prevent them from becoming socially isolated and promoted their emotional well-being.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

Staff supported people to access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Comments from healthcare professionals and advocates included, “Staff work well with us, they are approachable,” “The communication is great” and “Staff really make a great attempt to engage with people in the way that suits the individual.”

People received care and support that was responsive to their needs because staff were aware of the needs of people who lived at Newquay Nursing Home. Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks in relation to people’s care and support were identified and appropriately managed.

There was a wide range of meals on offer and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told they enjoyed their meals. People and their relatives said, “The food is lovely” and “There’s plenty of it (food).”

People were able to take part in a range of activities of their choice. The service has an activity coordinator. They provided daily group activities which are displayed so that people could choose if they wanted to participate. One person told us, “We have lots of things going on.” and “(activity coordinator name) is very enthusiastic and bubbly and has made a great difference to my day now.”

Where people stayed in their rooms, either through their choice or because they were cared for in bed, staff spent one-to-one time with them. Comments from people included “I enjoy the daily visits form (activity coordinator name) and “It’s a lovely time chatting with (activity coordinator name) and telling jokes.” This helped to

Newquay Nursing Home is a nursing and residential care home which predominately provides nursing and personal care to adults. The service is registered to accommodate up to a maximum of 41 people. On the day of the inspection 29 people were living at the service. Some of the people at the time of our visit had physical health needs and some mental frailty due to a diagnosis of dementia.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

We carried out this unannounced inspection of Newquay Nursing Home on 3 March 2015. Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and that their mobility was supported appropriately.

People felt safe living in the home. Relatives told us they felt their family member was cared for safely. One commented “Safe, absolutely” and “he’s very safe, safer than he is at home.” Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People told us staff were; “kind,” “caring,” “marvellous” and “they really look after me well”. They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives told us they found staff to have; “great skill” and were “competent and professional.”

Staff had attended appropriate training to ensure that their skills and knowledge, for example in the area of moving and handling, safeguarding and tissue viability was up to date. People were supported with their medicines in a safe way by staff that had been appropriately trained.

We found that there were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. A person told us “I press my call bell and staff respond. There seems to be enough staff.” Relatives echoed this view commenting staff were always available if they had any queries at any time.

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person so that they could; “really get to know them, their likes, dislikes, interests they wanted to know all about their life.” Relatives felt this gave staff a better understanding of their family member and how they could care for them. People chose how to spend their day and a range of activities were provided. Visitors told us they were always made welcome and were able to visit at any time.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the home involved family and relevant professionals to ensure decisions were made in the person’s best interests.

Staff told us they were supported by managers. They attended regular meetings (called supervision) with their line managers. This allowed staff the opportunity to discuss how they provided support to people, to ensure they met people’s needs and time to review their aims, objectives and any professional development plans. Staff also had an annual appraisal to review their work performance over the year.

People’s care plans, identified the person’s care and health needs and how the person wished to be supported. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all staff. People and relatives told us they were invited and attended care plan review meetings and found these meetings beneficial.

People told us staff were very caring and looked after them well. Visitors told us; “Staff are lovely.” We saw staff provided care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported.

Peoples' privacy, dignity and independence were respected by staff. At this visit we undertook direct observations using the SOFI tool to see how people were cared for by staff. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We saw examples of kindness, patience and empathy from staff to people who lived at the service.

We saw the home’s complaints procedure which provided people with information on how to make a complaint. The policy outlined the timescales within which complaints would be acknowledged, investigated and responded to. It also included contact details for the Care Quality Commission, the local social services department, the police and the ombudsman so people were able to take their grievance further if they wished. People and relatives told us they had; “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.

There was a management structure in the service which provided clear lines of responsibility and accountability. There was a clear ethos at the home which was clear to all staff. It was very important to all the staff and management at the service that people who lived there were supported to be as independent as possible and live their life as they chose. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

At the time of the inspection people told us they felt safe. Staff showed a good understanding of the care needs of the people they supported.

Newquay Nursing Home alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service.

Newquay Nursing Home had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), and further staff training was planned. This helped to ensure that people’s needs were met.

Systems were not in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This did not reduce the risks to people and help the service to continually improve.

Is the service effective?

At the time of the inspection we did not always find the service to be effective. People, or their representatives, were not usually involved in writing or reviewing their plans of care.

During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring?

At the time of the inspection we found the service to be caring. We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. The people we spoke with were positive about how staff supported them. Comments included “I am having good care” and “Very good, I’ve never been here when the staff weren’t being attentive…never had to look for anybody”.

Newquay Nursing Home had regular support from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

At the time of the inspection we found the service to be responsive to changing care needs, although staffing levels were an area of expressed concern for staff. Many people who lived at Newquay Nursing Home had complex health needs and were either not able, or chose not to join in group activities. There was evidence to show that people were routinely offered one-to-one time or group activities.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

At the time of the inspection we found the service not to be well-led. Newquay Nursing Home had a registered manager, supported by an office administrator.

We saw minutes of meetings held with the staff. The manager confirmed there were no meetings held with people who lived at Newquay Nursing Home, or their relatives and a quality assurance questionnaire had not been used since the 2013 survey. This showed the management had not consulted with people who used the service, or their relatives to gain their views and experiences.

The service did not have a quality assurance system. There was no planned monitoring of the quality of the service provided. This did not help to ensure that people received a good quality service at all times.

When we inspected Newquay Nursing Home in November 2013 we found them to be non-compliant in two outcomes. We inspected again to ensure the service was now compliant. There were 25 people who lived at Newquay Nursing Home and we spoke with three people at this follow-up inspection. We also spoke with four staff members including the registered manager.

People who lived at Newquay Nursing Home said “The food is good and well presented”, “They [the staff] ask me every day what I would like from the menu” and we get a choice of hot or cold drinks at any time”.

The staff we spoke with confirmed that training provision was ongoing and that they received supervision from senior staff.

People were protected from the risks of inadequate nutrition and dehydration.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

We did not speak with people that lived at Newquay Nursing Home at this inspection as it was agreed with the registered manager that a further follow-up inspection was needed. A further follow-up inspection is planned in the next few weeks.

People were not fully protected from the risks of inadequate nutrition and dehydration.

People were cared for by staff that were not fully supported to deliver care and treatment safely and to an appropriate standard.

People we spoke with told us there were activities offered. We saw that residents were mostly spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. Some of the people we spoke with were not able to comment about the service they received because of their health care needs.

We found that people did get the care they needed, and people’s consent was sought.

People were not fully protected from the risks of inadequate nutrition and dehydration.

People were protected from abuse because the provider had ensured staff were properly trained and had an understanding of the safeguarding process.

People were protected from infection because there was sufficient hand washing facilities around the home and staff could easily access personal protective equipment. Infection control guidance had been followed. The premises were effectively maintained.

People were protected because the home operated a robust recruitment procedure.

People were protected because there was sufficient numbers of staff to meet their needs.

Staff told us training was provided, and also confirmed staff supervision took place, but their comments were not supported by training records.

People we spoke with told us they didn’t know if “there were any activities offered”. We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. Some of the people we spoke with were not able to comment about the service they received because of their health care needs.

We found that people did not always get the care they needed. We saw people left unattended with no means of getting staff attention other than shouting. We saw people left without a drink. People’s consent was not sought.

People were not protected from abuse because the provider had not ensured staff were properly trained and had an understanding of the safeguarding process.

People were not fully protected from infection because there was insufficient hand washing facilities around the home and staff could not easily access personal protective equipment. Infection control guidance had not been followed.

The premises were not effectively maintained, and the provider did not monitor the development and maintenance of the property.

People were not protected because the home did not operate a robust recruitment procedure.

People were not protected because there was insufficient numbers of staff to meet their needs.

Staff told us minimal training was provided, and also confirmed staff supervision did not take place.

We reviewed all the information we hold about this provider, carried out a visit on 24 April 2012, observed how people were being cared for, talked with people who use services and their relatives, talked with staff and visiting professionals, and checked records.

Some of the people using the service were not able to comment in detail about the service they receive. One person said that the home and the staff were “wonderful”. We saw people’s privacy and dignity being respected and staff being helpful. Another person told us “there were no activities offered.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People talked with staff during personal care and when being assisted. We saw and heard one staff member take the time to explain what would happen next for a person waiting for some test results.

Staff told us that training was provided, and also confirmed that staff supervision took place. Staff told us they thought the home was staffed adequately.