Nicholas House Care Home provides accommodation and care for a maximum of 40 older people who may be living with dementia. The service does not provide nursing care. The service tends to operate with between 31-35 people and at the time of our inspection there were 31 people using the service. Bedroom accommodation is provided in single and double rooms on two floors and there is a passenger lift for access to the upper floor. There are two units in the premises, one is for people living with dementia.

At the last inspection the service was rated Good. At this inspection we found the service remained Good. There were no breaches of regulation and while the service met all fundamental standards it was not as forward looking as it might have been or showed evidence of continued development.

The registered provider was required to have a registered manager in post and there had been a registered manager at the service for the last five and a half years. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

People were protected from the risk of harm or abuse because staff employed were trained in safeguarding adults and understood their responsibilities. The registered provider had policies and systems in place to manager safeguarding incidents and maintained records of any suspected or actual safeguarding concerns. Risks were also managed and reduced so that people avoided injury or harm. The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s needs and recruitment systems were followed to ensure staff were suitable to support people. Medicines were found to be managed safely.

Qualified and competent staff were employed and supervised. Their personal performance was checked at an annual appraisal. People’s mental capacity was appropriately assessed and their rights were protected. They 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 received adequate nutrition and hydration to maintain their health and wellbeing. The premises were suitably designed and furnished for providing care and support to people living with dementia.

Compassionate care was provided by kind staff that knew people's needs and preferences. People were involved in their care and asked for their consent before staff undertook any support tasks. Their wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

People were supported according to person-centred care plans, which reflected their needs and were reviewed. They engaged in pastimes and activities if they wished to and were content. People had good family connections and support networks. An effective complaint system was used and complaints were investigated without bias. People and their friends and relatives were encouraged to maintain relationships of their choosing.

The service was well-led and people had the benefit of a culture and management style that were inclusive and caring. A system was in place for checking the quality of the service using audits, satisfaction surveys and meetings. People made their views known through direct discussion with the registered manager and staff or via the complaint and quality monitoring systems. People’s privacy and confidentiality were maintained as records were held securely on the premises.

We saw that people looked comfortable and well cared and that staff interacted with them in an open and friendly manner. We observed staff delivered support with a caring approach to ensure people’s personal dignity was respected.

People we spoke with told us they were comfortable and felt safe in the home and found safeguarding procedures were followed to ensure people were protected from harm .

People told us that staff supported them with their medication and received this when it was required. We found that staff responsible for administering medication had completed courses that were externally assessed, to ensure they were competent to handle medication safely.

People who used the service and their relatives told us that staff were, “Kind and helpful.” They told us that staff provided support in a considerate and sensitive way and that staff were friendly and approachable. There was evidence that training on a variety of courses was provided, to ensure staff had the right skills to perform their work.

Systems were in place to enable the quality of the service to be monitored. We saw these included regular audits of the service, together with follow up actions to address shortfalls where this was required. People told us that overall they were, “Very happy” with the service they received. A visiting relative told us they were, “Reassured” by the service and confident appropriate action would be taken when this was needed. We saw evidence of positive feedback from relatives and a social care professional, who had commented on the “Friendly staff who go out of their way to make clients happy.”

People confirmed that care and treatment options were discussed with them and they were asked for their consent. One patient commented, “I gave my consent to be here. I came on respite for a start.” A person’s relatives told us, “Consent was discussed with us.”

People and their relatives spoke positively about their care. One person told us, “I like being here. I can see my plan of care and I get involved in a review of care. I have a key worker.” A relative told us, “He’s happy enough here and I am happy. The staff are very warm and very caring. If he is not well they ring me. This is the best thing that happened to him.”

People were protected from the risk and spread of infection. One person told us, “I think it is as clean as it can be. They are at it every day. The two cleaning ladies are very good.” A relative said, “I think they do very well cleanliness wise. The place always looks clean. There is no smell.”

There were effective recruitment and selection processes in place and people spoke positively about the staff that worked with them. One person told us, “The staff seem to work together. They are all so cheerful and they will do anything for you.” A relative told us, “The staff are brilliant. They have been excellent.”

People’s complaints were fully investigated and resolved, where possible, to their satisfaction. A relative told us, “I have had a complaint and it was dealt with very well. I brought it up with the manager and she dealt with it.”

We spoke with people who used the service who told us about their experience of living in the home. One person said, “It is appropriate, and very good, care. I find it very nice. Another person said, “It is very nice and very clean.”

People we spoke with told us that they were respected and involved in the running of the home. People explained how they were involved in commenting on improvements in the home. Some people attended staff meetings as representatives. People were also aware of the complaints procedure and said they knew how to use it. People gave examples of things they had raised which had been resolved in discussion with staff.

People we spoke with said they felt safe in the home. People who use the service spoke with us quite positively about the staff that worked with them.

We undertook this unannounced inspection over two days, on the 18 and 24 March 2015.

Nicholas House Care Home is registered to provide residential and personal care for up to 40 older people, some of whom may be living with dementia related conditions. The care home is situated within the village of Haxey and car parking is available.

At the time of our inspection there were 28 people living in the service. The service was last inspected on 24 October 2013 when the service was found to be compliant with the regulations inspected.

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.

Staff training had been delivered about the protection of vulnerable adults to ensure people who used the service were safeguarded from harm or abuse. Staff understood with their roles and responsibilities for reporting safeguarding or whistleblowing concerns about the service and staff.

A variety of staff training was provided to enable them to safely carry out their roles. Regular supervision and appraisals of staff skills were undertaken to enable their individual performance to be monitored and help them develop their careers.

Recruitment checks were carried out on new staff to ensure they were safe to work with vulnerable people and did not pose an identified risk to their wellbeing.

People who had difficulty with making informed decisions were supported by staff who had received training about the promotion of people’s human rights to ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

Assessments about people’s nutritional status and associated risks were monitored and people were able to make choices from a variety of nutritious and wholesome meals, with involvement of specialist health care professionals when required.

People received their medicines as prescribed and systems were in place to ensure medicines were managed safely.

A range of opportunities were provided to enable people to engage and participate in meaningful activities.

A complaints procedure was in place to enable people to raise concerns about the service.

People knew how to make a complaint and have these investigated and resolved wherever this was possible.

Regular management checks were carried out to enable the quality of the service people received to be assessed and enable the identification of any changes when this was needed.