Porthgwara Nursing Home is a ‘care home’ that provides nursing care for a maximum of 20 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were 19 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post who was responsible for the day-to-day running of 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.

The management team demonstrated an open, transparent and reflective leadership style. They provided visible direction and a person centred approach to their staff teams. They exhibited a passion for providing a high quality service, which continually developed in order to meet people's needs in a holistic manner.

Professionals were highly complementary about the standard of care provided by the service. For example; “Porthgwara is an excellent nursing home with a conscientious manager who strives for the very best care for her residents. My patients in the home are well cared for in all respects,” and “All residents are well cared for, safe and happy with a holistic approach to their care.” and “This is an excellent well run home which cares for its residents with compassion and expertise.”

Staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at Porthgwara. People were highly complementary about the care they received from competent staff. There were many examples of how the caring approach of staff had a very positive impact on people’s lives. People told us; “It’s as near to home as you can get.”

Without exception family members all spoke extremely positively about the service their relatives received. They told us that their relative was very safe living at the service and that staff were kind, friendly and treated people in a way they could not have imagined. They told us that the registered provider, manager and staff were always available and approachable. For example, a relative commented; “I feel that not only my mother but I too, am totally supported by the Porthgwara family of management and staff.”

Relatives told us how well staff understood their family members. For example some people’s ability to communicate was affected by their disability but the staff were able to understand and provide for their needs effectively. Staff knew people’s care and support needs very well. A relative told us; “[Staff members name] can get mum to talk in a way that I can’t, they have just clicked. She knows my mums ways so well. It’s so lovely to see.”

The village of Coverack had experienced an extreme flood a few months before the inspection which cut off the village from the rest of the county. This had caused damage to the property and limited their access to utilities and the provision of essential supplies to the service. The road was assessed by the emergency services as being so damaged that staff could only access the home with emergency personnel escort. It was suggested at the time that people might have had to be airlifted out of the service to a safer location, however there would have been a serious risk to people’s health if this occurred. The owners and staff were highly committed to keeping people safe within the service and worked extremely hard with emergency services, contractors, food suppliers, medical services and health and social care professionals to ensure the service could continue to run as safely and smoothly as possible. A staff member commented; “W

Porthgwara is a nursing and residential care home which predominately provides care for primarily older people, some of whom have a form of dementia. The home can accommodate up to a maximum of 30 people. On the day of the inspection 29 people were living at the service. Some of the people at the time of our inspection 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 Porthgwara on 11 September 2015. We saw people were happy living at Porthgwara. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. People’s comments included “Staff are marvellous”,” There is no place like home but this is as good as it gets. This is my second home,” and “The staff are very kind and very understanding.” People told us they were completely satisfied with the care provided and the manner in which it was given.

People looked well cared for and their needs were met quickly and appropriately. People who used the service and their relatives were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs.

People told us “I feel safe here as I’m looked after so well.” They told us they were completely satisfied with the care provided and the manner in which it was given. Relatives felt their family member was cared for safely. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

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 as possible so that they could get to know the persons wishes and preferences. Relatives felt this gave staff a very good understanding of their family member and how they could care for them.

People were supported to live their lives in the way they chose. People’s preferences in how they wanted to spend their day were sought, listened to and respected. Activities were provided by the service individually and in a group format, such as for arts and crafts, outings and through outside entertainers coming into the service. 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 service involved family and relevant professionals to help ensure decisions were made in the person’s best interests.

People’s care plans identified the person’s care and health needs in depth and laid out how the person wished to be supported by the service. 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 the staff. People that used the service and their relatives told us they were invited and attended care plan review meetings and found these meetings really helpful.

People told us staff were very caring and looked after them well. We saw staff providing 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 really 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. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. People said that staff respond to the call bell promptly, which we observed. Relatives echoed this view commenting staff were always available if they had any queries at any time. Staff raised that they felt there was an issue with the organisation of the staff rota the registered manager stated she would address this issue with staff.

Staff told us they did not attend meetings (called supervision) with their line managers but did attend an annual appraisal. The registered manager said that supervisions were available at any time a staff member requested them or at least once every six months. Staff attended ‘group supervisions’ which allowed staff to discuss new and current guidance. The registered manager and deputy manager had recently commenced observations of staff members work practise individually to highlight if any further training was needed. Staff had an annual appraisal to review their work performance over the year.

Staff attended regular training to ensure that their skills remained up to date with recent guidance. They all received a thorough induction when they started work at the home and fully understood

their roles and responsibilities , as well as the values and philosophy of the home. People and relatives felt staff were skilled and competent to undertake their job.

We saw the service’s complaints procedure which provided people with information on how to make a complaint. People and relatives told us they had no concerns at the time of the inspection and if they had any issues they felt able to address them with the management team.

The registered manager promoted a culture that was well led and centred on people’s needs. People told us how they were involved in decisions about their care and how the service was run. The management and running of the service was ‘person centred’ with people being consulted and involved in decision making. People were empowered by being actively involved in decision making so the service was run to reflect their needs and preferences.

The service was keen to gain the views of people’s relatives and health and social care professionals. Some of this was completed via a questionnaire and the results of these were compiled in a report which identified areas for improvement and any actions the provider needed to make. The provider had an effective system to regularly assess and monitor the quality of service that people received and was continuously trying to further improve the quality of the service.

During our inspection we spoke with five members of staff, registered manager, five visitors and three people who lived at the home. We also walked around the home and reviewed records.

The staff we spoke with demonstrated a sound knowledge of the care needs of the people who lived at the home. Staff told us the home was “a lovely place” and it was “friendly”. People who lived at the home and/or their representatives told us the care was “very good” and one person told us “the staff know if something’s wrong…the GP is contacted straight away”.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection because appropriate guidance had been followed.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. On the day of our inspection the registered manager assured us that a dispensing error that we witnessed would be addressed.

During our inspection we spoke with five people who lived at Porthgwara nursing home. People told us the home was "nice" and one person thought it was "like being home from home".

The staff respected people’s likes and dislikes of the people that lived at the home. People were able to choose what food they would like. We heard staff talking with people in a respectful manner.

Staff demonstrated a sound knowledge of the care needs of most of the people that lived in the home. Everyone had a care plan in place that informed and directed staff how to care for a person.

Staff told us they were aware of the different types of abuse and how to respond to any allegations. The home did not hold any money for people that lived in the home.

There was a robust system in place to ensure that medication were ordered, stored and disposed of appropriately. The policies that were in place were in line with published guidance from professionals bodies. This ensured that the administration of medications were completed safely.

The quality of the service was monitored by means of a yearly survey. There was also a “Resident and Relatives Association” which allowed people who used the service to express and concerns and to share their opinions of the service.