This inspection took place on 17 & 24 November 2016 and was unannounced which meant the provider did not know we were coming. We last inspected the service on 17 July 2014 and found the service was meeting the legal requirements in force at that time.

Silloth Nursing & Residential Home is registered to provide nursing and personal care for up to 38 people some of whom may have a physical disability. There were 37 people in the home on the day of our visit. The home is on one level providing spacious accommodation and ample communal areas. All bedrooms are single with ensuite toilets and the home provides a range of equipment suitable to meet the needs of people living there. There is an interior courtyard with raised flowerbeds for residents and extensive views across the Solway towards Scotland.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

People who used the service and relatives we spoke with consistently highly praised the skills of staff working in the service. One person living in the home told us, “It's very reassuring that we have such good nurses here, they are always on hand to seek advice from. I get attention straight away.” A relative summed up the views we consistently gained from all the relatives we spoke to by saying, “It was a huge comfort to us knowing (relative) was being cared for at this home and we will be eternally grateful for this and the way they were looked after her in her final days, a rock of support every step of the way. This home makes a difference to people’s lives, they should never change.”

People received ongoing healthcare support from a range of external healthcare professionals and people’s health and nutrition were effectively monitored and responded to in line with nationally recognised practice. The registered manager took a pro-active approach to ensuring people who lived with a dementia related illness received care based on best practice.

The home was recognised nationally as a beacon for end of life care and was awarded the “National Gold Standard Framework (GSF) ‘Beacon’ Award - Winner” as the best nursing home in the country in November 2016 for end of life care as well as retaining this GSF Beacon status for the third year running. We received feedback from a relative who told us, “During the year that [relative] spent at the home [relative] received care that surpassed all of our expectations, especially during the last two months of her life. She received holistic care of the highest quality and her needs and choices were respected until her death. The staff also cared for us as a family, and fully involved us in our [relative]’s care.”

A healthcare professional told us, "My team have tremendous admiration and respect for the leadership and excellent standards shown by all the staff at Silloth Nursing home. Another professional said, "It is always a pleasure to visit Silloth Nursing Home because it proves to us there is good care out there, although we recognise that Silloth Nursing Home is a very rare gem."

People were supported with care and compassion and there was an ethos of care which was person-centred, valuing people as individuals. Without exception people who used the service, relatives and health professionals voiced that staff demonstrated exceptional kindness and compassion. Relatives told us, "I know my relative gets the very best care here. I'm 100% sure of that." We saw a relative had completed a recent survey and commented, ‘My [relative] is treated with respect and dignity, their needs are exceptionally well met and above all else they are safe and receive excellent medical attention."

We found that this home was p

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012.

There was a registered manager in post on the day of our visit.  ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.’

The inspection team consisted of one inspector who was supported on this inspection by an Expert by Experience. This is a person who has personal experience of using or caring for someone who has used services that provide care and support for older people with a variety of needs.

Silloth Nursing & Residential Home is registered to provide nursing and personal care for up to 38 people some of whom may have a physical disability. There were 38 people in the home on the day of our visit.

This was an unannounced inspection that took place on the 17 July 2014.  We also spent time with the registered manager, the administrator and members of the staff team. We also spoke to people who lived in the home and relatives and friends who visited on the day of our inspection.  We spent time in all the areas of the home. We observed the interaction of the staff with the people who lived there. We saw staff knew people well and respected their dignity at all times.

At the last inspection visit in November 2013 we found that this service met all the national standards we looked at. Since then there has been no incidents or concerns raised that needed investigation.

We spoke to people in their own rooms and those who were sitting in the communal and garden areas. People told us they were happy with the care and support they received. Comments included, “I love living here and now consider it my home”. And “I chose to move into the home on a recommendation and I am glad I did”.

People told us they felt safe living in Silloth Nursing and Residential Care Home. We found staff were aware of their roles and responsibilities to keep people safe at all times. There were procedures to follow if staff had any concerns about the safety of people they supported. The requirements of the Mental capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves.

People were involved in planning their care and support and this was reflected in the care records we looked at. Each person had been fully assessed prior to their admission and the information obtained during the assessment formed the basis for the individualised plan of care. Staff were given sufficient information in each care plan to provide the appropriate level of care.  All care plans were kept under constant review in order that changes could be acted upon as soon as they were noted.

The service worked well with external agencies such as social services and mental health professionals to provide appropriate care to meet people’s physical and emotional needs.

We saw that staffing levels were good throughout all areas of the service. Training in all aspects of care and support was up to date. This included those who worked in domestic and catering departments. All staff were supported by the management team through regular staff supervision and appraisals. Procedures in relation to recruitment and retention of staff were robust and ensured only suitable people were employed in Silloth Nursing and Residential Care Home.

We were told the registered manager had a high profile in the home and was “very much hands on”. People said, "I see her every day and it wouldn’t be the first time I have seen her helping the staff”.

People who lived in Silloth Nursing and Residential Home told us they were very happy with the care and support they received.

Comments included, “It is great here. As soon as I walked in the door I knew this was the place for me” and “The staff are so kind and encourage me to do as much as I can myself but they are there when I need help with my shower”.

We saw that people were able to join in sociable activities and go on outings if they wished. Staff were pleasant, polite and we saw that people who used the service were treated with respect and dignity.

We found that people’s care and support needs had been assessed and kept under regular review to help ensure people received the care they needed. We saw that people had access to health and social care professionals when this was necessary.

There was sufficient staff on duty to provide appropriate care and support to ensure people were safe and as independent as possible.

We found that there had been no complaints made about this service either by people who lived there or by relatives. We contacted the local authority and they had not received any complaints or concerns.

During our visit we spoke with people in groups in one of the lounges and in the dining room at lunchtime but we also spoke to individuals in the privacy of their own rooms. People had very positive things to say about the way they were supported.

We learned that people were fully aware of their options and choices in terms of the care and support provided. People told us that their consent was sought on a daily basis and that any care or nursing interventions were only done after their consent was given.

Everyone we spoke with had nothing but praise for the way the care was delivered:

"Care is exceptionally good...and is well organised, with good checks on my welfare."

The home was clean, bright and airy with all the resources necessary for a comfortable life for all the residents.

Staffing levels were good and this meant that the home was well organised and good care provided.

The home had received no complaints but people felt comfortable to complain about things if necessary. The home had suitable procedures in place to manage complaints promptly and appropriately.

People we spoke to during our visit were all pleased with the care and support they received. They told us the staff were kind and helpful and that they could move freely about the home.

Comments included,

"I usually have an electric wheelchair but it went wrong yesterday. The staff have arranged for it to be fixed the day after tomorrow."

"The staff are so kind and help me when I want and I really enjoy my meals".

"The staff are very kind and do so much for you. I love living here and it was like moving back home as I moved from the North East"

"The food is very good".

"I can see the doctor if I am not well".

One relative who was visiting her mother told us she was very pleased with the care her mother was receiving.