We inspected this service on 21 July 2017. It was an unannounced inspection. We last inspected the home on 9 March 2016 when we carried out a focused inspection. The previous comprehensive inspection was on 5 November 2015.

Sonesta Nursing Limited is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury, for up to 32 people. The people living at the service are older people, many with dementia and physical health needs. There were 23 people living at the service at the time of the inspection.

There was a registered manager at the service. 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.

We saw kind and caring interactions between staff and people living at the service on the day of the inspection. People and visitors confirmed staff were caring and attentive to their needs.

The service was clean throughout. We noted not all food was labelled in the fridge but the registered manager addressed this on the day of the inspection.

Staff received appropriate support through supervision and training, and told us they enjoyed working at the service.

Care records were up to date and described people’s needs. Risk assessments were in place and gave detailed guidance on how to keep people safe.

The service accommodated and supported people well with complex physical health needs and health professionals spoke well of the nursing care provided to people living there.

Medicines were safely stored and administered.

We could see there were sufficient staff to meet people’s needs on the day of the inspection. People and their relatives confirmed this was routinely the case. The service did not use agency staff to cover absences. This meant there was continuity for people receiving care.

The service followed safe and robust recruitment processes to ensure that only suitable staff were recruited to work with vulnerable people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found the service was working within the principles of the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was compliant in relation to MCA and DoLS.

The registered manager and senior nursing staff carried out a range of audits to check the quality of the service. These covered areas such as care records, medicines management, cleanliness and staff supervision. Completed quality assurance questionnaires from people living at the service, their relatives and professionals working with the service gave positive feedback on the care offered to people at the service.

We inspected this service on 9 March 2016. It was an unannounced inspection. We last inspected the home on 5 November 2015 and breaches of legal requirements were found. This was because we found that people were not always treated with dignity and respect, risk assessments to help staff to manage risks were not always detailed enough, and there were not always effective systems in place to manage the service well.

We undertook this unannounced focused inspection of 9 March 2016 to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these matters. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Sonesta Nursing Ltd on our website at www.cqc.org.uk .

Sonesta Nursing Limited is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 32 people. The people living at the service are older people, many with dementia and physical health needs. There were 24 people living at the service at the time of inspection.

During this inspection we met the registered manager who had run the home for over 16 years, and was also the owner. The conditions of registration for the service state that a registered manager is required. 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.

At this inspection, there was good feedback about the caring nature of staff and we saw good interactions between staff and the people using the service. We saw people were treated with dignity and respect and this was confirmed by people living there.

We found risk assessments had been updated and were thorough so staff were aware of people’s needs and were given detailed guidance on how to keep them safe.

We saw the registered manager had begun to put in place more effective audits to monitor the quality of the service. She had been supported to do this by officers from the local authority and told us she was committed to undertaking these on a regular basis. We found evidence of the registered manager discussing the breaches identified at the inspection in November 2015 with staff, people living at the service and relatives, and action had been taken to improve the quality of the service.

As a result of the above, we found that the provider was no longer in breach of the regulations identified at the inspection on 5 November 2015.

We inspected this service on 21 July 2017. It was an unannounced inspection. We last inspected the home on 9 March 2016 when we carried out a focused inspection. The previous comprehensive inspection was on 5 November 2015.

Sonesta Nursing Limited is registered to provide accommodation with nursing and personal care, diagnostic and screening procedures and treatment of disease, disorder or injury, for up to 32 people. The people living at the service are older people, many with dementia and physical health needs. There were 23 people living at the service at the time of the inspection.

There was a registered manager at the service. 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.

We saw kind and caring interactions between staff and people living at the service on the day of the inspection. People and visitors confirmed staff were caring and attentive to their needs.

The service was clean throughout. We noted not all food was labelled in the fridge but the registered manager addressed this on the day of the inspection.

Staff received appropriate support through supervision and training, and told us they enjoyed working at the service.

Care records were up to date and described people’s needs. Risk assessments were in place and gave detailed guidance on how to keep people safe.

The service accommodated and supported people well with complex physical health needs and health professionals spoke well of the nursing care provided to people living there.

Medicines were safely stored and administered.

We could see there were sufficient staff to meet people’s needs on the day of the inspection. People and their relatives confirmed this was routinely the case. The service did not use agency staff to cover absences. This meant there was continuity for people receiving care.

The service followed safe and robust recruitment processes to ensure that only suitable staff were recruited to work with vulnerable people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found the service was working within the principles of the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service was compliant in relation to MCA and DoLS.

The registered manager and senior nursing staff carried out a range of audits to check the quality of the service. These covered areas such as care records, medicines management, cleanliness and staff supervision. Completed quality assurance questionnaires from people living at the service, their relatives and professionals working with the service gave positive feedback on the care offered to people at the service.

A single inspector carried out this visit. They considered all the evidence gathered under the outcomes inspected and used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risk assessments had been carried out for each person and plans were put in place to minimise risks.

People who used the service were protected from the risk of abuse. Staff had received training in preventing abuse. They could describe what might constitute abuse, the strategies in place for preventing abuse, and what steps they could take to escalate concerns.

People who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). No one at the service had applications submitted under these systems. However, the provider had a written DoLS policy and had supplied staff with training in the operation of the DoLS.

Appropriate checks were undertaken before new staff began work. For example, the service carried out Disclosure and Barring Service (DBS) checks and followed up on people's references. Checks of nurse's registration status with the Nursing and Midwifery Council were also carried out.

Is the service effective?

Various audits were carried out to ensure the service was providing care effectively and in a suitable environment. For example, the nurse manager carried out a check of the medicines administration procedures every three months.

Staff described strategies for obtaining verbal consent before they provided care. The care records showed people were asked to give their written consent appropriately. The provider acted in accordance with legal requirements where people did not have the capacity to consent.

Is the service caring?

We spoke with four people who were using the service. They were satisfied with the care. One person said, "It is quite good here. I get on well with the staff." Another person told us, "I can't fault the care. If there is something wrong then they leap into action."

We spoke with a relative of someone who was using the service. They were pleased with the care provided by the service. They told us, "I live close by and visit my [relative] at different times of the day. The staff are always good and responsive. It is a nice, friendly environment. I think it is fantastic."

Is the service responsive?

The people we spoke with told us staff responded promptly if they asked for help. We also examined how the service responded to complaints and what actions they took in response to accidents involving people who used the service. The service responded to concerns promptly and carried out investigations in relation to any accidents. Actions were taken to prevent accidents from happening again.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people using the service, their relatives, and members of staff.

The provider had written policies, including those relating to safeguarding, whistleblowing and the operation of the Deprivation of Liberty Safeguards. The provider involved staff in an induction process which included a review of these documents. Staff were also asked to complete mandatory training courses to keep their skills up to date.

People were protected from the risks of inadequate nutrition and dehydration. The chef recorded daily meal choices and alternatives people had requested. People were surveyed regularly about the food and we saw the requests they had made featured on the menus. Meetings about food choices had been held and minutes showed that people were positive about the food provided.

People were protected from the risk of infection because effective systems were in place to reduce the risk and spread of infection. Cleaning schedules were in place and up to date. Communal bathrooms were generally clean and one had been completely refurbished along with the staff toilet. Some toilets had been replaced. Further refurbishments were due to start the following week.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The home was warm on the day of the inspection and the heating system had been serviced. A person we spoke with said “yes, I’m warm enough.” Systems were in place to record maintenance needed and undertaken and equipment was checked regularly.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The home carried out a series of regular audits and took account of complaints and comments to improve the service. This meant that risks were proactively managed, quality of care delivered was assessed and feedback was acted on.

A relative we spoke with said “these people are really nice and they look after them.” People were treated with respect and their choices considered. They had been involved in making decisions about their care. Whilst an extra monthly activity had been added, opportunities for meaningful activity were limited.

Care plans were comprehensive and up to date. Entries showed that staff involved people. Risk assessments were in place. Care and treatment was planned to ensure people’s safety and welfare.

One person said “food is good”. Another wanted more variety. Surveys confirmed this remained an issue after menu changes following our last inspection. The amount of food was sufficient and support provided to help people to eat. However, the home was not providing enough variety in the food offered.

The five communal bathrooms and a staff toilet were not clean. Three toilets did not flush adequately. Tiles in the bathrooms were chipped and broken. Two people’s rooms were cool, as was the lounge. The service delivered by the home was not following a number of its own policies.

People said staff were “very pleasant” but more than one said that “sometimes it feels like I wait a long time for someone to come.” Most people living in the home needed a hoist. Staff may not always be available when needed as only three staff were on duty at night.

Although people using the service told us that a relative had selected Sonesta Nursing Home on their behalf they agreed that the relatives had made a good choice. A relative told us they “had liked the atmosphere”. One person living in the home said that “it was a pleasant surprise. Better than where I left”.

They told us that they were involved in decision making in respect of their care and that they were able to exercise choice on a day to day basis. They were satisfied that their privacy and dignity was respected and that members of staff “always knock on the door and close curtains and doors”. They told us about the provision of activities in the home although some people would like more opportunities for stimulation.

Not all people that we spoke with were aware of their care plans but “they give me the help needed, nothing extra needed”. We discussed the meals served and people confirmed that the meals were “OK”. They told us that there was choice and that if there was something that they did not like “you can ask for something else and they will do it”. Confirmation was given that portion sizes were sufficient and that second helpings were available. “I like minestrone soup. I ask for extra and get it”.

They said that they felt safe and comfortable living in the home and that if they had any concerns or worries they would speak to the manager, who visited the home each day, as she was approachable. A person said “she will always help”. Comments regarding the adequacy of staffing levels were conflicting and some concerns were expressed in respect of waiting for assistance with personal care tasks. All people agreed that members of staff were “kind and caring”. Generally people agreed that the quality of care provided was “very good” and that “they do their best for me”. A relative said that they would “highly recommend” the service to others who were looking for a nursing care placement. People told us that although they knew who to speak to if they had any concerns or complaints “I have never had to raise concerns” and “I’m quite satisfied”.