This inspection took place on 14 July 2016 and was unannounced. At the last inspection in May 2015, the provider was meeting the regulations that we looked at.

Taymer Nursing Home provides accommodation and nursing care for up to 30 people with a variety of social and physical needs. There are six bedrooms commissioned by the NHS for rehabilitation where people can stay for up to six weeks. People receiving rehabilitation care have access to physiotherapy and occupational therapy provided by staff from the NHS.

At the time of our inspection there were 28 people living at the service, five of whom were receiving rehabilitation care.

There was a registered manager in post. 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.

People felt safe in the service. Staff were knowledgeable and understood their responsibilities with regards to safeguarding people. They had received effective training. Referrals to the local authority safeguarding team had been made appropriately when concerns had been raised.

Personalised risk assessments were in place to reduce the risk of harm to people and offered clear guidance to staff. Medicines were stored appropriately, managed safely and comprehensive audits completed.

There were sufficient numbers of staff on duty to meet people's care and support needs. Robust recruitment processes were in place and the required recruitment checks had been completed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff received training to ensure they had the skills and knowledge to support the people living in the service. Staff were supported in their roles and received regular supervision and appraisals. New members of staff received a comprehensive induction.

People had been in involved in determining their care needs and the way in which they wished to receive care. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were provided with a varied, balanced diet and were supported to make choices in relation to their food and drink. People were assisted to access other healthcare professionals to maintain their health and well-being, when required.

Staff were kind and caring. People's privacy and dignity was promoted throughout their care. People and their relatives received relevant information regarding the services available.

People's needs had been assessed before they moved into the service and care plans took account of their individual needs, preferences and choices. Care plans and risk assessments had been regularly reviewed and were reflective of people's current needs. People were encouraged to participate in a wide range of activities and to pursue their hobbies and interests.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.

Staff were aware of the vision and values of the provider and the overall development of the service and felt involved in decision making.

There was an effective quality assurance system in place. The registered manager completed quality monitoring audits and these were used to identify where actions needed to be taken and to drive future improvements in the service.

This inspection was carried out on 21 May 2015 and was unannounced.

Taymer nursing home provides nursing care for up to 33 people. There are six bedrooms commissioned by the NHS for rehabilitation where people can stay for up to six weeks. People receiving rehabilitation care have access to physiotherapy and occupational therapy provided by staff from the NHS. At the time of our inspection there were 28 people living at the home.

There was a registered manager in post. 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.

When we last inspected the service on 15 May 2014 we found them to be meeting the required standards in the areas we looked at. At this inspection we found that there were areas which required improvement.

Staff knew people well however during busy periods there were not sufficient staff to meet people’s needs. People had to wait to have their needs met.

There was sufficient food and drink available for people throughout the day.

Medicines were not always managed safely to ensure best practice.

There were not enough tables to support everyone who wanted to eat at the dining tables.

We found although risk assessments had been completed not all steps to mitigate risk had been taken to protect the people who used the service.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People had regular access to visiting health and social care professionals. Staff responded to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare. The manager responded to all concerns or complaints appropriately when they were made aware of them.

Staff were recruited through a robust procedure and provided with regular training to ensure their knowledge was up to date. Staff were clear on what their role. People and staff were positive about the manager and their leadership.

Inspectors gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 15 May 2014. This included speaking with people who used the service, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

During our inspection we saw that people who lived at the home were treated with consideration and respect. Staff provided care and support in a way that promoted people’s dignity, privacy and independence.

We looked at the care records relating to four people who lived at the home. These showed that people’s individual needs had been assessed, documented and reviewed. They provided staff with clear guidance about the care, support and treatment that people needed in a way that ensured their health and safety.

The provider had policies in place that gave staff guidance about relevant aspects of infection control procedures. This included information about how to maintain appropriate standards of cleanliness and hygiene. We looked at records which showed that staff had received infection control training. However, we saw that the floor covering in some communal toilets and bathrooms had become damaged and stained in areas. This meant that that appropriate standards of cleanliness had not been maintained in all cases.

We checked records which showed that effective recruitment policies and procedures were in place. These ensured that staff employed at the home were physically and mentally fit enough for the role performed, of good character and appropriately skilled to meet people’s needs. This included carrying out appropriate checks before staff began work.

Is the service effective?

We looked at care records which showed that people’s choices and preferences had been taken into account in the planning and delivery of the care they received.

We saw that risk assessments had been completed and regularly reviewed in relation to a wide range of issues relevant to people’s care needs and personal circumstances. These included assessments relating to the management of people’s medicines, skin integrity and risks associated with pressure care, nutrition and hydration and mobility and the risk of falls.

Is the service caring?

We observed the lunchtime meal and saw that staff provided appropriate levels of support where necessary to help people to eat and drink in a calm, patient and dignified manner.

Everybody we spoke with told us they were happy with the levels of support, care and treatment they received at the home. One person said, “It’s lovely here and I get extremely well looked after. The staff are really kind and caring and nothing is ever too much trouble for them.”

Is the service responsive?

We saw that people’s views, experiences and choices were taken into account in the way that care, support and treatment was delivered.

People told us they liked the opportunities provided by the activities coordinator and the range of facilities available at the home. These included arts and crafts, church services, exercise sessions, cooking activities, a mini gym, gardening and visiting entertainers. Trips out were also arranged on a regular basis including a meal at a local Chinese restaurant and a piano recital.

Is the service well led?

A relative of a person who lived at the home commented, “We are always made to feel very welcome here. The manager and staff keep us fully updated and involved. [Family member] feels at home here, they are encouraged to decide and make choices about their care and support.”

We saw that people had access to relevant health care professionals where necessary and appropriate including physiotherapists, chiropodists, GPs and occupational therapists.

Effective systems had been put in place to assess and monitor the quality of services provided. These included processes to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home. This meant that people had been protected against the risks of inappropriate or unsafe care.

When we visited Taymer Nursing Home on 01 June 2012, we spoke in detail with five people living at the home and to the relative of another person. All those we spoke to told us that they were very happy with the care provided and found the staff to be caring and kind. One person told us ‘‘you could never better this place’’. Another told us that ‘‘nothing is too much trouble’’ for the staff. Several residents told us of a forthcoming outing to the races and of other activities and outings arranged for them to participate in. Everyone we saw or spoke to demonstrated through speech, facial expressions and gestures that they were satisfied with the care and support they received.

People looked clean and well cared for, and where they needed support or assistance with personal care this was done in the privacy of their room, or discretely if not requiring privacy, to protect their dignity. The extensive food and drink choices were suitable and homely. One person told us "the food is good". There was a wealth of information available about the home and how residents and their families could participate widely in aspects of its running and care, or make a comment or complaint. People told us that they felt staff listened to them and that they were involved in decisions about their care.

We visited the home on 18 October 2011. During our visit we spoke with eight of the 27 people currently living at Taymer. People we spoke with told us that they felt that the care staff were very respectful of their individual needs. One person said, “you only have to ask for something and it is done” and another told us, “nothing is too much for them”. A relative told us that it was a pleasure to visit the home and the staff always kept her informed of her relative’s condition.

People told us that they felt well cared for and that the staff were thoughtful when providing care and support. One resident who had lived at the home for more than seven years said, “you can’t better this place”. Another person said, “the staff are so kind, I used to be a nurse so I know they are doing things right”. Two people were keen to tell us about a recent day trip to Stratford-Upon-Avon.

People told us that they knew what to do if they were unhappy with any aspect of their care. One person said, ‘there is always someone nearby’ when commenting on the number of staff on duty.

People told us that the home was kept clean and tidy. A visiting relative commented that they had not noticed an odour in the home at any time.

People using the service told us that they were asked about their views of the home and were regularly asked if they had enjoyed their meals and if the menu could be improved.

People living at the home told us they were happy with their care. One person said " They look after us very well." They went on to say "I get the care I need and I feel safe."

We saw that staff treated people with respect and protected their dignity by knocking on doors before entering or using curtains in shared rooms. People had consented to their care and this was formally recorded in their care plans which had been signed by the person themselves or their relative if this was appropriate. Care plans were person centred and individualised for each person's needs.

There were six rooms allocated to people who required rehabilitation after having an episode of illness such as a stroke or heart attack. Staff at the home worked alongside healthcare professionals to assess and support people during this process. People receiving rehabilitation were referred from local hospitals for care after discharge for up to six weeks.

The premises were clean and free from offensive odours. Systems in place ensured people lived in a clean and safe environment. Records of safety checks were seen to be maintained.

Staff were supported to carry out their role with supervision and training which was recorded as taking place on a regular basis.

There was a process in place informing people how to complain and a system had been developed to ensure these were responded to in a timely way. There had not been any complaints since our last inspection in 2012.