This was an unannounced inspection which took place on 27 September 2016.

The Dower House Nursing Home is registered to provide care with nursing for up to 43 older people. There were 41 people in residence on the day of the visit. The building offers accommodation over two floors in single rooms. Rooms are spacious and have en-suite facilities of the person’s choosing. The upstairs is accessed via a lift or staircases. The shared areas of the service are very spacious and comfortable. The garden is large, attractive and extremely well kept.

The service has a registered manager running 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 kept people, visitors to the service and staff as safe as possible. They did this by ensuring staff were provided with training in the safeguarding of vulnerable adults and health and safety. Staff were fully aware of their responsibilities with regard to protecting people in their care and were able to describe how they kept people safe from all forms of abuse. Risks were identified and managed to make sure that any risks to people and others were minimised.

There were unusually high numbers of staff available to ensure peoples’ needs were responded to quickly and they were given safe care. The service’s recruitment procedure ensured that as far as possible, all staff employed were suitable and safe to work with vulnerable people. Some additional work was necessary to ensure references were robustly verified. People were given their medicines in the right amounts at the right times by staff who had been trained to carry out this task.

The management team and staff protected people’s rights to make their own decisions and consent to their care. The staff team understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. The MCA legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. People in the home had the capacity to make their own decisions and choices and no one was deprived of their liberty.

People’s health and well- being needs were met by staff who were properly trained and supported to do so. People were assisted to make sure they received health and well-being care from appropriate professionals. Staff were trained in necessary areas so they could effectively meet people’s diverse and changing needs.

Staff built strong relationships with people and their families and provided kind and compassionate care. People were supported to make as many decisions and choices as they could to enable them to keep as much control of their daily lives, as was possible. People were treated with kindness, dignity and respect at all times. The service had a strong culture of person centred care which recognised that people were individuals with their own needs and preferences. However this needed to be more clearly noted in care plans.

People benefitted from a very well-managed service. The registered manager, general manager and provider were described as very approachable. People and staff were comfortable and confident to make their views known and felt they were valued and listened to. The registered manager was very knowledgeable about people’s individual needs. The service made sure they maintained and improved the quality of care provided.

During this inspection we spoke with the matron, nurses, care assistants, administration staff, maintenance staff and people living at the service.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. People told us that they were very happy living at the Dower House Nursing Home. Examples of the comments made by people were: ‘No faults found’ and from a short stay resident; ‘I consider I was extraordinarily well looked after throughout, with good food too’.

When we spoke with people they all were able to confirm that they were aware of the comments and complaints procedures, but had never needed to use these procedures. One person said: “The service is so good here; I would be extremely surprised if there were any formal complaints”. People who use 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.

Regular audits were carried out of the environment, buildings and clinical procedures, this meant that decisions about care and treatment were made by the appropriate staff at the appropriate level.

During our visit we spoke to seven people, observed their care and observed the care provided for one additional person. All those who spoke to us said that they were able to make choices about the care they received and the ways in which it was provided. Several people used the same terms to describe the care they received as "excellent, kind, caring and the best you could possibly ask for."

People told us that they felt safe at the home because of the care they received from the staff. They told us that they had frequent contact with the registered Manager and that they had confidence to raise any issues should any arise. On the day of our inspection we found people received the care and attention they needed in a timely and respectful manner.

People who use the service were given appropriate information and support regarding their care and treatment.

We observed care being provided to people and saw that this was professional and person orientated. We saw staff speak to people in ways that were respectful, calm and confident. We also observed that they did not rush their care and continually paid attention to the person receiving it.

Without exception, people using the service told us that they felt extremely safe and secure living at the home. They told us that they had confidence in the staff and management to ensure that their safety was protected at all times.