This inspection took place on 14 and 15 February 2018 and was unannounced. At our last inspection of the service on 23 and 24 February 2016 we rated the service 'Good' overall and Requires Improvement in Well led. This was because some systems and procedures to evaluate and monitor the quality of the service provided required improvement and some provider policies and procedures required reviewing and updating to ensure they were reflective of best practice. The Sloane Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 32 people using the service. The home had a manager in post who at the time of our inspection was in the process of registering with the CQC to become the registered manager for 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.

At this inspection we found a breach of regulations because systems in place to monitor the safety of the premises and equipment were not effective or well-led. We have also made a recommendation to the provider in relation to the safe management and administration of medicines. Staff were knowledgeable about people’s dietary needs and appropriate risks assessments were in place; however some improvement was required to enhance people’s meal time experience.

Staffing level ratios corresponded with staff that were on duty and call bell records showed staff responded promptly when required. There were arrangements in place to manage emergencies and staff were knowledgeable about what to do in the event of an emergency. There were systems and policies and procedures in place to protect people from the risk of infections. There were systems in place to ensure risks to people’s health and well-being were identified, assessed and managed appropriately. Accidents and incidents were recorded, managed and monitored to assist in reducing the risk of reoccurrence. There were systems in place to protect people from possible abuse and harm and staff were aware of their responsibilities to ensure people were kept safe. There were safe recruitment practices in place and appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a health and social care environment. We observed there were sufficient numbers of staff on duty to support people appropriately.

The manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation. People and their relatives where appropriate were involved in planning for and reviewing their care and had access to health and social care professionals when required. Staff received support, supervision and appraisals when required and had access to appropriate regular training. People told us they were happy with the care they received and staff were kind, supportive and attentive. People said that staff promoted their dignity and respected their privacy and independence. People told us they were involved in decisions about their care and their communication needs were met.

People’s physical and mental health needs and risks were assessed and care plans were implemented from assessments undertaken with participation from individuals and their relatives where appropriate. People’s end of life care needs and wishes were documented and respected. People's diverse needs and independence was promoted and respected and activities were provided to meet people’s need for stimul

This inspection took place on 23 and 24 February 2016 and was unannounced. At our previous comprehensive inspection of the service on 01 August 2013, we found the provider was meeting the regulations in relation to the outcomes we inspected.

The Sloane Nursing Home provides accommodation with nursing care for up to 33 people living with dementia, diabetes and stroke. The home also provides respite services and end of life care. At the time of our inspection there were 19 people using the service. The home had 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.

There were systems and procedures in place to evaluate and monitor the quality of the service provided, however, these required improvement.

People were protected from the risk of abuse and there were policies and procedure in place which enabled staff to identify abuse and take appropriate action. Risks related to the health and safety of people using the service were identified, assessed and reviewed. There were arrangements in place to deal with foreseeable emergencies and environmental and maintenance checks were conducted on a regular basis. Accidents and incidents involving the safety of people using the service were recorded, managed and acted on appropriately. There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff began working at the home. Medicines were managed, stored and administered safely.

Premises were adequately maintained and a refurbishment and development project on the building was near completion. There were adequate numbers of suitably qualified, experienced and appropriately trained staff to meet people’s needs. There were processes in place to ensure staff new to the home had appropriate skills and knowledge to deliver effective care. Staff were appropriately supported through regular supervision and were annually appraised of their performance. There were systems in place which ensured the service complied with the Mental Capacity Act 2005. This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs.

People told us staff were kind and caring. Staff showed good knowledge of people’s personalities and behaviour and were able to communicate effectively with them. Staff took time to build relationships with people and there was a keyworker system in place to allow this. Staff respected people’s dignity and privacy and treated people with respect. Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs.

People received care and support that was responsive to their needs and respected their wishes. Health and social care professional’s advice was sought when required and recorded in people’s care plans to ensure that people’s needs were met. People were supported to engage in a range of activities that reduced the risk of isolation and that met their needs and reflected their interests. There was a complaints policy and procedure in place and information on how to make a compliant was on display at the home.

People and their relatives told us the home was welcoming and the registered manager and staff were supportive and approachable. Staff spoke positively about the registered manager and the support they received to enable them to do their jobs well. People, their relatives and staff were provided with opportunities to provide feedback about the service.

Most people and their relatives we spoke with told us that they were happy with the care and treatment they received at the home. People told us that staff were “kind”, “helpful” and “polite”. One relative we spoke with told us that the care was “great”, and they had no concerns. However, another relative told us that although they were happy about the general care provided, they had made a complaint to the provider about some minor issues. People told us that they were involved in planning their care and knew the support that was in place for them. People said they enjoyed the food provided at the home and that they had a good choice of meals.

We found that each person who used the service had a care plan in place with relevant risk assessments which were regularly updated to meet people’s changing needs. People were provided with a choice of suitable and nutritious food and drink. We found that the provider had policies and procedures in place to ensure that vulnerable adults were protected from abuse and staff had appropriate access to these policies. Support was in place to ensure that staff received adequate induction, training, supervision and appraisals. We found that people's care and support plans, staff records and other records relevant to the management of the services were accurate and fit for purpose.

Two people who used the service and three visiting relatives told us that they were happy with the care provided and that they were treated with dignity and respect. All the relatives we spoke with told us that the care was good and staff were kind to people and understood people's care needs. One person told us that “the care is excellent and staff are very friendly and loving”. All the people we spoke with told us they were involved in the planning of care and their views were taken into consideration.

We found that people were able to express their views and were involved in making decisions about their care and support needs. We also found that the provider had policies and procedures in place to ensure vulnerable adults were protected from abuse.

We found that staff had regular team meetings however staff training was not up-to-date and staff supervisions were not being carried out in line with the provider’s timescale to support staff in performing their roles effectively. The provider had systems in place to assess and monitor the quality of the service people received.