This inspection took place on 25 April and 3 May 2018. Day one of the inspection was unannounced, and day two was announced.

The Weir is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service provides accommodation and nursing care for up to 35 people. At the time of this inspection, there were 31 people living at the home, some of whom were living with Parkinson's disease , motor-neurone disease, and dementia.

There was a registered manager in post, who was present during our inspection. 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 the time of our last inspection undertaken in October 2016, we rated the service as Good. At this inspection, we identified concerns in relation to safe medicine management and the governance in relation to this. The service is now rated Requires Improvement.

Stock balances of medicines had not always been accurately maintained, which meant there were medicines unaccounted for. Where people were prescribed creams, these were not always managed safely, with the wrong creams found in people's bedrooms. As prescribed creams and liquid medicine did not have opening dates on, we could not be assured medicine in use was within its shelf-life period.

Language and terminology used in people's care plans and on staff notice boards was not always in keeping with the principles of the Mental Capacity Act. Whilst no unlawful restrictions were in place for people, terminology used did not always reflect this.

Although the registered manager, clinical lead and provider had quality assurance measures in place, these had not identified the shortfalls in medicine administration.

The provider had not assured all relevant notifications had been submitted to the CQC, as required by law. Where there were unexplained injuries to people, the CQC had not always been informed.

There were enough staff to meet people's physical and emotional needs. The provider adhered to safe recruitment procedures.

Safety and maintenance checks were routinely carried out at the home to ensure people's physical environment was safe. People were protected from the risk of infection.

Staff received ongoing training and development in their roles, and this training was also made available to people living at the home, and their relatives.

People were encouraged to maintain their health, and were supported with their eating and drinking needs. Orientation boards were used at the home to help people navigate and to know the date and time.

People enjoyed positive and respectful relationships with staff. People's individual communication needs and styles were known. People had access to independent advocates, as required.

People were encouraged to enjoy a range of social and leisure opportunities. Staff knew people well, both in terms of their health and wellbeing needs, and in relation to their personal preferences. Complaints, feedback and suggestions were acted upon.

People, relatives, staff and health professionals were positive about how the home was run. Staff felt valued and motivated in their roles. People were involved in decisions about the running of their home.

This inspection was carried out on 19 and 24 October 2016 and was unannounced.

The Weir Nursing Home provides accommodation and personal care for up to 35 people. At the time of our inspection there were 29 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.

People were kept safe by staff that knew how to recognise and report any concerns about people's safety. Staff understood people's needs and about risks and how to keep people safe. There were enough staff on duty to make sure that people got the right support at the right time. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were positive about the support and care that they received. People were treated with dignity and respect and staff were kind and caring in their approach with people. People's care and support was centred on their individual needs.

People had their health needs responded to effectively. People were supported to access doctors and other health professionals when required. People were supported to have their medicines when needed. Medicines were stored and administered appropriately.

People were asked and gave staff permission before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.

People were supported by staff that had the skills and knowledge to understand and meet their needs. Staff had access to on-going training and support to meet people's specific health and wellbeing needs. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

People and their relatives found the staff and management approachable and, willing to listen to their views and opinions. People knew how to complain and who to complain to.

Audits and checks were completed regularly to ensure that good standards were maintained. There were established links with organisations relevant to the care and support provided.

This inspection took place on 28 October 2014 and was unannounced. The Weir provides nursing care for up to 35 people. There were 35 people living at the home when we visited and 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.

At the previous inspection no improvements were identified as being necessary.

People told us they felt safe living at The Weir. People knew who they could talk to if they had any concerns. There were sufficient numbers of appropriately trained staff to meet the needs of people and keep them safe.

Risk assessments had been completed so that staff had the information they needed to manage identified risks.

People’s healthcare needs were met as they were supported to see healthcare professionals when needed. They received their medicines as prescribed.

People were supported to have their needs met by staff who had the skills and knowledge and who received support and guidance to provide care. People told us that the staff were kind and respectful. Relatives told us they were kept informed about their family member’s care. We saw that staff involved people in their care giving them explanations of what could happen so that they could make informed choices. We saw that people were treated with dignity and respect.

People were able to raise their concerns or complaints and these were thoroughly investigated and responded to. People were confident they were listened to and their concerns taken seriously.

The provider acted in accordance with the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). The provisions of the MCA are used to protect people who might not be able to make informed decisions on their own about the care or treatment they receive. At the time of our inspection nobody was subject to DoLS.

People told us that if they needed anything they would ask the staff. Staff meetings were held so staff could discuss the service provided to people. People and their relative’s told us that the registered manager and the staff were approachable at all times. We saw that staff gave people choices and asked their opinions.

The provider had taken steps to assess and monitor the home which took account of people’s preferences and the views of relatives and other professionals. These had been used to make changes that benefitted the people living at the home. The manager showed that they clearly understood what their legal duties and responsibilities under The Mental Capacity Act particularly in relation to the Deprivation of Liberty Safeguarding process. This meant that people’s rights and liberty were being monitored and maintained.

People told us that they received a high standard of care at the home. One person said, "It is so lovely here, they really look after me so well" and a relative told us, "I just can't fault them, they really do care about the people who live here". Staff were responsive to people’s changing needs.

We saw that staff responded promptly to any requests for assistance. People told us that the staff were, "Kind, just so nice, nothing's too much trouble" and, "Always willing to help". Staff made sure that people were given choice and were encouraged to be as independent as possible. This meant that staff were compassionate and caring.

The home was a safe and comfortable place for people to live. The building had been adapted so that it was accessible for people using wheelchairs. The adaptations had been done without losing the character of the Georgian house.

The provider made sure that people were able to express their views of the service. People told us that they would feel comfortable raising any concerns, but stressed that they had never needed to. This meant that the service was effective and well led.

People were being looked after by staff who had received the training they needed. Staff were supported by the managers at the home. There were opportunities for staff to increase their knowledge and skills.

We spoke to some of the people who live at The Weir and some relatives, and one person told us “the staff are polite and friendly”. Another person said “it’s like a home from home here”. We spent time observing staff supporting people, and we saw that staff were kind and respectful, and that people were given plenty of time to do things at their own pace. One staff member took time to make sure that someone was sitting in their preferred chair, and checked that they were comfortable before they left them in the lounge.