‘Ticehurst Care Home With Nursing’ is a nursing home operated by Hampshire County Council. It is registered to provide accommodation for up to 86 people, including people living with a cognitive impairment. The home is split into two interconnected parts; a nursing unit and a residential unit each spread over two floors. At the time of the inspection 36 people were being accommodated in the residential unit and 41 people in the nursing unit. Six of the people in the nursing unit were using ‘discharge to assess’ beds funded by the Clinical Commissioning Group (CCG) to support their rehabilitation following discharge from hospital.

The inspection was conducted on 11 and 12 January 2016 and was unannounced. There was a registered manager in place. 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 and felt able to raise concerns. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. People were protected from individual risks in a way that supported their independence and environmental risks were managed effectively.

People were supported to take their medicines safely. Suitable arrangements were in place for ordering, storing, administering and disposing of medicines, including topical creams.

There were enough nursing and care staff to support people on a timely way. Staff recruitment practices were appropriate and helped ensure only suitable staff were employed.

Plans were in place to deal with foreseeable emergencies. Fire safety equipment and procedures were tested regularly; staff were trained to administer first aid and a defibrillator was available in the event of a cardiac arrest.

Staff underwent a comprehensive induction and training programme. They were knowledgeable and skilled at meeting people’s needs. They were suitably supported in their role by managers through the use of supervision and appraisal processes.

Staff acted in the best interests of people and followed legislation designed to protect people’s rights. They also involved people or their relatives, where appropriate, in discussing and planning the care and support they received.

People were offered a choice of meals and their dietary needs were met. They received appropriate support to eat, when needed, and were encouraged to drink often.

People were supported to access other healthcare services and staff worked well with external professionals. At the end of their lives, people received appropriate care and support to have a comfortable, dignified and pain free death.

Staff had created a positive, relaxed environment that suited the people living at the home. They maintained a calm atmosphere by supporting people in a patient, unhurried way. They cared for people with kindness and compassion, respected people’s privacy and treated them in a dignified way.

Staff put people at the heart of the service and were committed to meeting people’s needs in a personalised way according to their individual needs. Care plans contained comprehensive information to enable staff to support people in a consistent way and were reviewed regularly.

People were encouraged to make choices about every aspect of their lives and to remain as independent as possible. They had access to a range of suitable activities either in a group setting or on a one-to-one basis.

The provider sought and acted on feedback from people. There was a suitable complaints procedure in place and people were confident any concerns would be addressed.

People and their families felt the service was run well. They had confidence in the management, as did the staff. There was a clear management structure in place. Staff understood their ro

We found that people expressed their views and were involved in making decisions about their care and treatment.

We reviewed two care plans and noted that both were in a new format introduced by the provider. From the level of detail on views and preferences that had been recorded it was apparent that people and relatives had engaged in the process. In addition we saw that both plans had been reviewed in the last two months and had been signed by relatives.

This meant that opportunities were provided for people, relatives and representatives to discuss people’s care and support preferences.

In the Ticehurst service user guide, we noted that that the section relating to complaints and comments had been updated. The manager told us that people using the service and relatives were spoken with about the complaints procedure during reviews of their care plan and that a large print version of the document was now available.

We reviewed the service complaints folder and noted that three formal complaints had been made recently. We saw that each had been investigated thoroughly and that the outcome had been notified to each complainant. This meant that people’s complaints had been listened to and acted on.

We were unable to speak with people using the service during this inspection because all were suffering from dementia. We observed the interactions between staff and residents to gain an understanding of people’s experiences at this service. A relative told us that Ticehurst has a friendly family atmosphere and that the staff were very caring and always treated their relative with affection and respect.

We saw that people using the service had their individual needs assessed before admission. However, we saw no evidence that people or their relatives had been involved in planning their care and support.

A relative told us, “I’m happy with the care they provide. They are busy but there is always someone on hand to help them or talk to them”.

We observed that people looked well cared for and that those who wished to be were engaged in activities.

We noted that current guidance regarding safeguarding people from abuse was available to staff and that they had received training in how to deal with reports or suspicions of abuse.

All of the managers and staff that we spoke with said they were able to meet people's care needs safely. We found that there were enough qualified, skilled and experienced staff to meet people’s needs.

We reviewed the procedure for handling, storage and administration of medicines and found this to be compliant.

We noted that there was a complaints system in place but it was not readily accessible to people using the service.

People using the service that we spoke with said they felt well treated by staff. People gave examples of staff having the right skills and of offering choices about the way care was provided.

People said they received the care they needed. One person said they had been consulted about their needs when their care plan was being developed.

People reported that although staff were busy, they were able to meet their needs.

This inspection visit took place on 17 and 19 February 2015 and was unannounced.

Ticehurst provides accommodation, nursing and personal care for up to 86 older people, some of who are living with dementia. The home is comprised of a residential unit and a nursing unit. There were 64 people using the service at the time of this inspection.

The service has a registered manager. 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 last inspection on 7 and 8 August 2014, we asked the provider to take action to make improvements. This was because people were not being protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. At this inspection we found that improvements had been made.

Some areas required improvement. Good practice was not always followed for the recording of medicines or the assessment and administration of ‘variable dose’ or ‘as required medicines’, particularly around pain relief. The system for monitoring people’s food and fluid intake was not always implemented effectively.

People told us they felt safe and there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff deployed to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was a comprehensive induction, training and development programme, which supported staff to gain relevant knowledge and skills.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration.

People told us they were happy with the care they received and said they had good relationships with staff. One person told us “The staff understand me, they are very kind”. Another person said “The staff really look after me. It is amazing here nothing is too much trouble”.

People told us the service was responsive to their needs and staff listened to what they said. People were confident they could raise concerns or complaints and that these would be dealt with.

People spoke positively about the service and the registered manager and said they would recommend the home to their friends. There was an open and transparent culture within the service, which encouraged people’s involvement and their feedback was used to drive improvements. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.