This inspection took place on 3 and 9 January 2019 and was unannounced.

Ward House Nursing Home 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. The home is registered to provide accommodation and personal care for up to 23 people and there were 21 people living at the home at the time of the inspection. Ward House is a detached older property which has been extended and adapted. There is a passenger lift so people can access the upper floors where most of the bedrooms are situated. Bedrooms were a mixture of single rooms and some shared by two people. Communal areas included a lounge dining room divided into several separate areas and a quiet room which could be used for small meetings or activities. An enclosed rear garden was fully accessible for people.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Quality assurance process had not identified areas for improvement found during this inspection in relation to documentation and the recording of care. The registered manager responded promptly when we identified areas for improvement.

Where people were unable to make some or all decisions about their care the decision-making processes had not followed all the Mental Capacity Act 2005 (MCA) steps. Staff were aware of the need to gain people's consent to their care and support. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

There were gaps in the recording of some care such as repositioning and food and drinks people had been provided with. The service had introduced a new computerised care planning and recording system which staff acknowledged had been hard to adjust to.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people's needs and preferences.

People were supported to access healthcare services, such as GPs. At the end of their lives people received the care they required to remain comfortable and pain free.

Care and support were based on plans which considered people's needs and conditions, as well as their abilities and preferences. Care plans were adapted as people's needs changed, and were reviewed regularly.

People were supported to eat and drink enough to maintain their health and welfare. They could make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. New staff received appropriate training and arrangements were in place to ensure other staff completed required update training. Staff felt supported by the management team.

People and visitors found staff to be kind and caring. Staff respected people's individuality, privacy, dignity and independence. The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

People could take part in activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

This inspection took place on 7 and 14 July 2016 and was unannounced. Ward House provides accommodation and personal care for up to 23 adults, including people with dementia and physical disabilities, who require nursing care. There were 23 people living at the home when we visited.

There was a registered manager at the home. 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 and external health professionals were positive about the service people received. Medicines were managed safely and people received these as prescribed. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care involving people were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service. Quality assurance systems were in place using formal audits and through regular contact by the provider and registered manager with people, relatives and staff.

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

We spoke with four of the 17 people at the home. They all told us they were very happy with the service they received. They said they had consistent care staff who knew what support they required. We also spoke with four relatives. They were also all very positive about the service and said they felt their relatives were safe. Staff had completed safeguarding and other essential training and were able to tell us what they would do if they had any concerns about people’s safety or welfare.

Risks to people's health and safety had been assessed and management plans were in place to reduce these risks. We saw specific equipment identified in people’s care plans was in place to reduce risks and keep people safe. This included equipment such as pressure mattresses and movement sensor alert systems. Staff told us they had received training to use the equipment in use. Systems were in place to ensure the home was clean and infection control risks were appropriately managed. There were also systems in place to ensure only suitable people with appropriate skills and knowledge were employed.

Is the service effective?

Staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. The registered manager was aware of who to contact for specialist advice and when this may be required. For example, they had sought guidance about an infection control concern.

Systems were in place to monitor the care people received to ensure if continued to meet their needs. We heard during a staff handover, that the nurse had identified a person may have a new health need and had promptly sought medical advice and treatment from their GP. We spoke with two external healthcare professionals who had regular contact with the home. They told us they felt the home met people’s needs in a safe and effective way.

Is the service caring?

People were supported by kind and attentive staff. People also told us the staff were kind and helpful and they were happy with the way they were cared for. One person told us “you won’t find any problems here, I would recommend the place”. We spoke with four visitors. They were also all very satisfied with the care their relatives received. They commented that staff knew their relatives needs and kept them informed about any changes in their care needs.

Staff said they had time to meet people’s identified needs and could provide care at times people wanted it. Staff were aware of people’s rights to refuse care and stated they would respect this. Records of care provided showed people had received care as detailed in their care plans.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. For example, staff told us when a specific piece of moving and handling equipment had been required for a person this had been promptly provided. This meant the person’s needs could continue to be safely met. One person we spoke with told us they had decided to stay in bed on the day of our inspection and staff had supported this decision. They told us if they did not want care at a particular time they could tell staff and they “would come back later”. We saw one person who was unable to use a standard call bell system had been provided with an easy to see and use nurse call button. They told us “staff usually come quickly when I use it”. They demonstrated this and a care staff arrived within two minutes. This showed staff were able to respond to people’s requests and provide care at times suitable for people.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. A comprehensive contingency plan was in place which covered all possible emergencies. The registered manager described how they had used this when there had been a short interruption in the water supplies to the home in 2013.

Is the service well-led?

People and their relative’s views were sought and a monthly care plan review was completed by the person’s key nurse. Formal six monthly care reviews to which relatives were invited were also completed. There were procedures in place to monitor the quality of service provided including formal reviews with people and relatives and audits such as monthly infection control audits. A representative of the provider visited the home monthly and completed an audit of the service provided. Systems were in place to ensure accidents and incidents were managed correctly to safeguard people from repeat incidents. People and relatives had information about how to complain and there were systems to ensure complaints would be investigated by the registered manager or provider.

We spoke with four of the 18 people living at the home and three relatives. All people said they were happy with the way they were cared for. One person told us “the staff are wonderful, I cannot fault them, they are all friendly here”. Another said “the carers are excellent and know how to look after me”. All three relatives we contacted were very positive about the home. One said “care is excellent, my relative is very happy there”. Another said they visited at various times of the day and their relative “was always well cared for, clean and given lots of drinks”. The third commented they were impressed by the staff many of whom had worked at the home for at least several years and knew how to care for people.

We spoke with nursing and care staff. Staff were aware of people's individual likes and dislikes and the help they required. Staff stated they had sufficient time to meet people’s needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. The care we observed corresponded with care plans and risk assessments viewed. We found medication was stored and administered appropriately. There were sufficient staff available to meet people’s needs. Staff were receiving training and support. A range of quality monitoring procedures were in place.

We spoke with 6 of the 19 people who were living at the home. We met other people living at the home and spoke with two visitors. People told us that the staff were nice and friendly. All people said that they had no concerns about how their care needs were met. We were told that staff were available when people needed them and knew what care they required. People told us that they felt safe and happy at the home. They told us that their privacy was respected and that staff always knocked on their doors before entering. Two visitors confirmed the statements made by people and also said that the home had improved in terms of cleanliness and care since the new manager had taken over.

We spoke with two health professional involved in the care of people. They were complimentary about the way the service met people's needs. We were told that the home contacted them appropriately and followed guidance and suggestions.

We observed that staff were courteous and respectful of people's views and opinions and that dignity was respected. We saw that people were offered choices about where they sat and activities.

Whilst most people were spoken with on the day the majority were unable to tell us directly about their feelings and experiences of living at Ward House Nursing Home. However, a few people were able to tell us how they felt about living at the home. They told us they knew the staff members and the staff knew and were able to meet their needs. People told us they could spend their time how they wanted. They said they could have breakfast at a time that suited them.

Whilst most people were spoken with on the day the majority were unable to tell us directly about their feelings and experiences of living at Ward House Nursing Home. Two regular visitors to the home told us they had no concerns. They reported the cleanliness of the home had improved over the last two weeks. They told us the home had adequate staffing levels and they people they visited seemed happy with the care they received.