About the service:

Watlington and District Nursing Home is a care home that was providing personal and nursing care to 55 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

There was an extremely cheerful and welcoming atmosphere in the service. People were recognised as individuals and were supported by staff who valued people for their uniqueness. People were encouraged to be as independent as possible and staff went to exceptional lengths to ensure people achieved their chosen outcomes.

People enjoyed a wide range of activities that were individual and others that involved relatives, visitors and staff. It was clear from photographs and feedback that these were wonderful events and promoted strong, meaningful relationships.

The management team were totally committed to providing a high-quality service that valued and respected everyone. The registered manager was dedicated to their role and demonstrated the values of the service at all times. Feedback was overwhelmingly positive about the management team and staff.

Staff were extremely well supported and showed great dedication to people, relatives and other staff. This created a service with a ‘family’ atmosphere which was commented on in the feedback we received and our observations during the inspection.

There were systems in place to ensure people were supported in a way that kept them safe whilst recognising their rights to choice and control.

People and relatives were complimentary about the food they received and enjoyed a wide variety of menu choices to meet their individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The service met the characteristics of Outstanding in Responsive and Well Led and Good in Safe, Effective and Caring.

Rating at last inspection: Good. Comprehensive inspection report published 9 August 2016. Focused inspection report published13 March 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Outstanding.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Watlington and District Nursing Home on the 16 February 2017. It was an unannounced inspection.

The service provides accommodation for people requiring personal and nursing care. The service supports people with dementia and has a 15 bedded intermediate care unit. The service accommodates up to 60 people. At the time of our inspection 55 people were 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 2008 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 8 June 2016 and found the provider was not meeting the legal requirements relating to people’s nutrition and hydration needs.

This inspection in February 2017 was to check they had met the legal requirements of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which relates to meeting people’s nutrition and hydration needs.

At this inspection we found improvements had been made and people’s nutrition and hydration needs were being met.

People had access to food and fluids to meet their needs. People who had been assessed as requiring a specialised diet received food and drink in line with their care plan.

Where people required their food and fluids monitored, records were completed to ensure people's food and fluid intake was monitored.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

Staff understood the Mental Capacity Act (MCA) and all staff applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included Deprivation of Liberty Safeguards (DoLs).

Staff spoke positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Watlington and District Nursing Home on our website at www.cqc.org.uk

The inspection took place on 8 June 2016 and was unannounced.

The service provides accommodation for people requiring personal and nursing care. The service supports people with dementia and has a 15 bedded intermediate care unit. The service accommodates up to 60 people. The home was full at the time of our inspection.

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.

People's nutrition and hydration needs were not always met and people did not always receive food at an appropriate temperature. Where people had guidance from health care professionals relating to their dietary requirements this was not always followed.

The registered manager promoted a service that put people at the centre of all it did. The registered manager constantly strived to improve the quality of people's lives, particularly in the field of dementia care. Planned improvements were focused on the environment for people living with dementia.

There was a welcoming atmosphere created by the staff's friendliness and cheerfulness. There was a calm, relaxed atmosphere throughout the inspection. People were engaged in a variety of activities and were supported to spend their day how they chose.

Staff were extremely caring and people benefitted from meaningful relationships. People were encouraged to maintain and improve their independence by staff who understood the importance of people being in control and feeling valued.

There were enough staff to meet people's needs. The registered manager ensured that all staff were suitable to work with vulnerable people. Staff were well supported and had access to development opportunities to improve their skills and knowledge. Staff were knowledgeable about people's needs and were skilled in supporting people. Staff understood their responsibilities to report any concerns relating to abuse of vulnerable people.

People were involved in all decisions about their care and personalised care plans were in place that identified how people's needs were met. Where people were assessed as lacking capacity to make specific decisions care plans identified how people were supported in line with the principles of the Mental Capacity Act 2005. Care plans included risk assessments and where risks were identified management plans were in place.

People's nutrition and hydration needs were not always met and people did not always receive food at an appropriate temperature.

Feedback about the quality of the service was sought from people and relatives. Feedback was used to improve the service. There were residents and relatives meetings and a newsletter keeping people informed about what was happening in the service.

There were effective systems in place to monitor and improve the service. This included regular audits carried out in the home and quality audit carried out by the provider.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

When we visited the service on 22 October 2013, we had concerns about standards of records. This was because some people’s care plans and risk assessments had not been kept up to date to reflect their changing needs. We set a compliance action for the provider to improve practice. The provider sent us an action plan which outlined the changes they would make to become compliant. We returned to the service on 7 August 2014 to check whether improvements had been made. This was after the date the provider told us all actions to improve the service would be completed.

We considered all the evidence we had gathered under the outcome we inspected. We used the information to determine whether Watlington and District Care Home provided a safe service to people.

This is a summary of what we found -

Is the service safe?

We found Watlington and District Care home provided a safe service.

We saw improvements had been made to standards of record keeping. People’s personal records were now accurate and fit for purpose. We read six people’s care plans. These provided detailed accounts of the care and support each person required. The files were well kept which made information easy to locate for staff. In each case, we found care needs had been assessed and reviewed regularly. This ensured any changes to people’s circumstances were noted and appropriate adjustments made, where needed. For example, we saw that an instruction from a relative about one person’s resuscitation requirements had been recorded, signed and put on their care plan file the day after they requested it.

We spoke with the manager and deputy manager to see what monitoring was undertaken of care plans. There were several auditing tools including a specific care plan audit tool. This was used each month for a sample of three to four files. There were also quarterly and annual audits of overall care provision, which included sampling care plans and risk assessments. These tools helped to ensure the improvements would be sustained.

We spoke with ten people and two people's relatives. At the time of our visit 47 people were living at the home and 11 were receiving support to regain their independence after a hospital stay.

Everyone we spoke with felt involved in their care. One person told us’’ I can do what I please really and the staff respect my wishes. If I don’t want to have lunch in the dining room I don't have to".

People benefitted from engagement from care workers. We noticed numerous positive care worker interactions.

We saw that the design of the premises promoted people’s dignity, independence and wellbeing. We saw that people were able to move around areas of the home freely. They had a choice in how and where they spent their day.

Care workers and other staff were supported appropriately. Staff said that they felt able to speak to management when there was an issue. One care worker told us, “They are incredibly supportive. I feel confident to go to them with any concerns”.

The provider had clear evidence of how the views of people and their representatives were sought. We saw records of the home’s last quality assurance survey conducted in 2013. We saw that people and their relatives stated they were happy with the service they received.

People's care records were detailed and person centred. However people were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We spoke with six people and eight members of staff, as well as conducting a short observation framework inspection.

All people we spoke with were positive about the service. One person said “I can’t praise the staff highly enough” and that they received “wonderful care”.

Staff we spoke with told us that they always asked for permission before providing personal care. Staff discussed how they explained what they were going to do during personal care and how they respected peoples’ dignity and choice. One member of staff said “I always ask permission first before helping anyone, it gets them talking and involves them”.

All the staff we spoke with were able to identify the types of abuse and understood the responsibilities of their role regarding safeguarding. They said they felt supported and that there was an open environment within the home.

The home appeared clean throughout the visit and staff and management discussed how they ensured the home remained clean. There were hand gel dispensers around the home and in the reception area.

The management of the home conducted monthly quality audits. These audits covered areas within the home such as care planning, medication monitoring, safeguarding and mandatory standards. Where the management had identified concerns, actions plans had been implemented and acted on.