The inspection took place on 5 and 9 April 2018 and was unannounced.

Westhampnett 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 provides accommodation, for up to 32 older people, who are living with dementia and who require support with their personal care or nursing care needs. On the day of our inspection there were 26 people living at the home. The home is a large property situated in Westhampnett, West Sussex. A combination of single or double bedrooms were available for people. Shared bedrooms were only used when two people, such as a married couple, or partners, chose to share. There was a communal lounge and dining room as well as a conservatory which people could use. The home had attractive gardens. There is a passenger lift so people can access the first and second floors and there is ramped access on the ground floor for those with mobility needs.

At the last inspection on 18 August 2015 we found the service was in breach of a regulation as the staff recruitment process did not ensure adequate checks were made that staff were suitable to work in a care setting. We made a requirement notice regarding this and the provider sent us an action plan of how they would be addressing this. At this inspection we found the provider carried out the required checks on newly appointed staff and this regulation was now met.

At this inspection we found risks to people were assessed and actions put in place to mitigate people coming to harm. These, however were not always consistently applied and we found sufficient action had not been taken regarding those people assessed of being at risk of developing pressure injuries to their skin. We have made a recommendation about this.

Where people did not have capacity to consent to their care and treatment this was assessed. Where these people had their liberty restricted an application for a Deprivation of Liberty Safeguards (DoLS) had been made to the local authority. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

There service did not have a registered manager in post but the current manager had submitted an application to register with the Commission. 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 their relatives were satisfied with the standard and safety of the care provided. Staff had a good awareness of the principles and procedures for safeguarding people in their care.

Sufficient numbers of registered nurses (RGNs) and care staff were employed to ensure people were looked after well.

Medicines were safely managed.

The home was found to be clean and hygienic and there were no offensive odours.

The premises were safe and well maintained. Adaptations had been made so people with mobility needs could move around the home. People were able to personalise their rooms.

There were systems to review people’s care and when incidents or accidents had occurred.

People’s health and social care needs were assessed. There was evidence staff were trained in current guidance such as in palliative care and in supporting people who had needs regarding problems when swallowing food. Staff had access to a range of training courses including nationally recognised qualifications in care. Staff were also supported with supervision and their performance was monitored by regular appraisals.

People were provided with varied and nutritious meals. There was a choice of nutritious meals.

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The inspection took place on 18 August 2015 and was unannounced.

The home provides care and accommodation, including nursing care, for up to 32 people and there were 24 people living at the home when we inspected. These people were all aged over 65 years who had needs associated with old age and frailty including nursing care needs.

A combination of single or double bedrooms were available for people. Shared bedrooms were only provided when two people, such as a married couple, or partners, wished to share. There was a communal lounge and dining area as well as a conservatory which people could use. The home had attractive gardens with seats and tables.

The service had a registered manager but this person was no longer working in the role. They had applied to cancel their registration with the Commission, but this had not been completed correctly. 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 was a new manager who had been in post since July 2015 and had applied to register with the Care Quality Commission.

Adequate checks were not carried out on newly appointed staff to ensure only those staff suitable to work in care setting were employed. This included lack of reference checks from previous employers and a lack of checks that nurses were registered with the Nursing and Midwifery Council (NMC) as ‘fit’ to practice. The manager took immediate action following the inspection by carrying out checks that all nursing staff were registered with the NMC.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or they reported any abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs although staff felt there were times when this was not the case.

People received their medicines safely but there was a lack of clarity regarding one person’s medicine which was prescribed to be taken on an ‘as required’ basis.

People told us they were supported by staff who knew their needs and preferences. Staff had access to a range of relevant training courses and said they were supported in their work.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were not fully aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and additional training had been arranged in these topics. Despite this, staff had followed the principles of the MCA Code of Practice in obtaining lawful consent. There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care and the manager knew when these procedures needed to be used.

There was a choice of food and people were generally complimentary about the meals. Referrals were made to the dietician and relevant health care professionals so people were supported with any special dietary requirements.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular checks such as dental and eyesight checks.

Staff were observed to treat people with kindness and dignity. People were able to exercise choice in how they spent their time. Staff took time to consult with people before providing care and showed they cared about the people in the home.

People were consulted and agreed to their care. Each person’s needs were assessed and this included obtaining a life history of people as well as ascertaining their preferences for their daily lives. Care plans showed how people’s needs were to be met and showed how and when people were supported or treated by the care and nursing staff.

Activities which were appropriate to people’s age and interests were provided. For example, people were supported to attend services at a nearby church. On the day of the inspection people were taking part in a presentation and discussion about the popular culture of the 1960s. People were observed in communal areas reading their daily newspaper and chatting with each other.

The complaints procedure was available and displayed in the entrance hall. There was a record to show complaints were looked into and a response of the findings made to the complainant.

The service promoted a person centred culture. Staff were committed to treating people as individuals, by providing a personalised service to each person and to giving the best care they could.

There has been a recent change of manager and the new manager was introducing additional audits checks so any trends could be identified and appropriate action taken. A number of other audit tools were used to check on the effectiveness, safety and quality of the service. This included seeking the views of people and staff.

We found a 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 this report.

When we visited Westhampnett nursing home there was no registered manager in place. However we met with the head of care and the nominated individual. They told us that a new manager was due to start the following week.

We spoke with five people and two visitors who told us that people were treated as individuals and that they were given information and choices in relation to their care. One person said “the staff always have the best intentions”. Another said “I am very happy here and the cleaning is very good”. People told us that their dignity, independence and privacy were respected. This was confirmed by our review of people's records as well as our observations. A visitor told us “It is very caring here and the food is good”.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example we observed staff being patient and respectful, and asking rather than directing.

We were shown examples of person centred care records which were organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

We spoke with three people at the home. They all told us that they were happy living there and had no complaints to make. They also told us that their choices were respected, for example in the pursuit of social activities. One told us that the home was “top notch”.

We spoke with two relatives, both of whom always visited the home unannounced. They told us that the privacy and dignity of their relatives was maintained at all times and that they were always shown courtesy and respect. We observed that people’s own space, such as their bedrooms, was respected and staff did not enter without permission. One relative said that the care given was “of a very high standard” and that people were safe living at the home. Another relative told us that staff were “very caring”. Both relatives felt that any complaints or suggestions they made to staff would be listened to, but had none to make. They told us that they felt part of the process of caring for their relatives and that staff understood the importance of this.

To help us understand the experience of people using the service, we used our Short Observation Framework for Inspection tool (SOFI). This allowed us to spend time watching what was going on in a service and to record how people spent their time, the support they got and whether or not they had positive experiences. Using this, we found that staff had the necessary time and skills to care for people well.