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Inspection carried out on 1 December 2017

During a routine inspection

This inspection took place on 1 December 2017 and was unannounced.

Kelso 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 care home accommodates 12 people in one detached building. There were 10 people living there at the time of our inspection. Bedrooms are situated on the first floor with two on the ground floor and there are four rooms which could accommodate two people. The first floor is accessed via a main staircase or a lift. People have access to a communal lounge and dining area and accessible rear garden. People had a variety of care and support needs related to their physical and mental health and most were unable to speak with us to tell us their views.

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 were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

Staff had worked at the service for many years and this meant that they knew people extremely well. Interactions were kind and tactile and relatives told us that they had peace of mind that their loved ones were receiving safe, compassionate care.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care.

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around weight loss were monitored. People’s preferences for meals were well known and choices were offered if people did not want the meal provided.

People preferred to spend time in their rooms, but there was access to more open areas to spend time with family or other’s if people wanted to use these. Infection control measures were in place and monitored to ensure that people were living in a safe environment.

People and those important to them were involved in planning the support they would receive and also regularly asked for their views about the support and any changes to people’s needs. Reviews identified where people’s needs had changed and reflected changes to the support provided in response to this.

People and those important to them were supported to make decisions about end of life care.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected. Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

People were supported to have one to one time with staff in social activities which were meaningful to them. Visitors were welcomed at the home and kept up to date about how their loved ones were.

Staff were confident in their roles an

Inspection carried out on 17 and 19 August 2015

During a routine inspection

This was an unannounced comprehensive inspection that took place on 17 and 19 August 2015. At the last inspection completed in April 2013 we found the provider was compliant with the regulations and quality standards we reviewed.

Kelso Nursing Home provides accommodation, care and nursing for up to 12 older people in a small homely environment. At the time of the inspection there were 8 people living there.

There was a registered manager at the home at the time of the 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.

Overall, there were high satisfaction levels about the way people were nursed and cared for.

People felt safe and there were systems in place make sure that the environment and way people were looked after was safe.

Staff had been trained in safeguarding adults and were knowledgeable in this field.

Risk assessments had been completed to make sure that care and nursing was delivered safely with action taken to minimise identified hazards.

The premises had also been risk assessed to make sure that hazards to people living at the home minimised.

Accidents and incidents were monitored to look for any trends where action could be taken to reduce chance of such accidents recurring.

There were sufficient staff employed at the home to meet the needs of people accommodated.

There were recruitment systems in place to make sure that suitable, qualified staff were employed at the home. The home had a longstanding, loyal staff team who had worked at the home for many years.

Medicines were ordered, stored, administered and disposed of safely and overall there was good management of people’s medicines ensuring people had medicines as prescribed by their doctor.

The staff team were both knowledgeable and well trained and there were induction systems in place for any new staff.

There were good communication systems in place to make sure that staff were kept up to date with any changes in people’s routines or nursing requirements.

Staff were well-supported through supervision sessions with a line manager, an annual performance review and also practice observations by the manager or deputy who often worked alongside other staff in delivering people’s care.

Staff and the registered manager were aware of the requirements of the Mental Capacity Act 2005 and acted in people’s best interest where people lacked capacity to consent. The home was compliant with the Deprivation of Liberty Safeguards with appropriate referrals being made to the local authority.

People were provided with a good standard of food, appropriate to their needs. Action was taken in circumstances where people had lost weight.

Relatives, staff and people were very positive about the standards of care provided at Kelso Nursing Home. People were treated compassionately as individuals with staff knowing people’s needs.

People’s care and nursing needs had been thoroughly assessed and care plans put in place to inform staff of how to care for people. The plans were person centred and covered people’s overall needs. The plans we looked at in depth were up to date and accurate.

There was good evidence of the staff and registered manager taking action when people’s needs changed or responding to newly assessed needs.

There were limited communal activities but steps were taken to provide individualised activities to keep people meaningfully occupied.

There were complaint systems in place and people were aware of how to make a complaint. None had been raised since out last inspection in April 2013.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on.

The home was well-led. There was a very positive, open culture with staff proud of how they supported people.

There were systems in place to audit and monitor the quality of service provided to people.

Inspection carried out on 25 April 2013

During an inspection to make sure that the improvements required had been made

We visited Kelso Nursing Home on 25 April 2013. We spoke with five people who lived in the home, three members of staff and the provider.

People's needs were assessed and care plans developed to meet these needs. Care plans detailed how needs should be met and identified risks to individuals and how these were managed to prevent harm.

People we spoke with told us "I like it here very much" and "They really really take care of you".

People were protected from abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People lived in a home where there were effective infection control procedures in place, which protected people form the risk of infection.

Staff received regular supervision sessions and on going training to ensure they supported people to meet their needs.

The provider had a range of systems in place to monitor the quality of service provision. These included a complaints procedure, which was followed, and audits of the environment to inform the ongoing maintenance programme. There was also analysis of accidents and incidents to identify trends and actions to reduce the risk of further incidents.

Inspection carried out on 19 December 2012

During a routine inspection

People living in the home were addressed by their preferred name and were able to make choices about how they spent their time.

Consent had been obtained from the person or their representative prior to support being given.

People’s care plans evidence how and when they needed support and the manner in which it should be given. Care records were reviewed on a regular basis and updated if needed.

People were supported to maintain their nutritional intake and support with meals and drinking was given discreetly and at a pace that suited the individual.

Medicines were handled and administered safely in the home.

People we spoke with considered there were sufficient numbers of staff to meet people’s needs and staff were kind and caring.

Staff were recruited in a safe manner and received opportunities for professional development. However, supervision procedures for staff were not sufficiently robust to ensure staff were supported in their role.

Records required for the purpose of running the service were securely stored and up to date and accurate.

Reports under our old system of regulation (including those from before CQC was created)