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Inspection carried out on 30 October 2018

During a routine inspection

At the last inspection on 5 May 2015, the service was rated as Outstanding. This comprehensive unannounced inspection was carried out on 30 October 2018. At this inspection, the overall rating is Good.

The service is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

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.

Cheviot Nursing Home is registered to support 33 older people, some of whom may be living with dementia. On the date of our inspection, 28 people were being supported by the service.

People and their relatives were very complimentary about the service. They told us it was a safe place to live. Staff understood their responsibilities and knew how to safeguard and protect people from harm.

There was a system in place to assess risks to people’s health and wellbeing, however, these were not always appropriately recorded and reviewed in a timely manner. We have recommended that the provider review their system to ensure records were completed in a timely way.

Staff were recruited appropriately. Checks had been undertaken so that people were kept safe. There were sufficient numbers of staff deployed to meet the needs of people who used the service.

People received their medicines as prescribed and medicines were managed safely. Infection control processes were in place to minimise the risks and spread of infection.

Staff were well supported and received induction, training and supervision to carry out their role. People had sufficient food and drink and were provided with choices at meal times. Access to healthcare services to maintain people's health and well-being was provided.

People’s capacity to make their own choices and decisions were recorded and they or their representatives were involved in important decisions about their lives. However, some information was unclear and confusing. We have recommended that the service look at best practice guidance in relation to capacity and risk to ensure that high quality care is provided to everyone in the service.

The premises were purpose built and had been extended and adapted to meet people's needs. People had comfortable rooms which were personalised to their taste.

The staff were very caring, kind and compassionate. They knew people extremely well and were sensitive to their needs. People were encouraged to be as independent as possible and staff treated them with dignity and courtesy. Staff ensured people’s privacy was maintained and respected.

People received a service from staff who responded to them with excellent care and attention. Care plans were individual and recorded people’s diverse needs, wishes and preferences. People were actively involved in developing the service they received and feedback from them and their relatives about the service was very complimentary.

People had opportunities to participate and pursue their own leisure interests. One to one and group activities and events were offered and people could choose to get involved. Volunteers provided support, company and entertainment.

Information on how to raise concerns or complaints was available and people and their relatives were confident that any concerns they had would be listened to and acted upon.

End of life care for people and their families was outstanding. The service had achieved the Gold Standard Framework and had been commended for the quality of its care for people at the end of their life.

The management team were visible in the service and we

Inspection carried out on 5 May 2015

During a routine inspection

We carried out this inspection on 5 May 2015. It was unannounced.

The service is registered to provide care for up to 33 people. Some people live permanently at the service others are receiving respite care, rehabilitation or palliative care. On the day of our inspection there were 29 people living in the service.

The service had 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.

The care and practices we observed demonstrated that this home provides an outstanding quality of service. People were settled and contented living in the service. Relatives and friends visiting told us their experiences were excellent and freely praised staff. Staff treated people as individuals and were knowledgeable about their likes, dislikes, preferences and care needs.

The provider, registered manager and staff from all levels of the service we spoke with were passionate about providing a service that placed people and their families at the centre of the service.

Staff told us they would not work anywhere else as the service supported them so well. The service provided placements for nursing students and speech and language therapy students. It also participated in innovative research carried out by the University of Kent into compassionate care and national initiatives for example Prosper project which promotes high quality care in care homes. This ensured the service was at the forefront of providing high quality care with up to date thinking.

Staff had received training in how to ensure people’s rights were respected and how to safeguard people from abuse. They were able to confidentially describe the different types of abuse that may occur and how it should be reported.

The standard of training delivered to staff was of a high quality and covered additional areas such as mentoring and reminiscence and other relevant specialism. Universities had chosen this home to support both training materials and student placements which confirmed the quality of care provided.

People were actively involved in their care planning. Care plans were detailed and contained relevant risk assessments. They were used by staff as working documents which supported staff to provide the care and support that people needed.

People were offered appropriate food and fluids to maintain their nutrition. Innovative methods were used to encourage people to eat and drink a suitable diet.

People were integral to the running of Cheviot Nursing Home. People were involved in the recruitment of staff and planning of activities. Families and friends were encouraged to visit the service. A wide range of activities were organised to enable people to live a full and active a life as possible. The service respected and celebrated the cultural differences of people living at Cheviot Nursing Home

Staffing levels were maintained at a high level and were adjusted to meet people’s needs. Students on placement at the service worked additional to permanent staff members. This meant that there were sufficient staff available to meet people’s needs.

Staff were highly motivated to provide excellent support to people, supporting people with their assessed needs whilst encouraging independence.

The service actively sought feedback from people on the quality of the service they received. This was analysed and any deficiencies or suggestions for improvement were addressed.

Inspection carried out on 7 October 2013

During a routine inspection

We spoke with three people who used the service, all of whom confirmed that they were asked for their consent before they received care. One person said, �They always ask my consent. The carers leave me to do the things I can do myself, which I prefer.�

We looked at the care files for three people who used the service. We saw that where people did not have mental capacity, appropriate assessments and decisions had been undertaken. We saw that each person had an assessment of their needs and a range of care plans, based on their needs.

We saw there were regular meetings with people who used the service when activities were planned. One person told us, �There are not an awful lot of activities. There is the hairdresser and we have entertainers come in. Usually I go into the lounge or the garden to read or attend to my affairs.�

Staff received regular support in a range of ways in order to enable them to safely deliver care and treatment to people. We spoke with one nurse who said, �It is a good place to work. I would not go anywhere else.�

People who used the service and their relatives had been asked for their views and we saw evidence that these had been acted upon in order to improve the quality of the service.

We spoke with three people who used the service about the complaints process. One person told us, �I was given information about making a complaint in a little brochure.� We saw that there was an effective complaints system in place.

Inspection carried out on 17 January 2013

During a routine inspection

We spoke with five people who used the service, one relative and three members of staff. People told us that they were consulted about the care they were provided with and that the staff listened and acted on what they said.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We tracked the care records of four people who used the service which showed that people were provided with the care and support that they required and preferred to meet their assessed needs.

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

People were complimentary about the approach of the staff who supported them. One person said, "The girls are wonderful." Another person told us, "the staff are very good, nothing is too much trouble." We also observed the care and support provided to people and we saw that the staff interacted with people in a caring, respectful and professional manner.

We also saw evidence of a system of regular audits of various areas relating to the overall quality of the service. These audits related to care plans, medication, health & safety, files, complaints and nutritional needs. In addition, we saw records of audits relating to staff. These included training, staff surveys, supervision and CRB's amongst others.

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