We inspected the service unannounced on 14 November 2018. Agnes House provides care and support for up to 26 older people some of whom are living with dementia and physical disabilities. At the time of our inspection there were 26 people using the service.

Agnes House 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.

At our last inspection on 11 April 2016 we rated the service ‘Good’ overall in and in all domains except ‘Responsive’ which was ‘Requires Improvement’. At this inspection we found the evidence continued to support the overall rating of ‘Good’, with ‘Responsive’ having improved it’s rating to ‘Good’. 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.

People continued to receive a safe service. People told us they felt safe because there were enough staff duty and they were experienced. People had risk assessments in place so staff knew how to support them to say safe. People received their medicines when they needed them and staff were kind and patient when they gave medicines out. The home was clean and fresh throughout and staff followed the provider’s infection control policy. If an accident or incident occurred lessons were learnt and staff acted to prevent a reoccurrence.

People continued to receive an effective service. The staff were well-trained, skilled and knowledgeable and had experience of meeting the needs of people from a variety of cultural and religious backgrounds. People told us the food was good and they had plenty of choice at mealtimes.

People had access to the healthcare services they needed and staff knew when they needed to refer them for medical assistance. The premises were spacious with good access to all areas for people with limited mobility. Staff followed the principles of the Mental Capacity Act (MCA) and sought people’s consent before they cared for them.

People continued to receive a caring service. They told us the staff were caring and kind and went out of their way to support them. People were actively involved in making decisions about their care and support and said the staff respected and promoted their privacy and dignity. The home had its own Chaplin who was based on-site and available to people, relatives and staff for pastoral and spiritual care.

People received a responsive service. People’s care plans were personalised and provided clear instructions to staff on how to meet people’s needs in the way they wanted. People took part in group and/or individual activities depending on what they preferred. Staff listened to people and made improvements to the service if they were needed. People were supported at the end of their lives to have a comfortable, dignified and pain-free death.

People continued to receive a well-led service. All the people we spoke with reported high levels of satisfaction with the home and made many positive comments about the care provided. The home had an open and friendly culture. The registered manager carried out audits to ensure the home was running effectively and kept up with changes in legislation and guidance. People, relatives, and staff were encouraged to share their views on the home and contribute to how it was run.

Further information is in the detailed findings below

Agnes House provides personal care and accommodation for up to 26 people. On the day of the inspection the registered manager informed us that 26 people were living at the home. The service accommodates older people with a range of needs including people living with dementia.

This inspection took place on 11 and 12 April 2016.

A registered manager was 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 and associated Regulations about how the service is run. The registered manager responsible for nursing was managing the service at the time of the inspection.

People using the service and the relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely.

People using the service relatives told us they thought medicines were given safely and on time. Some improvements were needed to the way medicines were recorded to evidence that medicines were always supplied to people.

Staff were subject to checks to ensure they were appropriate to work with the people who used the service.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs though more training was needed with regard to people's health conditions.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone told us they liked the food served and people were assisted to eat when they needed help.

People's health care needs had been protected by referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way, though there was one incident observed of not treating a person with respect.

People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and usually covered their health and social care needs.

There were not always sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

People, their relatives, staff and professionals were satisfied with how the home was run by the registered manager.

Management carried out audits and checks to ensure the home was running properly to meet people's needs.

We spoke with five people who used the services of Agnes House. People told us they were happy with the care and support they received. People’s comments included: “I think it’s wonderful and the carers are really good. It’s perfect.” “Privacy and dignity to a great point, they’re a thoughtful lot” (referring to the staff). When we spoke with people we asked them how they spent their time. People told us they had taken part and had the opportunity to attend organised events within Agnes House or other buildings on the site, which they had enjoyed.

We asked the people we spoke with for their views about the meals which were provided. People’s comments included: “The food is very good, the quality of the food as in the raw materials as you may sight is first rate and the cooking is most acceptable.” We spent time with people during the lunchtime meal and saw people chose where to sit with many people conversing with each other during the meal. People were happy with the meals provided and through discussions with the chef and the reading of records we found people’s meals were made from fresh produce and met their dietary needs and expectations.

Records showed staff were employed in sufficient numbers to meet people’s needs. Training records and discussions with staff evidenced that staff had the necessary training to provide good and informed care to people. We asked the people we spoke with for their views about the attitude and approach of staff. People’s comments included: “They come quite quickly if I press the buzzer and the carers are really good.” “Staff are pretty good and they’re quick. They’re a thoughtful lot and they care about their jobs.”

We looked around the service and found the environment was well maintained and records were in place which showed that systems were maintained by external contractors.

We spoke with eight people who live at Agnes House. They spoke to us about their experiences and views of the service. People’s comments were positive and included: - “I think it’s good. It’s good without being oppressive and regimented.” “The attitude and approach of staff is both helpful and thoughtful.” “The cook is always very approachable and is always asking us for suggestions for the menu.”

People told us a range of social events took place at Agnes House and that they were supported to practice their religious beliefs by attending the Chapel which is located on site and by visiting religious practitioners.

People’s needs and the support they required were recorded within their care plans. People had signed their care plans when they were able. Records showed that the service supported people to access a range of health care professionals to monitor and promote people’s health.

Records showed staff had received training which enabled them to meet the needs of people using the service, which supported their health and welfare and protected their rights and promoted their equality and diversity. Discussions with staff showed staff had a good understanding of the needs of people and were able to support people in making decisions about their daily lives.

We found records to be accurate and up to date, which included records detailing the maintenance of equipment and systems, which included electrical, gas and fire.

People told us their needs had been assessed before moving into Agnes House and that they had had the opportunity to visit the home before making a decision to move in. People told us they were involved in the day to day running of the home. They told us they were involved in the decisions about the care and support they needed and were happy about the service they received. People’s comments included: - “I visited and then I visited a second time and had lunch with people who already lived here I decided it was where I wanted to live.” “I go to the resident meetings where we have the opportunity to discuss what activities and events are happening in the home and on site. We also talk about anything changes to the home such as decorating.” “There’s a maintenance book and if we want anything doing we record it within the book and the maintenance man takes care of it. We asked that pictures be put up in our room when we moved into the home, it was done for us.” “I’m just pretty happy about being here, I’m looked after well and the carers are lovely.”

People told us they had been supported to access a range of events and activities which included services held at the Chapel which is located within the grounds as well as services held within Agnes House. People spoke about ‘themed days’ organised by the home, Founders Day and trips on the canal.

People told us they had taken part in resident meetings and had had the opportunity to complete an annual survey which sought their views about the service.