Areley House provides accommodation for up to 37 older people some of whom live with dementia. At the time of our inspection there were 32 people living in the home. At the last inspection, in June 2015, the service was rated Good. At this inspection we found the service remained Good.

People continued to receive care in ways which helped them to remain as safe as possible. Staff understood the risks to people’s safety and people were protected from the risk of harm. There was enough staff to provide support to people to meet their needs and people received their prescribed medicines safely.

The care people received continued to be effective. Staff received training which matched the needs of people who lived at the home. People made their own day to day decisions about their care. Staff checked people agreed to the care offered before assisting them. Support was available to people if they needed help making key decisions about their life. People enjoyed their mealtime experiences and were supported to stay well and had access to health care services.

People had built caring relationships with staff and were encouraged to make their own choices and maintain their independence. People were treated with dignity.

People and their relatives’ views and suggestions were listened to. People’s care plans reflected their preferences and unique histories and there were opportunities for people to do fun and interesting things. Systems were in place to promote and manage complaints.

People, their relatives and staff were encouraged to make any suggestions to improve the care provided and develop the home further. The registered manager worked with people, their relatives and other organisations in an open way so people would enjoy the best well-being possible. Regular checks were in place to assess and monitor the quality of the service and action taken to drive through improvements for the benefit of people living at the home.

Areley House provides accommodation and personal care for a maximum of 33 older people. On the day of our inspection there were 31 people living at the home.

The inspection took place on the 2 June 2015 and was unannounced. At our last inspection in June 2014 we found the provider was meeting the all the regulations focussed on.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Relatives said they had no concerns about the care their family member received. Relatives told us staff were caring and promoted peoples independence. Staff we spoke with demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. Staff had up to date knowledge and training to support people who lived at the home.

We saw staff treated people with dignity and respect whilst supporting their needs. Staff really knew people well, and took people’s preferences into account and respected them. Staff used different ways to ensure people understood what was happening around them.

We found the provider had consistently followed the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when assessing people’s ability to make specific decisions. Applications had been submitted to the supervisory body so the decision to restrict somebody’s liberty was only made by people who had suitable authority to do so.

We saw people had food and drink they enjoyed, the cook made every effort to ensure people had their choices available to them, to maintain a healthy diet. People were supported to eat and drink well.

Relatives told us their family member had access to access to health professionals as soon as they were needed. They said they were always kept up to date with any concerns for their relative.

People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home. Relatives knew how to raise complaints and the registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

The registered manager promoted a positive approach to include people’s views about their care and service development. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. Systems were in place to monitor and improve the quality of the service.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five of the people using the service and five of their relatives, three care staff supporting them and looking at three people's care records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "I feel safe here". One relative told us, "I feel confident that my relative is safe here". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about risk management plans and we saw that they supported people in line with those plans. This meant people were cared for in a way that protected them from harm.

We found that medicines that people needed were stored and administered in a safe way by staff who were appropriately trained and competent. This meant people were protected from the risks associated with medicines.

The manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way. The provider had robust recruitment procedures in place to ensure staff were of good character and had the skills and knowledge to support people in a safe way.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that an application had needed to be submitted for one person and that this had been completed in line with legal requirements.

Is the service effective?

People’s care needs were assessed with them. All of the people we spoke with told us they were involved in their care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "Everyone who works here is very kind".

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

Areley House is registered to provide personal care for older people. During this inspection we spoke with five people who lived at the home, five relatives, six staff, and the registered manager. We spoke to the provider on the telephone after the inspection. We looked at three care records. A specialist advisor attended the inspection with their focus on care for people with dementia.

People we spoke with were complimentary about the care and support that they received. One person who lived in the home told us; “It’s great”.

Staff understood people's needs and responded to them in the way the person wished.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were provided with a choice of nutritious meals that they enjoyed.

We found the provider ensured people lived in a safe environment that met their needs

We found that any comments and complaints people made had been responded to appropriately and this ensured that people were listened to.

The purpose of this inspection was to check on improvements the provider had made following our last inspection on 6 July 2012.

We looked at a variety of care plans for four people living at the home and found improvements had been made. The care plans described each person’s needs and how staff were required to meet these. Whilst speaking with staff they told us about people's health conditions, how they preferred personal care to be delivered, and about risks and how they were minimised. This matched the information we had looked at in the care plans and ensured people were not at risk of receiving inappropriate care.

Three people were able to tell us about the care that they received from staff. One person told us, “They (staff) are very kind” and another person said, “They (staff) accommodate your needs.”

We saw that any incidents that involved people living at the home had been reviewed by the manager so that they could make decisions about whether these were potential abuse situations. This meant that people where appropriate were safeguarded from harm due to the improved arrangements that were put in place following our last inspection.

We identified that the manager had a satisfactory system in place to manage risks to the health and welfare of the people living at the home. This had been developed following our last inspection and helped the manager to recognise where improvements were required for the benefit of the people living at the home.

There were 28 people were living in the home when we visited. Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed.

We talked with the relatives of one person who lived in the home and the relatives of four people after our inspection visit, and two staff and the manager of the home. We looked at the care plans for four people who lived in the home to see how their needs should be met. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

The relatives we talked with were happy with the quality of the care provided and the staffing levels in the home. Comments received included:-

‘’They (staff) do their best.’’

‘’Always plenty of staff to talk to, giving care and attending to people’s needs.’’

‘’Very good, delighted with care, very caring, giving lots of time and understanding of needs.’’

‘’Always staff around.’’

‘’Really pleased, look after people very well.’’

During our observations we saw that people’s privacy and dignity was respected. Each person who lived in the home had their own room and some of the relatives we spoke with told us that staff ‘’knocked on the door’’ if they wanted to come in.

We observed lunch being served to people who lived in the home during our inspection visit. We heard one person say that they ‘’enjoyed’’ their meal and one relative who had eaten some meals at the home told us, ‘’Meals are really nice.’’

Relatives that we spoke with were confident that they could raise concerns if they were not happy with the care being received and that they would be listened to. One relative told us that they would talk to the manager if not happy and they would ‘’listen to us.’’

The service had recently been registered with the Care Quality Commission. At the time of our visit there were 10 people living in the home.

We walked around the home and looked at some people’s rooms. The rooms we saw were furnished to a good standard and we could see that people had been able to bring in personal items of their choosing. People we spoke to told us they liked their accommodation.

The home has several communal lounges for people to use and we saw that these were homely in appearance and appropriately furnished.

The room temperature throughout the home was variable. Some corridors felt quite cool and several of the radiators in the home in communal areas were hot to touch, and had no protective covers in place to protect people from harm. There was no evidence that room temperatures were being monitored to ensure people were being kept warm.

We found that not all of the toilets, shower rooms and one of the sun lounges in the home had a call bell point for people to call for help. In addition to this there was one area in the home where call bells could not be heard by staff working in this area and they would be unable to know if people were calling for help. The points where the noise emitted from were low level and there was a risk it may not be heard.

The home manager took immediate action to deal with the concerns raised and carried out an audit of call bells and sent us details of their plans to improve the situation.

People we spoke to told us they felt safe and that they were happy with the care they received from staff. They told us that they were able to choose where to spend their time and where they wished to eat their meals.

During our visit we saw people sitting together having lunch. The atmosphere was very relaxed, with staff talking to people in a warm and friendly manner and providing support to people as necessary. People were offered a choice at mealtimes. They told us that they were given plenty to eat and that they enjoyed the meals served to them. One person told us that they particularly enjoyed their bacon sandwiches at breakfast.

We were told that activities were being provided three hours each afternoon but this under review to ensure this was the best time for people living in the home and was therefore subject to change. The home was recruiting for a designated activity coordinator but in the meantime cover was being provided by care workers who had an interest in this area.

The home had extensive gardens which were not secure. There were no risk assessments in place to show how any risks were to be managed. We were told by the home manager that there were plans to erect fencing next to the main road but in the meantime people would only access gardens with the support and supervision from staff.

At the time of our visit the service had a manager responsible for the day to day management of the home but the manager was not registered with the Care Quality Commission.