We inspected Bearwardcote Hall on 1 November 2016 and it was an unannounced inspection. The home provided residential accommodation for up to 38 older people. At the time of our inspection 30 people were living at the home.

They were last inspected on 23 September 2015 and were found to require improvement. At this inspection the service had a registered manager. 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.

At the last inspection we found that the provider was not assessing whether people had the capacity to make decisions and had not considered whether they were legally restricted. At this inspection we saw that some improvements had been made because staff had an understanding of people’s capacity and some assessments had been made. However, they had not considered people’s capacity to make particular decisions. There was an authorisation to restrict somebody’s liberty for their safety but the provider had not followed the conditions stated in this to ensure it was lawful.

At our last inspection we found that risks to people were not always assessed and reviewed. At this inspection we saw that risks to people’s health and wellbeing were assessed, actions were put in place to reduce them and their effectiveness was monitored and regularly reviewed. Audits were established so that the managers could review accidents and incidents to ensure that they reduced the likelihood of the occurring again. There were other audits and systems in place to drive quality improvement.

Staff received training and support to support people effectively. They said that communication had improved and they were knowledgeable about people’s preferences and any changes to their needs. There were sufficient staff to meet people’s needs promptly and safe recruitment procedures were followed.

Staff understood their responsibilities to protect people from harm. Medicines were administered to meet individual needs and were stored securely in order to reduce the risks associated with them. People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and were complimentary about the choice and quality.

Staff developed caring relationships with people and their privacy and dignity were maintained at all times. They were encouraged to maintain their independence and consented to the care and support they received. People were encouraged to pursue their interests and activities were provided. Visitors were welcomed at any time and surveys were in place to receive feedback on people’s experiences.

We inspected Bearwardcote Hall on 1 November 2016 and it was an unannounced inspection. The home provided residential accommodation for up to 38 older people. At the time of our inspection 30 people were living at the home.

They were last inspected on 23 September 2015 and were found to require improvement. At this inspection the service had a registered manager. 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.

At the last inspection we found that the provider was not assessing whether people had the capacity to make decisions and had not considered whether they were legally restricted. At this inspection we saw that some improvements had been made because staff had an understanding of people’s capacity and some assessments had been made. However, they had not considered people’s capacity to make particular decisions. There was an authorisation to restrict somebody’s liberty for their safety but the provider had not followed the conditions stated in this to ensure it was lawful.

At our last inspection we found that risks to people were not always assessed and reviewed. At this inspection we saw that risks to people’s health and wellbeing were assessed, actions were put in place to reduce them and their effectiveness was monitored and regularly reviewed. Audits were established so that the managers could review accidents and incidents to ensure that they reduced the likelihood of the occurring again. There were other audits and systems in place to drive quality improvement.

Staff received training and support to support people effectively. They said that communication had improved and they were knowledgeable about people’s preferences and any changes to their needs. There were sufficient staff to meet people’s needs promptly and safe recruitment procedures were followed.

Staff understood their responsibilities to protect people from harm. Medicines were administered to meet individual needs and were stored securely in order to reduce the risks associated with them. People were supported to maintain good health and had regular access to healthcare professionals. They had enough to eat and drink and were complimentary about the choice and quality.

Staff developed caring relationships with people and their privacy and dignity were maintained at all times. They were encouraged to maintain their independence and consented to the care and support they received. People were encouraged to pursue their interests and activities were provided. Visitors were welcomed at any time and surveys were in place to receive feedback on people’s experiences.

Bearwardcote Hall is a care home registered to provide personal care and accommodation for up to 38 people. There were 33 people in residence when we undertook our inspection, and one person was in hospital.

This inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with nine people living in the home, one visitor, five staff and the deputy manager.

In this report the name of a registered manager appears. Their name appears because they were still a registered manager on our register at the time. A new manager was in post and they were in the process of submitting their registered manager’s application to CQC.

At our last inspection in October 2013 we made two compliance actions regarding recruitment practices and the quality monitoring of the service. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in these areas. We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required.

Was it safe?

People we spoke with told us they felt safe. One person told us, “I would rather be in my own home, but it’s the second best thing and I do feel safe here.” Another person said, “They are wonderful staff they have the patience of Job. I have never heard a raised voice in six years. I see them handle people; they are ever so good and so calm.”

Staff handled medicines safely. Records in relation to medication administration, protocols and temperature checks were in place which meant medicines were well managed.

We saw recruitment records demonstrated there were systems in place to ensure the staff were suitable to work with vulnerable people.

The provider and staff needed to increase their understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The provider needed to ensure suitable information about capacity and consent was evident. No DoLS applications had been and although these may not be required

Was it effective?

People’s health, care and support needs were assessed with people using the service and/or their relative or advocate. We saw people’s care records were up to date and reflected individual current needs.

People had access to a range of health care professional which included doctors, opticians and dentists to ensure their health needs were met.

People told us they were happy with the care and support they received and their needs had been met. One person said, “It was clear from our observations and from speaking with staff they had a good understanding of the people’s support needs and knew people well. We saw the staff had received training to meet the needs of the people using the service.

Was it caring?

We saw people were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. People’s rights, privacy and dignity were considered. One relative told us, “The staff are amazing, they are so respectful, kind and caring.”

When speaking with staff it was clear they genuinely cared for the people they supported. People told us the staff were kind and thoughtful. The staff knew how to support people in a caring and sensitive manner.

People had detailed care and support plans relating to all aspects of their support needs. They contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. People’s preferences, interests, aspirations and diverse needs had been recorded.

Was it responsive?

People told us the staff were responsive to their needs, one person said, “They are good at answering the buzzer, they respond quickly. When I ring, they are there.”

We saw people’s needs had been assessed before they moved into the service. We saw records where people using the service had met with their named member of staff on a monthly basis to discuss what was important to them and this information was recorded in their care records to ensure these reflected people’s preferences.

People had access to activities in their own home and also in the community. They had been supported to maintain or forge relationships with friends and relatives. One person said, “I never get bored.” Another person told us they had opportunities to be involved in activities in the home such as laying tables, updating the menu board and dusting.

Some of the staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We found some information was in place of how to support people who could not make decisions for themselves, but further evidence was needed.

Was it well led?

The provider had a quality assurance system in place. We saw records which showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. One person told us, “You only need to mention something and it is sorted really quickly.”

There were systems in place to make sure the staff learnt from events such as accidents, incidents and concerns. This helped to reduce the risks to people using the service and helped the service to continually improve and develop.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and knew there were quality assurance processes in place. One staff member said, “It like home from home. We all really care about getting things right.”

We spoke with twelve people who used the service, two relatives and a close friend.

People able to share their views told us they were happy with the care and service they received, and felt that their needs were being met. One person told us ''there is nothing I would alter about the home; I am very happy living here.’’ Another person told us ‘’the staff are friendly and helpful and they can’t do enough for you.’’

People told us they were involved in decisions and had agreed to their care and treatment.

People said they enjoyed their meals, which usually included a choice of home cooked foods. People were given enough to eat and drink. People felt that the meals included a good variety of foods, and were appetising and well presented.

People told us that they received their medicines at the times they needed them.

People said they liked the staff that supported them. People felt that they get the help they needed as there was usually enough staff on duty. Relatives shared this view.

We spoke to nine people who use the service, seven relatives and eight members of staff.

Some people who use the service were unable to share their views with us. People able to express their views said they were happy with the care and support they received, and felt that their needs were being met. One person said “It’s a lovely home.” Another person told us “I am happy with the way they look after me. They get a doctor if I am ill.”

Most people felt that they get the help and support they need as there is usually enough staff on duty. People felt that staff treated them with dignity and respected their privacy. People also felt safe and able to raise concerns with staff if they were unhappy.

Relatives we spoke with praised the care and support their family member received, and felt involved in decisions about their care and treatment.

We spoke with nine people who used the service and four relatives.

People told us they were happy with the care they received, and felt that their needs were being met. Comments included "I declared that I would not come into care but it's brilliant here; they are an incredible team of staff; it’s as well run as it can be; they look after us well; I’m alright here."

People also said that they felt that they received the help they needed as there was usually enough staff on duty.

People's care and treatment was planned and delivered in a way that ensured their welfare and safety.

The premises were clean, safe and appropriately maintained. People said that they felt that the premises were decorated and furnished to a good standard.

The service had sufficient equipment to meet people's needs. The equipment was used correctly and was properly maintained.

People told us they liked the staff that supported them as they were honest and reliable, and they understood their needs. We found that the provider had not obtained all appropriate information before staff began work, to ensure that people were cared for by appropriate staff.

People said that they felt listened to and able to raise any concerns about the service with the staff. Systems were in place to monitor the service that people received, although not all risks relating to people's safety had been properly assessed and managed to ensure their continued welfare.