Bedwardine house provides accommodation and personal care for a maximum of 25 older people. On the day of our inspection there were 24 people living at the home.

The inspection took place on the 10 and 11 January 2017 and was unannounced.

There was no registered manager at this home because the provider was both the registered provider and the manager. 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.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to them. People told us they were supported in a safe way and had their medicines as prescribed. The registered provider had systems in place to monitor how medicines were administered to ensure people were not at risk of poor practice.

People told us staff knew how to support them. Relatives said staff were well trained. Staff had up to date knowledge and training to support people. Staff respected people's rights to make their own decisions and choices about their support. People's permission was sought by staff before they helped them with anything. Staff spent time ensuring people understood what was being said to them, and used a range of communication methods. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do so.

People had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being and staff were responsive to changes with their family members health. Two members of the district nurse team confirmed staff made appropriate referrals to them and followed their advice.

People said they enjoyed living at the home and supported by kind and caring staff. Relatives told us they were reassured staff listened to their family members wishes and knew them well. People living at the home saw their friends and relatives as they wanted. People and their relatives explained how staff treated them as individuals and respected their choices. Staff told us they knew people well, and took their preferences into account and respected them.

People and their relatives were included in decisions about how care was provided. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. People had access to interesting things to do and staff spent time with people to meet their needs. We saw staff knew people and their histories well.

The registered provider sought people’s views through meetings and questionnaires. The management team had responded to suggestions made by people, their families and staff where possible, and took an inclusive approach to improvements to the service.

The registered provider had systems in place to monitor the quality of care and treatment people living at the home received. They told us they had recently replaced key staff who were undertaking training to complete their new responsibilities, therefore some systems were in the process of being updated at the time of our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant that people would be safeguarded as required.

We found that sometimes the risk to the person safety was not always assessed properly. This meant that people were at risk as the provider had not appropriately risk assessed people.

Is the service effective?

People were provided with a choice of suitable and nutritious food and drink. Specialist dietary needs had been assessed and included when the menus were planned.

People told us that their visitors were able to see them in private and that visiting times were flexible. They also told us the home were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well.

We found that the care plans did not always match what care was being delivered. For example, in one care record, we saw someone’s care plan said they were to be assisted out of bed for a wash in the morning. We found that the person was being nursed in bed.

Staff told us they received effective support from the provider and said they had good regular communication.

Is the service caring?

We spoke with eight people who used the service and one relative. We asked them for their opinions about the staff that supported them. What people told us was positive, one person said; “It's nice here”. Another person said; "Very good staff".

People were supported by staff who demonstrated a clear understanding of their needs. When we spoke with staff it was clear that they genuinely cared for the people they supported.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. We saw that one person was supported to paint crockery, which we saw displayed around the home.

People were treated with respect and dignity by the staff on duty. For example we saw one staff member discreetly wipe a person’s face after they had finished their lunch.

Is the service responsive?

The provider was responsive to people’s needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service regularly. People told us they were supported by staff to play games and activities that they enjoyed.

The provider told us that they regularly held residents meetings to gather the views of the people who lived there. This meant that the provider had considered the views of people in running the home.

Is the service well-led?

Staff were clear about their roles and responsibilities. They told us the management team always welcomed their suggestions for improvement. They considered the service was well-led. They said they received regular opportunities to meet on an individual and felt supported in their work.

The provider had some quality assurance systems in place. We saw records that showed areas of the quality of the environment had been reviewed. For example, the maintenance audits and fridge temperature audits were completed. However, we found that risks to the health and welfare of people that lived at the home were not always assessed. This meant that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We inspected Bedwardine House and spoke with five people who lived at the home. We also observed how staff interacted with people who were unable to express their views.

We looked at care records for two people and looked at other supporting documents for the service. We spent some time with the registered manager and the deputy manager of the service.

Consent had been obtained from people before care and treatment had been provided. Alternative arrangements had been made to support people who were unable to consent to their treatment or support. Staff told us they: “Always ask people if it’s ok or if they are happy with me providing care”. One staff member said: “You have to approach people in the right manner”.

People’s needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person’s needs and how to give care and support to meet those needs.

Recruitment procedures were in place to make sure that suitable staff were provided to care for people.

People who used the service were supported by staff who were suitably trained and qualified to meet people’s needs. The provider made sure they carried out an annual appraisal of the staff and held quarterly meetings with senior staff so they were able to raise any concerns or issues they had.

The provider did not have an effective process in place that monitored the quality of its service.

As part of this inspection we visited the home and spoke with the registered provider, deputy manager and two people who were using the service. We also reviewed the care files for three people.

We saw that people were very relaxed and at ease with staff. Many of the people who lived at Bedwardine House were not able to tell us much about their experience at the home due to their condition. We were able to speak with two people and received comments about the care they were receiving and their ability to make decisions and choices. We were told:

“I chose to live here.”

“They usually ask if I want a bath or a shower.”

We last inspected Bedwardine House May 2012, we found that the registered provider was not compliant with one of the Regulations concerning recordings of people’s mental health illnesses. During this inspection we found that the registered provider had made good improvements. We found that assessments had been carried out and care plans written to ensure that care workers had guidance about people’s mental health illnesses and the care they needed to provide to those people.

When we visited the home we met with people who lived there, staff who were on duty, the registered provider who was also the registered manager and the deputy manager.

We saw that people were quite relaxed, at ease with staff and comfortable within their environment. We saw that staff interacted with people who used the service in a friendly, courteous and helpful manner.

We were unable to speak with some people who used the service. This was due to their health problems. Others we spoke with told us they were satisfied with the standards of care they had received. They made the following comments:

“We are well cared for.”

“I have very good care.”

“I choose what time to get up.”

People who used the service provided positive feedback about the staff who provided their care, they said:

“They are very considerate.”

“Everyone has been very kind.”

People told us they felt safe living in the home. They reported that they were able to make decisions about how their care was being provided and the way in which they preferred to live.

When we visited the service we met some people who lived there and also spoke to a relative and a visiting health professional. We asked people what it was like to live at the home and they told us it was “very good”, “very nice”, “quite OK”, “fantastic”. “I think its lovely” and “I like being here”. “Everybody has been kind to me”. “If you need a Doctor he is here the same day”. People told us the staff were “very good”, “very kind”, “all kind”, “very helpful”, “never rude”, “kind and gentle”. They told us, “If you get upset, they come and comfort you”. The “staff are friends”. “I can sleep at night knowing that she is being cared for here…the staff are so kind and they really seem to care about everyone”.

People told us staff respect their privacy and “staff do not come into our room until you invite them”.

People told us the “food is very good”, and there is “plenty to eat and drink”. They told us they do not have a choice of menu, but the home cater for people’s likes and dislikes and never give you food you dislike.

People told us they had a hairdresser who visited the home twice a week. An optician came to check their eyes and a chiropodist visited every six weeks. They told us about the social opportunities which were provided by the home. People said they had “music every month”, and a “church service and holy communion”. Staff took people out everyday into the garden. People enjoyed interests such as reading books, newspapers, playing bingo and games, exercises, and listening to the radio and television. People told us there was “enough going on” in the home.

We spoke to a visiting health professional and a relative who told us, the care provided by the home was very good. The told us the staff were very kind, and the home was always clean.

Bedwardine house provides accommodation and personal care for a maximum of 25 older people. On the day of our inspection there were 24 people living at the home.

The inspection took place on the 16 and 18 March 2015 and was unannounced. At our last inspection in April 2014 we found the provider was not meeting the regulations in relation to the care and welfare of people who use services. Following our April 2014 inspection the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found that these improvements had been made.

There was no registered manager at this home as the provider was both the registered provider and the manager. 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.

People who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us staff were kind and caring and thoughtful towards people. Staff we spoke with understood they had responsibility to take action to reduce the risk of harm for people. They 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 who lived at the home were supported by staff with up to date knowledge and training. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We saw staff treated people with dignity and respect whilst supporting their needs. People’s preferences were taken into account and respected.

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.

People had sufficient food and drink to maintain a healthy diet. People told us they enjoyed the food and we saw at mealtimes there was a relaxed atmosphere. People were supported to eat and drink well and had access to health professionals in a timely manner.

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. Some visitors bought their pets into the home to visit their friend or relative. People who lived in the home told us it was very important to them to see these animals.

Relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action taken to make any necessary improvements.

The provider promoted a positive approach to including people’s views about their care and service development. People who lived at the home and staff were encouraged to be involved in regular meetings to share their thoughts and concerns about the quality of the service. Systems were in place to monitor and improve the quality of the service.