We inspected Botham Hall Care Home (known to people using the service, their relatives and staff as Botham Hall) on 29 and 30 January 2018. The first day of the inspection was unannounced which meant the home did not know we were coming.

Botham Hall is registered to provide personal care and accommodation for up to 40 older people, some of whom live with dementia. There were 36 people living at the home at the time of the inspection. The home has two floors. Eight bedrooms on each floor were ensuite; each floor also had communal bathrooms, a lounge and dining area. The first floor of the home was designed especially for people living with dementia.

Botham Hall is a ‘care home’. People in care homes receive accommodation and nursing 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.

The home 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.

We identified some concerns relating to the administration and storage of medicines at Botham Hall. These were immediately addressed by the registered manager. All other aspects of medicines management were safe.

Contingency arrangements for the lift, which was broken at the time of this inspection, required improvement.

People told us they felt safe. Risks to people’s health and wellbeing had been assessed and managed. The registered manager analysed incidents in order to learn lessons and make improvements.

The home was clean and odour-free.

Sufficient staff were deployed to meet people’s needs. Recruitment procedures in place were robust.

Records showed, and staff told us, they received the training and supervision they needed to provide people with effective care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they liked the food and drinks served at the home was positive. The registered manager had taken action to address concerns about the quality of service provided by the catering company which ran the home’s kitchen.

Staff at Botham Hall worked well together as a team. People were supported to meet their wider health needs.

People and their relatives liked the décor of the home. We saw adaptations had been made to better suit the environment for people living with dementia.

People and relatives told us staff at Botham Hall were kind and caring. All interactions between staff and people we observed during the inspection were respectful and supportive.

Staff could describe people well as individuals. Information about people’s personal histories and preferences had been recorded.

We saw staff supported people to make their own decisions by offering them choices. People had been involved in developing their care plans and had access to advocates if they needed support with decision-making.

The registered manager promoted an open and inclusive culture which ensured people’s diverse needs were met.

People’s care plans contained the information staff needed to meet people’s care and treatment needs. Staff had received training on end of life care and the home had achieved accreditation in end of life care.

People’s care plans contained information about their communication needs in line with the Accessible Information Standard. The registered manager planned to review the guidance and implement any further requirements.

Feedback about activities at Botham Hall was positive. At the time of this inspection activities were provided by coordinators three days. The registered manage

This inspection took place on 8 December 2015 and was unannounced. We previously inspected the service on 9 September 2013. The service was not in breach of health and social care regulations at that time.

Botham Hall is registered to provide personal care and accommodation for up to 40 older people and people living with dementia. There were 38 people living at the home at the time of the inspection. Accommodation was split over two floors. Eight of the rooms on each floor provided en-suite accommodation and each floor had communal bathrooms, lounge and dining areas.

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.

People told us they felt safe living at Botham Hall Care Home and their family members also said they felt their relatives were safe. Staff had a thorough understanding of safeguarding procedures and staff knew what to do if they thought anyone was at risk of harm or abuse.

We found staff were recruited safely and trained appropriately. There were enough staff to meet people’s needs.

Medicines were managed appropriately and staff who were responsible for administering medicines had been trained to do so.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. We found that staff had a thorough understanding of these safeguards. Authorisation had been appropriately sought when people’s freedom or liberty was being restricted.

People were involved in their care planning and people received personalised care that was regularly reviewed.

A caring environment was evident and people’s cultural and religious needs were considered. Staff were caring in their approach and there was a positive atmosphere in the home. People’s dignity and privacy were respected.

Regular checks and audits took place to try to continually improve the home. The registered manager held regular meetings with staff and with people who lived at the home, and their relatives, with a view to assessing and improving quality.

On the day of our Inspection there were 37 people living at the home;18 people on the ground floor of the building, receiving residential care and 19 people on the first floor, receiving residential dementia care. The manager explained that in addition to this, one person came for respite care during the day, three times a week and they were visiting on the day of the inspection. There were 38 people in total receiving a care service.

We spoke with eight people who used the service, four visitors, (two relatives and two friends of people who used the service,) the registered manager and four staff.

During our SOFI observation we found that staff had positive interactions with people, they spoke patiently and kindly whilst offering choices and involving people.

We saw that staff knew people well; they called them by name when talking to them and knew what their preferences were. For example we heard one member of staff confirming that the person wanted two sugars in their tea.

Staff told us that although they were busy, there was sufficient staff on duty to meet people's needs. A visitor told us, “The staff are busy but they always have time for you and we always get a cup of tea.”

The provider had an appropriate system in place for gathering and evaluating information about the quality of care the service provided.

People told us their views were taken into consideration when planning their care and staff respected their wishes. For example, what time they liked to go to bed at night.

People told us they were looked after well by the staff.

We spoke with a visiting doctor and community nurse and both people spoke positively about the service.

Comments included, Botham Hall is, “A very good home with very good care. There is always a lot going on and they celebrate birthdays with entertainers, for example, singers.”

There was an effective complaints system available. People who were spoken with on the day said they had never needed to complain but knew who to speak with if they were not happy.