This inspection took place on 17 and 19 April 2018 and was unannounced.

Breadstone Care Home with Nursing 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.

Breadstone Care Home with Nursing accommodates up to 35 people in one adapted building. There were 26 people living at the home at the time of this inspection. The service will be described as Breadstone throughout this report.

There was a registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous inspection was completed in October 2016. The service was rated as Requires Improvement and there was one breach of regulation in relation to person centred care at that time. People's care plans were not comprehensive, up to date or person centred. We found the provider had met the requirements of the regulation breached during this inspection. Care plans had been updated, reviewed and reflected each individual's needs. The service was rated as Good at this inspection.

Medicines were managed safely and people received their medicines as prescribed. Health and safety checks were carried out regularly to ensure the service was safe for people living there. There was a robust recruitment process to ensure suitable staff were recruited. The service had effective arrangements to respond to incidents, accidents, concerns and safeguarding events.

People were supported to access health professionals when required. Changes to people’s needs were identified promptly and were reviewed with the involvement of other health and social care professionals where required. People could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible.

People and their relatives were positive about the care and support they received. They told us there was sufficient staff on duty and staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred and detailed to support staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People were treated equally and their differences respected, accepted and celebrated.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team. From looking at the accident and incident reports, we found the provider was reporting to us appropriately.

This unannounced comprehensive inspection took place on 5, 6 and 10 October 2016.

Breadstone House Care Centre is a care home with nursing care for up to 35 people, most of whom are living with dementia. On the day we visited 32 people were living there. The home is a converted house and has a passenger lift to reach two floors where people are accommodated. There is also a third floor and a mezzanine floor serviced by stair lifts. There was manager who had applied to CQC to become the 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.

Care plans for people were not always person centred and complete to ensure staff knew how to meet peoples individual needs when they were living with dementia. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The environment could be improved as there were some areas that required decoration, repair, new carpet and furniture. The provider had planned to commence the improvements required. We have made a recommendation about improving the environment for people living with dementia. Not all areas and equipment were clean, although recent improvements had been made. We have made a recommendation that infection control procedures are improved. The services quality assurance system had not identified all the shortfalls.

People and their relatives told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were well trained and had access to training to develop their knowledge.

People were treated with kindness and compassion and we observed staff engaged with people in a positive way and they were caring when they supported them. Relatives felt welcomed in the home and told us the staff were kind but sometimes people had to wait for assistance.

People were able to make some choices and decisions and staff supported them to do this. Staff knew what people valued and how they liked to be supported. Peoples care was regularly reviewed. External healthcare professionals supported people when required and people living with dementia were well supported by visiting mental healthcare professional and their GP.

People had a choice of meals and we observed most people ate their food and could have a second helping. When people required assistance with their food staff supported them and gave them time to enjoy their meal. People had a range of activities to choose from which included exercise classes, arts and crafts, musical entertainments and skittles. There were links with the local community with trips out organised.

The manager and the service quality manager monitored the quality of the service with regular checks and when necessary action was taken. Staff felt well supported by the manager. Staff meetings and relative meetings were held and they were able to contribute to the running of the home.

A single inspector conducted the inspection and helped to answer our 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, from speaking with people who use the service, from speaking with the staff supporting them and from looking at records. We spoke with five people who lived in the home although they did not all comment on the service provided.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. There were safeguarding procedures and staff received training so that they understood how to safeguard the people they supported. Information about how to report a concern was made available to people who lived in the home and their relatives.

Each person had a series of risk assessments which included the action that was needed to reduce risk and keep people safe. There were also general risk assessments and risk management plans so that the people who lived in the home, staff and visitors were kept safe.

There were systems to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, and investigations. This reduced the risks to people and helped the service to improve continually.

The home had policies and procedures about the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be made. Relevant staff had been trained to understand when an application should be made, and about how to submit one. This meant that people would be safeguarded as required.

The home looked safe, clean and hygienic. We saw hand washing facilities and hand gel for staff and visitors. Staff wore plastic aprons and gloves when giving personal care and when serving food. These measures helped to control the spread of infection.

There were jugs of squash and snacks available at all times. People’s likes and dislikes for food and drinks and any needs for a special diet were recorded. This information was given to the kitchen staff so that they could plan meals that people would enjoy. People’s weight was checked regularly and changes were made to their diet if needed. All these arrangements helped to keep people healthy.

There was a staff rota which showed that there were sufficient numbers of staff with a mix of qualifications, skills and experience on each shift. We saw that there were enough staff so that they were not rushed and could respond to people calmly. This helped to make sure that people’s needs were always met.

A senior manager visited once a month to monitor the quality of service and make sure that practice was safe.

Is the service effective?

People’s health and care needs were assessed with them if they were able to express their views. Where they were able they were involved in writing their plans of care. When people did not have capacity their relatives provided information on their behalf. Specialist dietary, mobility and equipment needs had been identified in care plans where required. When we looked at the care plans we saw that relatives had provided information for them and they were regularly reviewed so that they reflected people's current needs.

People’s needs were taken into account with signage and the layout of the service which enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with dementia. For example the toilet doors had been painted red and they had pictorial signs so that people could find them independently. There was an enclosed rear garden where people could walk about safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People’s relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

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

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had an activity co-ordinator every day including weekends. Staff took care to find out what each person was interested in so that they could provide activities that suited their needs.

People’s relatives knew how to make a complaint if they were unhappy. There had been only one complaint in the last year. We looked at how this had been dealt with, and found that the response had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Information about people’s dietary needs and their likes and dislikes were recorded so that people could have food they would enjoy. Two people told us that the food was very good.

Is the service well-led?

The service worked well with other agencies such as the social care commissioners, district nurse and GP to make sure people received their care in a joined up way. The service has notified CQC of incidents as required.

The service had a quality assurance system. We saw records, which showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

There was a computer system with all the service’s policies and procedures and record templates. This was accessible to staff so that they would always know what was expected of them.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and said that the senior managers provided good support and direction. We saw records of the director of nursing’s monthly visits which including identifying good practice and actions for improvements. These provided strong direction for staff.

We spoke with people and their relatives. Comments made about the home, staff and food were favourable. One person told us they had chosen the home because it was local to where they had lived. They said “The staff are cheerful and friendly, it’s lovely”. They also said the “Food is beautiful”. Another person said “I have a comfortable room, I like my life” and others said they liked the home.

A relative told us they had been recommended the home and said they felt their parent “seems happy and is well looked after”. They complimented the food.

A person told us they did not have to do anything they did not want to and we saw documents that showed people had been asked to give consent.

People’s needs were assessed and care was delivered according to objectives set to address the needs. Care given was documented and there were records of health interventions. A record maintained a diary of people’s well being.

The arrangements for storage, administration and recording of medicines were suitable and we saw the nurse administering medicines stayed with the person until they were confident they had taken the medicines.

Records showed that staff were subject to robust recruitment checks including a check with the Disclosure and Barring Service to check their suitability to work in the home.

People knew the procedure for making complaints that was displayed in the foyer of the home. The organisation had a suitable system for the management of complaints.

When we arrived at the home we saw that lounges had been prepared for the day. There were jugs of fruit squash available for people and all of the calendars we saw had been changed to the correct date. The display board in the dining room recorded that this was Breadstone and showed the correct date.

One person living in the home told us there was “good food and companionship”. Another said there was “brilliant staff and good food”. One person we spoke with said “I am very pleased with the level of care here, I can’t fault the staff”.

We spoke with some visiting relatives and friends. One relative we spoke with told us they had regular contact with the home. They said they found the staff to be friendly and helpful and appreciated the regular contact they had with the staff. They described the staff as friendly and helpful.

People we spoke with told us the food was good.The home had recently changed the meals service and now provided ready prepared meals. Staff interacted with people and people engaged with each other. We observed that one person was assisted to eat their meal by a staff member who engaged with them. We felt the mealtime was a pleasant experience for everyone.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The arrangements for supporting staff and quality monitoring of the home were good.