We carried out this inspection on 9 August 2016. The inspection was unannounced. This meant no-one at the service knew that we were planning to visit.

Cairn Home was last inspected by CQC on 13 May 2014 and was compliant with the regulations in force at that time.

Cairn Home is a purpose built residential home that is registered to provide accommodation for up to 30 older people, some of whom may have visual impairments. It is located in the Crosspool area of Sheffield and is close to local amenities and bus routes. On the day of our inspection there were 29 people using the service.

There was a manager at the service who was registered with CQC. 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. The registered manager and the senior assistant manager had both worked for the service for over 20 years.

People living at Cairn Home and their relatives told us they thought the service was very good. Comments from people included, “I feel safe and secure” and “I would never be anywhere else.”

Recent questionnaires completed by friends and relatives held only positive comments about Cairn Home.

All staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

The service had a safe and effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

There were sufficient numbers of staff employed in order to meet the needs of the people who used the service. We saw staff had some time to spend chatting with people during the day.

Staff were suitably trained to carry out their job roles effectively. All staff had training in understanding and supporting people with visual impairments.

Staff told us and records showed that they received regular supervisions and appraisals. Staff told us they found these meetings useful and they felt supported by management.

People living at Cairn Home told us they enjoyed the variety of food and drinks available to them. We saw there were different options available at every mealtime, and drinks and snacks were served throughout the day.

We saw the home was clean and freshly decorated. People told us the cleaners were good and came every day. People were also very complimentary about the laundry service.

There was a range of activities on offer to people living at Cairn Home. The service had its own mini bus so staff were able to take people out on trips to local amenities and further afield.

People who lived at Cairn Home, and their relatives, were aware of how to make a complaint. However there had been no formal complaints recorded at the service.

Processes were in place to monitor the quality and safety of the service. The registered manager had taken action where appropriate to resolve any issues raised effectively and in a timely manner.

An unannounced inspection was carried out of Cairn Home on Tuesday 13 May 2014. An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at during the inspection.

Is the service safe?

People’s needs were assessed and treatment was planned with the help of individuals and their representatives. The care files we checked confirmed that initial assessments had been carried out by experienced staff before people were accepted into the service. This was to ensure the service could meet identified needs, thereby promoting the safety of people.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The main aim was to promote independence and minimise the risk caused by poor eyesight. When we looked round the premises we noted colours red and yellow had been used. The manager told us there was a special emphasis on the environment to ensure people were able to move around the home freely and safely. They said the carpets were colour coded throughout the corridors and the handrails and all fittings were also colour coded to make them more visible.

The manager knew the procedure to follow if they found staff were no longer fit to work in the health or social care sector; thereby making sure people were protected and their safety was maintained.

There was a gap in the information held by the provider in respect of the staff employed by them. This related to staff declarations of any physical or mental condition which would be relevant to their ability to work in the environment safely. We have asked the provider to take action and comply with the relevant regulation. However we noted that staff were in receipt of regular supervision therefore such issues would be identified and dealt with by the manager.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People’s experiences were taken into account and their privacy and dignity was respected in the way people were cared for. People who were in receipt of this service had difficulty with their eyesight. Some people were blind and others were partially sighted. This meant people needed clear instructions from staff and others. They also needed to familiarise themselves with the environment to maintain their independence. They were assisted with this by staff at the home.

The manager and the deputy told us that at the initial assessment they involved professionals including people’s own GPs and family members to establish the best way to help the people familiarise themselves with the new environment. People told us that they had visited the home several times before they moved in. One person said, “When I visited the first time I knew I could live here. Staff were very friendly and I felt comfortable.” This meant people were consulted from the initial stages of their admission to the home and therefore they felt involved.

During our observations we noted that people’s views and expectations were taken into account by staff who were supporting them. People told us staff respected their privacy and dignity. They said that they understood the care and treatment choices available to them.

The manager told us that all the people who lived at the home had capacity to make decisions. They said staff had received training on the mental capacity act and deprivation of liberty safeguards as part of their induction. This was to ensure staff had a basic understanding of the subject and relevant legislation.

People told us that they were happy with the care they received and their needs had been met. It was clear from our observations that staff had a good understanding of people’s care and support needs and they knew how to meet them and avoid unnecessary risks.

Is the service caring?

We were informed by people and care staff that people were able to be involved in making decisions about their care and treatment each day. They said they were able to change their mind and not be worried. People said that care workers appreciated and respected their wishes. These were some comments from the people we spoke with: “The staff give me options, whether I want to have a shower or a wash. I can choose and have it when I want. Within reason mind you”, “Sometimes staff ask me if I want to go out to the shops. I have no problem telling them if I didn’t feel like it.” “There are some lovely people who work here; they have a lot of patience. They don’t seem to mind repeating things to me. I keep forgetting. It’s good to know staff don’t mind.”

People were supported by staff who were attentive and friendly. We saw care workers showed patience and gave encouragement when supporting people. We observed people were able to take their time, doing things at their own pace and were not rushed.

People’s care and treatment was planned and delivered in a way that protected them from unlawful discrimination. This is because staff had received training and received supervision to make sure they followed the correct procedures when caring for people.

Is the service responsive?

Appropriate professionals were involved at the correct time to make sure people were in receipt of care and treatment promptly.

Records confirmed people’s preferences, interests, aspirations and diverse needs had been taken into account when care and support was planned and delivered. People were supported in promoting their independence and community involvement. On the day of our inspection a number of people were out on a trip to a garden centre and then out to lunch. We saw people being involved in activities during the afternoon in the dining room. We heard a lot of laughter. One person said, “I ask staff to take me to the garden to get some fresh air and sit for a little while. They are very obliging.”

Is the service well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on. We were informed by the manager that they carried out annual satisfaction surveys. Feedback was analysed and the manager, with the help of the provider, took appropriate action. They told us that the results of the surveys were very positive from the people who used the service and from staff. They said they did not have any negative comments from the surveys.

Staff had a good understanding of the ethos of the home. Senior staff were involved in the quality assurance processes which were in place. Staff told us they were clear about their roles and responsibilities. They said they worked as a team and helped each other.

We found there were effective processes in place to ensure people’s capacity to make decisions had been adequately assessed and managed.

During our inspection we found the home had a warm, welcoming and ‘homely’ environment. We found people looked clean, tidy and we saw their basic care needs had been met. We talked with seven people who used the service. People said, “very happy in here …couldn’t think of anywhere better”, “staff are very caring”, “nothing any trouble, they sort everything straight away” and “(the home is) heaven!” One relative said “happy atmosphere, happy staff and management.”

We found the home had systems and processes in place to ensure the safe administration of medications.

We found people had their health and welfare needs met by safe and competent staff.

We found there were effective systems to regularly assess and monitor the quality of service that patients receive.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, joined by a practising professional.

People we spoke with told us that they liked living at the home and staff were very kind. They said staff always knocked on doors and hesitated before they went in, they respected their wishes in everything and always asked what they wanted to wear when they were being helped to get dressed. They said staff responded quickly to call bells and they don’t feel rushed when being helped with their care needs. People told us they could use their rooms when they wished.

People we spoke with told us that managers asked if they were happy with the care they received and made changes if not. They said they bring a “sheet” and go through it with you. They said this happened regularly. People also told us about the resident meetings that were held. They told us you were able to air your views and trivial complaints.

People told us the food served at the home was of good quality and there was always plenty of choice. They said there was a fortnightly menu and that there was always two choices at meal times and if you didn’t like them you just asked for something else. They told us the choices were made the day before. They said food would be available between meals if you wanted, but there wasn’t any need. They said if they happened to be out at meal times, their meal was saved for them. People told us the meals were warm enough when they were served.

People told us they felt safe living at the home and if they were worried about anything they would tell someone.

People felt staff had the right skills to provide the care they needed.