Cary Brook is a purpose built home which provides accommodation and personal care for up to 45 people. The home specialises in the care of older people who are living with dementia.

At the last inspection in March 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse.

Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People received 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 support this practice. People’s health care needs were monitored and met. Staff had been trained to care for people who were living with dementia.

The home continued to provide a caring service to people. One person told us “Staff are good, really good actually. Very kind.” Another person said, “They are kind and look after you.” One person who was at the home for respite care told us, “I like coming here because everyone is friendly. You can have a bit of fun. I like to pull their legs.” Staff treated people with respect and worked hard to make sure people’s wishes during their final days and following death were respected.

The home provided a responsive service. People received care and support which was tailored to their needs and preferences. For example one care plan said the person liked to cuddle a large soft dog toy. When we met this person they had the soft toy with them. It also said they liked milkshake and we saw this was regularly offered to them. Staff were kept up to date with each person’s health and well-being. They attended a handover meeting at the start of every shift. One member of staff said “Handover tells you everything you need to know. Like if someone is not themselves and you need to keep an extra eye on them.”

The service continued to be well led. The registered manager had managed the home for several years. Staff morale was good and staff felt well supported. One member of staff said “There is good teamwork which creates a good atmosphere. The more relaxed we are the more relaxed people are.” The views of people who lived at the home were valued and responded to. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

A single 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 relatives of people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

We saw that there were procedures in place in the event of a fire and emergency hospitalization.

The provider had taken steps to ensure that the premises were appropriately risk assessed and maintained. This meant that people were protected from the risks of an unsuitable environment.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. People at the home were at risk of being unlawfully deprived of their liberty. There were no records of mental capacity assessments taking place before decisions were made about people's care by others on their behalf.

Is the service effective?

People living at the home had care assessments and plans to identify their needs. One relative said that there was, “Good care.” They described how staff had supported a person living at the home to visit the GP, dentist, and to attend a hearing appointment. Another relative said, “Medication is given ok.”

People were supported to eat enough food and drink to meet their needs. One relative said, “There is enough food and drink and an ok choice.” Another relative said, “There is a drinks trolley between meals, breakfast, snack, lunch, and dinner.”

Is the service caring?

We observed that interactions between staff and people living at the home were supportive and friendly. One relative said, “All staff are friendly and considerate.” Another relative said of staff, “They are so nice and speak gently.”

Is the service responsive?

We saw that systems were in place to enable managers to learn from complaints, concerns, accidents, incidents, and audits and improve care due to this information. One relative said, “I’ve not made a complaint. I would phone and speak to the manager. The policy was in the pack we were given.” Another relative said, "I would find it difficult to fault. They listen to anything asked and resolve it."

Is the service well led?

There was a system to assess and monitor the quality of service that people receive. The views of people living at the home and their relatives were sought and action plans were developed to improve the service if appropriate. This meant that the provider had taken some steps to reduce the risk of inappropriate care and treatment through monitoring the quality of the service.

We spoke with three people who use the service, one relative, two members of staff and the manager. We observed activity throughout the building and we also reviewed the care plans of three people.

We saw that staff maintained people's dignity and treated them respectfully. We saw that people were offered choice throughout the day, from where to sit, what to eat and what to do.

We saw that people's care was planned and reviewed regularly and that it was based on the individual's needs. One person told us "I have my own room, self-contained" and "the staff are very nice, polite and treat you like a person".

We saw evidence that there were procedures in place and staff training was provided in order to protect people from the risk of abuse.

We saw that staff were well trained and supported to perform their role. One staff member told us "I feel like I'm an important part of someone's life here" and another told us "I like making sure that people are well cared for and safe".

We saw evidence that the provider continually monitored the quality of the service provided at Cary Brook and that they invited input from staff, people and relatives.

People living in the home and those supporting them told us that they were happy with the support people received and evidence indicated that where possible, they were consulted and involved in how they wished to lead their lives.

We found that peoples health and welfare needs were being met and that support given was individualised and person centred.

Evidence informed us that systems were in place to protect people from possible abuse and that staff had an awareness of safeguarding issues.

We found that staff were available in enough numbers and had experience to meet the needs of the people living in the home.

We found the quality of the service was being regularly monitored and evidence indicated that concerns were promptly acted upon.

People who lived at the home told us that they were able to make choices about all aspects of their daily lives. During our visit we observed that people moved freely around the home and they were able to access their bedrooms when ever they wished.

When we arrived at the home one person using the service was involved in interviewing a prospective member of staff. We were informed that people were always provided with the opportunity of being involved in the selection of staff.

People told us that they had been consulted about their preferences for food, drink, activities and daily routines. Comments included “the staff here know about my favourite things and they know the things I don’t like” and “the staff know exactly how I want to be cared for and they remember all the little things that are so important to me”.

People who lived at the home were very positive about the care they received. Comments included “I am very well looked after and the girls are excellent”, “there is always somebody there to help you when you want them” and “this is my home and I am very happy with everything”.

People appeared very comfortable in the presence of staff and it was evident that staff knew people well. Staff interactions were noted to be kind and respectful. The atmosphere in the home was relaxed and inclusive and people were offered assistance with personal care in a dignified and discreet manner. We saw that staff knocked on people’s bedroom doors before entering. People said “the staff are so kind and they never make you feel embarrassed when they help you with intimate care” and “I am always treated with respect and the staff are so kind”.

People were positive about the meals offered at the home. Comments included “the food is first class, I can’t fault it” and “the meals are very good indeed and there is so much to eat and drink”. We observed lunch being served and found the atmosphere to be relaxed and unhurried. People had access to a choice of drinks and condiments and staff enabled people to make an informed choice of meal by showing them plated options. Vegetables had been provided in serving dishes on each table to enable people to help themselves Specialised cutlery and crockery had been made available to those with an assessed need. People who required staff assistance to eat their meal were assisted in a pleasant and dignified manner. We saw that, in addition to regular drinks offered by staff, a selection of cold drinks and fruit were available in all communal areas for people to help themselves.

People told us that they were provided with opportunities for social stimulation. Comments included “we often have trips out and sing-a-longs” and “something is happening every day”. A varied programme of activities had been displayed in the home.

No concerns were raised with us during our visit and people told us that they would feel comfortable raising concerns if they had any. Comments included “I could talk to any one of the staff here if I had any concerns” and “I don’t have any complaints at all and I can’t think of anything they could do better”.

Cary Brook is a care home which is registered to provide care for up to 45 people. The home specialises in the care of older people who are living with dementia. The home does not provide nursing care. There is a registered manager who is responsible for the home. 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 and associated Regulations about how the service is run.

This inspection took place on 18 and 19 March 2015 and was unannounced.

At our last inspection carried out on 8 August 2014 we found people were not protected against the risks of unsafe or unsuitable care because assessments of people’s capacity to consent to their care and treatment had not been completed. The provider was required to tell us what they would do to address this shortfall. At this inspection we found that appropriate action had been taken which meant staff knew how to support people to make decisions and knew about the procedures to follow where an individual lacked the capacity to consent to their care and treatment. This ensured people’s legal rights were protected.

People told us they felt safe living at the home. They commented on the kindness of staff and they said they would feel comfortable in raising concerns if they had any. One person told us “I was very frightened about having to move to a care home but I have to say; it was the right decision and I feel much safer here rather than being at home by myself.” Another person said “I’ve never experienced staff being unkind. I believe they do care about all of us.”

Staff told us they were able to meet people’s care needs and maintain their safety. However we observed; and staff told us they had limited opportunities to spend quality time with people. Staff were busy assisting people with tasks such as eating, drinking and meeting personal care needs. We observed opportunities for social interactions for people who were more dependent on staff both mentally and physically, were limited. We have recommended that the provider reviews the numbers and deployment of staff.

Systems were in place to reduce risks to the health, safety and well-being of people. Risk assessments included reducing the risk of pressure sores, nutrition, moving and handling and reducing the risk of choking. Effective care plans were in place and we found these were known and followed by staff. Care plans had been regularly reviewed to ensure they reflected people’s current needs. We saw people had been involved in the development and review of their plan of care where ever possible.

People saw health care professionals when they needed to. A local GP visited the home each week and we saw referrals to other health care professionals were made where required. Examples included speech and language therapists, district nurses and dieticians. Staff made sure recommendations made by health care professionals were appropriately implemented. An example included changing the consistency of people’s food and drink.

People had enough to eat and drink and staff were available to support people who required assistance. The lunch time experience was relaxed and sociable. Comments about the food and drink were positive. One person told us “The food is lovely. You can have as much as you want and there are nice cups of tea.” Another person said “I’m not going to die of thirst. I really enjoyed my lunch. It was lovely.”

Staff had the skills and knowledge to meet the needs of the people who lived at the home. Staff were required to complete a range of training which included health and safety, dementia care and safeguarding adults from abuse. The skills and competency of staff were regularly reviewed to make sure they remained up to date.

The registered manager told us about their ethos and vision for the home. They said they wanted to ensure a comfortable homely environment for people with no unnecessary restrictions. They told us they wanted to support people to be as independent as they could be. This ethos had been communicated to and adopted by staff.

Systems were in place to monitor and improve the quality of the service provided to people. These included regular meetings for people and their representatives, annual satisfaction surveys and regular audits to monitor the health safety and well-being of people. We saw the home responded to suggestions and implemented action plans for any areas highlighted for improvement.