We carried out this inspection on 13 December 2017 unannounced and returned announced on 18 December 2017.

Church Farm Nursing Home at Skylarks is registered to provide accommodation and care for up to 50 people living with dementia. The home is located over two floors and arranged in four separate houses, Swallow, Robin, Nightingale and Dove . Each house provides a service to meet people's changing needs and has its own lounge and dining area. Accommodation is also available on the first floor and is accessed via a passenger lift.

The service 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.

At our last inspection on 26 July 2015 we rated the service as overall good with requires improvement in well-led. At this inspection the services remains good.

People continued to receive safe care. People were protected from the risk of avoidable harm. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Risk assessments were in place and were reviewed regularly. People received their medicines in line with their prescriptions.

Staff were appropriately recruited. People received care from staff that had received training and support to carry out their roles. There were enough staff available to meet people's needs safely. The care that people received was effective.

People were supported in line with the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Staff and the registered manager had an understanding of the MCA. Staff told us that they sought people's consent before delivering their support.

People had enough to eat and drink to maintain their health and well-being and received support when they needed it. People had access to relevant health and social care professionals when they needed them. People were supported by staff who were caring and treated them with respect, kindness and dignity.

People had care plans in place that were focused on them as individuals. This ensured staff provided consistent support in line with people's personal preferences.

Relatives felt they could raise any concerns. There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

The service had a positive ethos and an open culture which encouraged communication and learning. The registered manager was a visible role model in the home. Relatives and staff told us that they felt confident that they could approach the manager about anything and that they would listen. There were quality assurance systems in place to monitor and review the quality of the service that was provided.

We carried out an unannounced inspection of the service on 26 March 2015. Church Farm Nursing Home at Skylarks provides accommodation for persons who require nursing or personal care and the treatment of disease, disorder or injury for up to 50 people. On the day of our inspection 47 people were using the service and there was 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.

At the last inspection on 30 May and 2 June 2014, we asked the provider to take action to make improvements to the way they reviewed the quality of the service people received and to ensure that all notifiable incidents had been reported to the CQC. During this inspection we saw some improvements had been made but there were some notifiable incidents that had not been reported to the CQC.

This was a breach of Regulation 18 Care Quality Commission (Registration) Regulations 2009 (Part 4)

At the last inspection, we asked the provider to take action to make improvements to the way they assessed staff performance and how they recorded the training that staff had completed. During this inspection we saw this action has been completed.

The risk to people experiencing abuse at the home was reduced because the staff had received training on safeguarding of adults, could identify the different types of abuse and knew who to report concerns to. People’s freedom was respected by the staff and there were plans in place to evacuate people from the home in an emergency. There were enough staff to meet people’s needs. Concerns were raised by a relative and some external professionals about the number of staff working at weekends. Following the recruitment of new staff the registered manager assured us there were enough staff to meet people’s needs at all times. People’s medicines were stored, managed and handled safely; although protocols were not in place for all people when ‘as needed’ medicines were administered.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately.

People spoke positively about the food they received. When people were at risk of dehydration or malnutrition their food intake was monitored and people were referred to external professionals if required. People had regular access to the GP and other health care professionals.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Staff listened to people and responded to people’s discomfort or distress in a timely manner. People were supported to access an independent advocate if they wanted to. There were no restrictions on friends and relatives visiting their family members.

People’s care was planned and provided in the way they wanted it to be. People and their relatives were able to contribute to decisions about the care provided and their feedback was acted upon. People were supported to partake in the activities and hobbies that interested them. People and their relatives felt able to raise any concerns or complaints with the staff and the registered manager and they were confident that they would be dealt with appropriately.

There was a positive, friendly atmosphere at the home. Staff told us they enjoyed working at the home and people spoke positively about living there. The aims of the service and the risks people could face at the home were understood by the staff.

People, their relatives and the staff spoke highly of the registered manager and the provider.

During the inspection there were 33 people using the service. We spoke with three people who used the service and four relatives and asked them about the care they or their family member received. We carried out a tour of the building and reviewed records relevant to the running of the service. We observed staff interaction with people throughout the home. We spoke with the registered manager, two directors, the director’s personal assistant, two care assistants and a nurse.

Throughout this inspection we focused on these 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 we observed, the records we looked at and what people who used the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Each person who used the service and the relatives we spoke with told us they or their family member was safe. A person who used the service told us, “I do feel safe here, the staff help with my care as much as I need.” A relative we spoke with told us, “I come here two or three times a week. I am very happy overall; my grand dad is definitely safe.”

The people we spoke with and the care plans showed that people were involved with decisions about their care. They were encouraged to be as independent as possible and to do as much for themselves as they could. Staff ensured where support was needed they did so whilst ensuring people’s dignity and privacy were respected.

There were procedures in place to identify and prevent abuse to people occurring. Staff showed a good knowledge of the referral process and could explain the process they would follow, both internally and externally, should they suspect someone had been the victim of abuse.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. We found the provider currently had a DOLS in place for one person, who was living with dementia and was at risk from absconding from the home. An application to prevent the person from leaving the home unattended had been made to the authorising authority and this had been granted. We reviewed the paperwork and saw that on the whole it had been completed correctly.

Is the service effective?

People told us they felt their needs were being met. A relative, whose family member had recently moved to the home, told us the registered manager had handled the admission process with respect and understanding.

Staff spoken with had a good knowledge of people’s needs. We saw staff interact with people in an effective way. A relative, whose family member was of Italian origin, had recently lost their ability to speak English and could only communicate in Italian. They told us the registered manager had asked them for some Italian phrases that help them to alleviate any behaviour that challenges. The relative told us, “They are really trying to help him, you can’t fault the staff.”

We looked at four staff personnel and training records and the training matrix. The matrix showed there were substantial gaps in the training that staff had completed, although the registered manager assured us staff were appropriately trained.

We asked to see the registered manager’s staff supervision and appraisal records. Records seen showed that staff, on the whole had received only one supervision in the past nine months. Not all staff had received an appraisal and the documentation that had not always been fully completed.

Training records also indicated that few staff had achieved or were currently working towards professional qualifications, such as NVQ in Adult Social Care (now referred to as Diplomas).

Staff told us on the whole they felt they had received the training relevant to their role, although, due to the current needs of some people who used the service they would like further Dementia training. The registered manager told us they were aware of this training need and this would be arranged.

Is the service caring?

We observed staff interact with people throughout the day. Staff were calm, patient and caring in their approach. Staff took the time to sit and talk to people and when people needed reassurance staff knew how to provide this. A person who used the service told us, “I am well looked after here, the food is good and the staff help me and do what I ask.” Another person told us, “The staff are very kind, they listen to me.”

We observed activities taking place and lunch and afternoon snacks being served. Staff assisted people, where required, with eating their lunch. When they supported someone, they ensured they had their full attention and spoke to them in a way that ensured they treated them with the respect and dignity they deserved.

Is the service responsive?

People’s individual needs were assessed and responded to appropriately. We saw staff respond to a variety of different situations throughout the day. We viewed a member of staff assist people with an arts and crafts activity. They demonstrated a good knowledge of people’s individual needs and adapted their approach accordingly. We saw the member staff provide encouragement where needed, but also left people who were more able, to take part in the activity independently.

A relative of a person who used the service told us their family member had recently lost their ability to speak English (they were of Italian origin) and could now only speak Italian. They told us the registered manager had responded to this by requesting key Italian words and phrases from them that would assist them in providing safe and effective care for them. The relative told us they were relieved the home were prepared to make these provisions to ensure their family member was not isolated due to the language barrier.

People’s care and support was planned and delivered in a way that protected them from unlawful discrimination. People’s rights were respected and their beliefs and values were incorporated into their care plan.

Is the service well-led?

Staff, relatives and people who used the service on the whole spoke highly of the registered manager. A relative of a person who used the service told us, “The manager is really good, although they could feedback to us a bit more often.” Another relative told us, “I have a really good feeling about this place; the manager takes the time to talk to me, which really helps.” A staff member we spoke with told us, “The manager is approachable; I can go and speak to them if I need to.”

There was a lack of regular monitoring of the quality of service people received. The registered manager could not provide records that showed they conducted regular checks that enabled them to assess the standard of the care provided by staff or the environment that people lived in.

Recommendations made by the registered manager, following accidents or incidents were not always followed up. We saw a complaints procedure in the reception area for relatives but not for people who used the service. The registered manager was also unaware that the notes recorded for a person who was receiving one to one care contained limited information and according to the relative of this person, did not always accurately reflect what had occurred during the one to one period.