This inspection took place on 25 and 30 May 2017.

Critchill Court provides care and accommodation for up to 50 people. At the time of our inspection there were 37 people using the service. There is a separate part of the home known as Cedar Oak which provides care to people living with dementia. The “main house” provides care and support to older people some of whom are living with dementia. The home does not provide nursing care and people who require nursing assistance are supported by the local district nursing team.

The registered manager had been absent from work since 02/05/2017 and prior to this had been absent due to routine annual leave and other leave. Immediately following the inspection we were informed they had resigned. Since the inspection an interim manager has been put in place. We were told the provider is advertising for a permanent manager who will, if suitable, make an application to be the registered manager for 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The recruitment arrangements whilst generally safe and meeting required standards in relation to checks did not ensure full employment history was obtained so the provider could be assured there were no gaps in employment history. Such gaps if identified may have questioned the suitability of the perspective employee to work with vulnerable adults.

The manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. However, we identified two people where such applications needed to have made and had not been.

Social activities were an area which needed to improve reflected in comments made by people. There had been a change with new appointments of activities coordinators as previous coordinators had left. This had impacted on the quality of activities provided with lack of a organisation and reduction in the availability of activities particularly one to one activities.

One person was being administered their medicines covertly i.e. disguised in food or drink. This was an appropriate decision and referred to as "best interests decision". However, there was no consultation with the pharmacist to ensure the method used to administer the medicine was safe and retained the effectiveness of the medicine.

Improvements had been made in the arrangements for the administration of "as required" medicines. This had been an area for improvement identified at our last inspection. There was a robust system for the management of medicines which ensured people received their medicines at the time it was required.

All of the people we spoke with said they felt safe living at Critchill Court. One person told us "It is lovely here staff are very kind and look after us." This was also reiterated by relatives we spoke with who also commented on how caring and welcoming staff were.

People spoke of staff being caring and kind. We observed staff supporting people in a sensitive and caring manner. They were confident in responding to people who were distressed or confused and needed re-assurance. They did so in a respectful professional way engaging with people in a positive manner.

People and relatives told us staffing arrangements were good and staff were available at a time they were needed. Staff responded promptly to requests for help and support.

People had access to community health services and their GPs when this was requested. Healthcare professionals we spoke with were positive about the care provided by the service. There were good relationships with outside professionals and people had access to specialist support and advice.

Mealtimes were calm

On entering Critchill Court we found the atmosphere to be warm and welcoming. We spoke with people who use the service and staff. We observed staffs understanding of the care and support needed. The people who use the service we spoke with said "staff treat me very well" and that they "enjoy it here, very friendly atmosphere." We noted people's rooms were decorated with their personal belongings.

We looked at people's individual records which incorporated their care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People who use the service and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There were policies and procedures in place providing guidance and all staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by management and that they had received regular training.

We looked at the management of medicines and the quality of the service and found that the provider had adequate systems in place to ensure the safety of the people regarding the administration of medicines and that people were given the opportunity to provide feedback on the service.

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.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People we spoke with told us that they liked living at the home one person said ”I wouldn’t move out of the home for no-one”. People told us that they are involved in making decisions about the care and support they received at the home. Staff we spoke with told us that they involved people in their care and support by offering them choices and discussing their care plans with them regularly.

Everyone we spoke with said that they enjoyed the food at the home and had plenty of choice. One person told us “the food is good here and the staff are good company”, another person said “the food is lovely, and there’s plenty of it!”. We saw that people’s needs around nutrition and hydration were assessed and plans put in place to meet these needs.

Throughout the day we observed staff addressing people by their name and knocking on doors before entering people’s rooms. Staff we spoke with were clear about promoting people’s dignity and treating people with respect.

This inspection took place on 05 and 09 March 2015 and was unannounced.

Critchill Court provides care and accommodation for up to 50 people. There is a separate part of the home known as Cedar Oak which provides care to people living with dementia. The “main house” provides care and support to older people some of whom are living with dementia. The home does not provide nursing care and people who require nursing assistance are supported by the local district nursing team.

There is a registered manager in post. 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.

There were generally safe arrangements for the administering and management of medicines however improvement was needed in the management of “as required” medicines. There were not consistent arrangements for the giving of “as required” medicines to ensure people received this medicine in appropriate circumstances. There was also a risk people received some medicines when they would not be effective because opening dates had not been recorded. These medicines had limited lifespan once opened.

People told us they felt safe because of the availability of staff and how they were always responsive to their requests for assistance and support. One person told us “It is really good here, so friendly and I feel safe because staff know what they need to do.”

The service provided a personalised service which recognised the specific needs of people ensuring they received the care they needed. People told us how they were able to choose how they lived their lives and how their privacy and dignity was respected.

People’s nutritional needs were met and specialist support and advice was available to address any concerns about people’s health and wellbeing. People had access to a range of community healthcare professionals.

There was a caring and supportive environment which recognised people’s rights and choices and encouraged people to lead an independent lifestyle.

People were supported to voice their views about the care they received and make suggestions for improvements. People told us they felt able to make a complaint and were confident they would be listened to and action taken. One person told us “I know how to make a complaint and they would do something if I was unhappy about something”. Staff recognised the importance of people feeling able to say what they wanted and felt about the care and service they received. The service was open to complaints and had responded honestly and made changes where these had been identified as a result of the complaint.

Staff had an understanding of potential risks to people’s wellbeing and how to support people in alleviating such risks and responding to behaviour which could cause distress to the person or others. Risk assessments reinforced how staff could respond to identified risks as a result of people’s dementia such as aggressive behaviour or people being reluctant to accept personal care.

People told us they found the registered manager approachable and “someone we can talk to” and “always around in the home”.

After a period of change a registered manager was now in place and staff commented on the improvement in morale and how “the home has turned a corner”. Staff were optimistic about the future of the home and how it was improving.

There were systems in place to monitor the quality of care and make improvement where they were needed.