Cromwell House is a residential care home for 38 older people. It is set across two floors, and there is a small number of people living with dementia. Rooms had en-suite toilet facilities, and some had showers. There were communal bathrooms and lounges for people to use in addition, as well as a dining area. At the time of our inspection, 37 people were living in the home.

At our last inspection in 2015 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

The service was safe, as staff had a good knowledge of safeguarding, and there were risk assessments meeting people’s needs. The environment was maintained and kept safe for people, and there were enough staff to keep people safe. Staff were recruited safely. Medicines were administered as prescribed.

Staff had training relevant to their roles and people were confident in their ability. People received a choice of meals, and enough to eat and drink. Staff supported people to have specialist diets, and to access healthcare services when needed.

People’s needs were preassessed to ensure the service could meet these needs before they moved in. Care plans were in place to guide staff on how to meet people’s needs and these were reviewed regularly.

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 supported this practice. However, further records relating to individual’s mental capacity assessments and best interest decisions were needed.

Staff were caring towards people and respected their privacy and dignity, and encouraged independence.

There were many activities on offer throughout the week in the home and people were supported to go out. People and their visitors felt comfortable to speak with staff or raise any concerns.

There was good leadership in place, and the registered manager was known to everybody. The staff team worked well together. There were effective quality assurance systems in place to monitor and improve the service.

Further information is in the detailed findings below.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe ?

During our inspection we spoke with ten people who used the service. We asked four of them whether they felt safe living at Cromwell House. They all told us that they felt very safe. One person we spoke with told us, “I feel safe and well cared for." We looked around the service. We found that it was clean and well maintained and equipment in use was maintained regularly.

There were sufficient staff working on the day of our inspection to meet the needs of people who used the service, and when we looked at staffing rotas for the period before and after our inspection, these showed that staffing levels remained sufficient to meet the current needs.

Records were well maintained and readily available, guiding staff in their day to day duties.

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

Is the service effective?

People we spoke with told us that they were well looked after. They said that the service was meeting their needs. One person said, "I am well looked after and well fed." Another person told us, “I can't think of any problems, everything is good.” We observed staff during our inspection as they carried out their day to day duties. We noted that the staff were aware of people’s needs and their likes and dislikes, for example the chef knew who preferred tea and who coffee when serving the after lunch drinks We looked at recent training records which showed that the service had provided staff with suitable training to ensure the needs of people who used the service would be met.

Is the service caring?

People who used the service were well cared for. The service supported their needs but also helped them maintain their independence, for example one person was still able to drive and had their own car and several others attended a church friendship group. One person we spoke with told us that, “The staff are wonderful, they are here for me when (or if) I need them.”

We spoke with a visitor to the service who told us that they thought it was excellent. They said, “I never have any concerns here.”

Is the service responsive?

People who used the service met with the registered manager before moving to the service. A detailed assessment was carried out to identify their needs and whether Cromwell house were able to meet those needs. People we spoke with told us that staff completed their care plans every day and sometimes talked to them about the care plan. Care plans were kept by the person they related to and recorded their likes and dislikes, life history and significant events, health and social care needs and professional support received.

People were able to access a variety of activities including bingo, quizzes, flower arranging and craft work if they chose to do so although some of the people we spoke with told us they preferred to spend their time in their room reading or watching television.

Is the service well-led

People we spoke with told us that there were regular residents meetings and that they were able to discuss a variety of topics including changes to the menus and trips and activities. We looked at the quality survey completed by people who used the service late in 2013. The results of this were shared with people who used the service at their residents meeting and the service scored highly in most areas. We spoke with staff who told us about a staff forum that was now held by senior managers. They were able to voice any concerns or issues and told us that they felt listened to. They told us of changes that had resulted from concerns raised within the staff forum.

We looked at the care records for seven people using the service and found that each had a set of care plans and risk assessments. Each person had an assessment of their needs prior to being admitted to Cromwell house, which meant that the service could ensure they could meet the needs of the person.

We observed the lunch time meal service and found that people were provided with a choice of suitable and nutritious food and drink. People were supported to eat their meals and to maintain good nutrition.

We found that people were cared for in a safe and suitable environment. A member of maintenance staff undertook regular checks to ensure that the exterior and interior of the building remained safe. People were cared for in a well decorated and furnished environment which promoted their dignity.

We found that there was not enough suitably qualified and experienced staff to meet people's needs. People were waiting extended periods of time to have their call bells answered, and staff told us that they did not feel they could meet people's needs.

We found that staff received the appropriate training to be able to undertake their role safely. The provider may find it useful to note that staff did not always receive appropriate supervision and appraisal.

We found that there was an effective complaints system available and people were made aware of how to complain. The service had not received any complaints.

We spoke with eight people who used the service. They told us they felt safe and were treated with respect. One person said 'my family don't need to worry about me'. People said they were encouraged to take part in activities and had choice over what time they got up.

People said the staff were supportive and responded promptly to calls for assistance. One person said 'they (the staff) look after me well, I have no complaints'. One person said there were sometimes delays in receiving help to get dressed at the busiest times of day.

People told us the food was good and there was choice at mealtimes

This inspection took place on 22 and 23 September 2015 and was unannounced.

Cromwell House provides support and care for up to 38 older people who may be living with dementia. At the time of our inspection there were 38 people living there.

There was 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.

On the day of the inspection, the current registered manager was not available. We spoke with the person in charge who was currently undergoing checks to become the registered manager of the service following a period of absence. It is this person who is currently taking overall responsibility for managing the service and is referred to as the manager throughout this report.

The Care Quality Commission is required to monitor adherence to the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. People were not being deprived of their liberty unlawfully. Staff understood about people’s capacity to consent to care and had a good understanding of the MCA and DoLS which they put into practice.

People living in the home were supported by staff who were employed following robust checks to ensure they were suitable to work in care. There were enough staff to meet people’s individual needs and they were well trained. Staff understood the importance of reporting any concerns in relation to people being harmed or abused. Medicines were managed safely and administered by staff who were trained and competent to do so.

Staff were supported in their roles and encouraged to develop their skills. People were treated with kindness and respect and their dignity was maintained. Care and support plans were individualised and took account of people’s preferences. People were involved in making decisions and, where people were unable to do this, staff understood the correct procedure for making decisions on their behalf. People’s needs were reviewed regularly and, where necessary, those important to them were involved.

People were supported in a warm, happy and supportive atmosphere and they felt in control of how they spent their days. People received enough to eat and drink and staff understood the importance of supporting people to maintain health. The service sought healthcare advice in a timely manner and followed advice. Activities were based around people’s hobbies and interests and they were plentiful.

The service had an open and transparent culture and sought people’s views and comments. Complaints and concerns were addressed and people felt confident in raising issues. People felt listened to and were complimentary about the care they received.

The manager was knowledgeable and experienced. The provider and manager took responsibility for carefully monitoring the service and premises in order to maintain a safe and caring environment. Records were detailed and consistent. Checks on the quality of the service were regularly undertaken. The service had, and was further forging, good links with the local community.