We inspected the service on 25 September 2018. The inspection was unannounced.

Curtis Weston House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Curtis Weston House is registered to accommodate 44 people in one adapted building. On the day of our inspection 34 people were using the service.

We previously inspected the service on 7 December 2015. We rated the service as `Good’ overall, but rated the key question ‘Safe’ as requiring improvement because risk assessments were not always reviewed and updated and aspects of medicines management were not consistently good. We found at this inspection that improvements to ‘Safe’ had been made and that all other key questions remained Good.

The service had a registered manager in place at the time of our inspection. 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm and they lived in a clean, hygienic service.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

The service had safe procedures to respond to outbreaks of infection which protected people, staff and visitors.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. 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.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. The provider had implemented a refurbishment plan for the premises at the time of our inspection.

People had access to information in a format which met their needs.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them and got to know them. People’s support needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

There was an open and transparent culture. People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided. People had access to a complaints procedure.

We carried out our inspection on 7 December 2015. The inspection was unannounced.

The service provides accommodation for up to 44 older people, including people living with dementia and similar health conditions. There were 37 people using the service at the time of our inspection.

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.

People felt safe at Curtis Weston House. This was because staff understood and applied the provider’s policies and procedures to guide them on their responsibilities to keep people safe and how to report any concerns on people’s safety.

Staffing levels were not always sufficient to meet people’s assessed needs.

People did not consistently receive their medicines as prescribed. Staff did not always evidence that they had followed given instructions when they administered people’s medication.

Staff were supported to meet the standards expected from them through training and regular supervision.

People were not deprived of their liberty. Staff sought people consent before they provided care and treatment. Staff understood the relevance of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards to their work. They supported people in accordance to the MCA.

People were supported to have a healthy and balanced diet. They had access to a choice of meals.

Staff supported people to have access to healthcare services when they needed them.

We observed that staff supported people in a caring manner, and promoted people’s dignity and privacy.

People felt that they mattered because staff listened to their views and acted on them.

Staff were knowledgeable about the individual needs of the people using the service. We saw evidence that they provided the support that met people’s needs including where people behaved in a way that may challenge others.

The provider had effective procedures for monitoring and assessing the quality of service that promoted people’s safety and continuous improvement of the service.

As part of this inspection we spoke with eight people who used the service, two relatives, seven members of the staff team and the registered manager. We were also able to speak with the provider’s compliance and care standards officer who was visiting the service at the time of our inspection. We looked at records including people's personal records, medication records and records kept in relation to the management of the service.

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. This is a summary of what we found:

Is the service safe?

All eight people spoken with told us that they felt safe living at Curtis Weston and that they were treated well. One person explained: “I feel very safe here, there is always someone available day or night, you ring your bell and they are there.” Another person told us: “It is a marvellous place; the staff are wonderful they can’t do enough for you.”

Care workers spoken with knew what to do if they suspected that someone was being abused. One care worker explained: “I would report anything to the manager straight the way.”

We talked to care workers to determine whether there were enough staff on duty to meet the needs of those in their care. We were told that at times care workers felt rushed, and this wasn’t helped by the amount of paperwork they were required to complete. One care worker told us: “I feel frustrated because I feel that I’m not giving care to the residents because of all the paperwork we have to fill out.”

People who used the service told us that there were enough staff on duty to meet their needs. One person told us: “The staff always come when you ring your bell, they treat me very well.”

We noted during our visit that the people who used the service were left for large periods of time, particularly in the lounges, without seeing a member of the care team.

The manager completed a pre-assessment of people’s needs before people moved in to the service. This ensured that they were aware of each person’s care and support needs and they were confident that those needs could be met by the staff working at the service.

On checking the medication records we found that on a number of occasions, the senior in charge had failed to sign to say that they had dispensed people’s medicine. There were also occasions where the senior in charge had signed to say that they had given someone their medication, when it was in fact still in the blister pack. This meant that the people who used the service were not always getting their medication as prescribed by their doctor.

Personal protective equipment was available for care workers to use including disposable aprons and gloves. This ensured that care and support was provided safely and in line with the services infection control policy.

Is the service effective?

We spoke with eight people who used the service to find out if they were satisfied with the care and support they received. They told us they were, though one person told us that just sometimes the care staff could be a little sharp. One person explained: “I don’t know what I would do without them; I have no worries what so ever, all of us have an immediate carer, who makes sure we have a shower.” Another person told us: “The staff look after me very well.”

Relatives told us that they were happy with the care and support their relative received. One relative explained: “My wife came here in January and I couldn’t have asked for better.” Another relative told us: “Sometimes I have to mention about a shower, but she always looks cared for and the staff are all very nice.”

Care plans provided care workers with information about people’s care and support needs though these had not always been followed. This meant that people had not received the care and support they needed.

The provider had systems in place that demonstrated they co-operated with other health and social care professionals. This meant people received a person centred and coordinated approach to their health, safety and welfare needs.

Is the service caring?

We observed care workers going about their work. They treated the people they were supporting in a kind and gentle way and people looked relaxed and comfortable in the presence of staff.

The people who used the service told us that, on the whole they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us: The staff mostly treat me with respect, but the odd one can sometimes be a little sharp.” Another person explained: “The staff have a real way with us and they’ve always got a smile on their face.”

Is the service responsive?

The needs of the people who used the service had been assessed before they moved into the service. They and their relatives/advocates, had been involved in this process.

Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, the district nurse and the local speech and language team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information needed, should they wish to make a complaint about the service they received. One relative explained: “We were made aware of the complaints procedure and they were always available to talk to if you needed to.”

Is the service well-led?

Staff meetings had been held. This provided the staff team with the opportunity to have a say on how the service was run. A meeting for the relatives and advocates of those who used the service had also been held. This gave relatives and advocates an opportunity to have a say about the service that was provided. The people who used the service were also given the opportunity to discuss any concerns on a day to day basis. One relative explained: “I was allowed to attend meetings and comment, and any issues raised were always followed up.”

Staff felt supported by the manager and told us that they felt able to talk to someone should they have a concern of any kind. One care worker explained: “I do feel supported by the manager, I love my job and I love being in care.” Another care worker told us: “If there are enough staff on, it is a lovely place to work.” Another care worker explained: “I feel supported, there is always someone to talk to should you need to.”

We spoke with four people who used the service and two relatives. All the people we spoke with gave positive feedback about the home. One person told us "I am perfectly satisfied with how I’m treated. Everyone is kind and considerate”.

We also looked at four care plans. All had a care and support plan in place and contained risk assessments related to people's individual needs and information about how people wished to be cared for and supported.

We spoke with five staff and looked at three staff files. All the staff we spoke with had received training. They demonstrated a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report this to.

We saw evidence of appropriate checks being made on staff prior to employment and that staff received training and regular supervision.

We saw evidence of a range of measures designed to ensure the service maintained quality. People were regularly asked for their opinions and ideas for improvement through weekly 'listening forms'. People and their representatives were also invited to attend regular residents' meetings.