This inspection took place on 6, 13 and 14 June 2018. The first day of the inspection was unannounced.

Dairy Lane Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Dairy Lane Care Centre accommodates 22 people with personal care needs in one adapted building. Some of the people were living with dementia. At the time of our inspection, there were 21 people using the service.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

We last inspected the service in May 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

People told us they felt safe Dairy Lane Care Centre. There were sufficient numbers of staff on duty to keep people safe.

There was an effective recruitment and selection procedure in place and relevant vetting checks were carried out. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. Safeguarding procedures had been correctly followed and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service. Health and safety checks had been carried out however there was no evidence that the seated scales had been calibrated, which meant people’s weight may not be accurately measured. The registered manager agreed to action this as soon as possible.

Appropriate arrangements were in place for the safe administration and storage of medicines.

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 were supported with their dietary needs and care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Dairy Lane Care Centre. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation.

The provider had a complaints policy and procedure in place, and people who used the service and family members were aware of how to make a complaint.

Staff said they felt supported by the management team. People who used the service and staff were regularly consulted about the quality of the service via meetings and surveys.

The registered manager conducted regular audits of the service.

We have made a recommendation that the registered manager formally records their daily walkarounds of the home.

The inspection took place on 17 March 2016 and was unannounced. A second day of inspection took place on 23 March 2016 and was announced.

We previously inspected the service on 27 April 2014 and found the service met the regulations we inspected against at that time.

Dairy Lane Care Centre provides residential care and support for up to 22 people, most of whom are living with dementia. At the time of our inspection there were 17 people using the service.

The home 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.

Staff had a good understanding of safeguarding and were confident in their role of safeguarding people. Any safeguarding concerns were investigated with the outcomes fed back and practices changed if necessary in order to prevent reoccurrences.

Records were kept for all accidents and incidents including details of investigations, outcomes and action taken.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews.

Medicines were managed effectively with safe storage and appropriate administration. All records were complete and up to date with regular medicine audits being carried out.

The home had an emergency kit bag which contained records such as personal emergency evacuation plans (PEEPs), latest medicine administration records (MAR) and the service’s business continuity plan. It also included emergency equipment such as a light, a first aid kit and space blankets.

Staff were recruited in a safe and consistent manner with all necessary checks carried out. Staffing requirements were assessed in line with peoples’ needs. From staffing rotas we saw staffing levels were consistent and staffing cover was provided by staff within the home, without needing to use agency staff.

Staff had up to date training and competency assessments were carried out in relation to specific areas, including the management of medicines. Regular observations were carried out as part of supervisions.

Staff told us they felt supported in their roles and they received regular supervisions, as well as annual appraisals. Records we viewed reflected this.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place where appropriate.

We observed during mealtimes that people enjoyed their meals, some independently and others with support from staff. There were choices available for people and support was provided by staff with patience and at an appropriate pace to each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

There was a wide range of activities available both within the home and in the community for people to become involved in and enjoy. The home had an activity co-ordinator who worked with people and family members to design activities programmes tailored to people using the service both as a group and individually.

The home décor was dementia friendly as communal toilet doors had a border painted red and light switches were green. Brightly coloured place mats were used in the dining room as well as bright red and yellow cups.

A range of regular audits were carried out that related to the service the home provided, as well as the premises and environment.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the premises identified on our previous visit on 8 April 2014. We found the premises were being appropriately maintained, free from unpleasant odours, and suitable for the people who used the service.

Below is a summary of what we found. We considered all the evidence we had gathered under the outcomes we inspected and we used the information to answer the five questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Systems were in place to ensure the manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. This means that people would be safeguarded as required. The manager took people’s care needs into account when making decisions about the staff rotas and considered the numbers, qualifications, skills and experience required. There were enough staff on duty to meet the needs of the people living at the home and this helped to ensure that people’s needs were being met.

People had been cared for in an environment that was clean and hygienic however a compliance action has been set in relation to a lack of access to hot water and unpleasant odours in two of the bedrooms we looked at. This meant that some people who used the service were not protected against the risks of unsuitable premises and the provider must tell us how they plan to improve.

Is the service effective?

There was an advocacy service available if people needed it, and this meant that when people required additional support they could access it. People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. People told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations that care staff had a good understanding of people’s care and support needs and that they knew them well. One person told us. "They give me the help I need and they are wonderful”.

Is the service caring?

People were supported by caring and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People using the service, their relatives, and friends completed an annual satisfaction survey. Comments made included “Suits my mother’s needs”, “Very homely” and “Staff are friendly”. People’s preferences, interests, aspirations and needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests and different needs had been recorded and care and support had been provided in accordance with people’s wishes. People completed a range of in house activities at the service. People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with and found that responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action taken as necessary.

Is the service well-led?

The service worked with other agencies and services to make sure people received the care they were entitled to. Staff told us they were clear about their roles and responsibilities.

They said the home manager had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.