This inspection took place on 1 November 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting. At the last inspection in April 2015 we saw that some decisions had not been made in accordance with the Mental Capacity Act 2005. This was a breach of Regulation 11: Need for Consent. The registered provider sent us a report of the actions they would take to meet the legal requirements of these regulations. We checked whether this regulation had been met as part of this inspection. We saw that sufficient action had been taken to meet the requirements of the regulation.

Darwin house is a residential care home providing personal care for up to 28 older people. The facilities are over three floors and accessed by a lift. At the time of our inspection, 20 people were living at Darwin House. Two of those people were receiving respite care at the service.

There was a registered manager employed at 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.

People we spoke with told us they felt ‘safe’ and did not express any worries or concerns.

Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

Staff confirmed they had been provided with safeguarding vulnerable adults training so they had an understanding of their responsibilities to protect people from harm.

We found there were satisfactory arrangements in place for people who had monies managed by the service.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations.

We did not receive any concerns from relatives or people regarding the staffing levels at the service. There were sufficient staff to meet people’s needs.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines.

We did not find any concerns about the cleanliness of the service. This was supported by people and relatives we spoke with.

Regular checks of the building were carried out to keep people safe and the service well maintained.

We found people’s care plans and risk assessments were reviewed regularly and in response to any change in needs. During the inspection we found a few shortfalls in some people’s records. We discussed this with the registered manager who assured us action would be taken to ensure an accurate record of each person’s care would be maintained.

All the people we spoke with told us they were very satisfied with the quality of care they had received. Comments included, “I am surrounded by the most caring staff you could wish for” and “I cannot express my gratitude for the love and care I receive.”

The care records showed people were provided with support from a range of health professionals to maintain their health.

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.

All the relatives we spoke with made very positive comments about the care their family member had received and about the staff working at the service. Comments included, “[Family member] is well looked after and enjoys the company of the other residents” and “The best thing about Darwin House, it's a home from home.”

People made positive comments about the quality of food provided and told us their preferences and dietary needs were accommodated.

We saw staff had been provided with relevant training, supervision and appraisal so they had the sk

The inspection took place on 28 April 2015 and was unannounced which meant we did not inform anyone beforehand that we would be inspecting. We last inspected this service in October 2013 and found that the service was meeting the requirements of the regulations we inspected at that time.

Darwin house is a residential care home providing personal care for up to 25 older people. The facilities are over three floors and accessed by a lift. 15 of the rooms are designed for single occupancy, with five larger bedrooms being able to accommodate couples. A variety of communal lounge space, as well as a communal library room and dining room are provided. At the time of our inspection, 20 people were living at Darwin House.

There was a registered manager employed at 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.

People who used the service, their relatives, and professionals involved with the service all gave positive feedback about Darwin House. We witnessed positive and caring interactions between staff and people. People were treated with respect and dignity. Staff demonstrated familiarity with people’s preferences and wishes. Activities were available to provide and encourage stimulation for people.

Systems and processes were in place for checking medicines to ensure that they were administered safely. Checks of medicines took place at each handover as well as monthly by the registered manager. Staff undertook annual training and regular observations to assess their competency to administer medicines.

We saw that some decisions had not been made in accordance with the Mental Capacity Act 2005. In particular where people were administered medicines covertly, the principles of the Act had not been followed. Consideration needed to be given as to whether any people at the service required a deprivation of liberty safeguard authorisation to be in place where they may lack capacity to consent to their accommodation.

Individual risk assessments were in place in order to minimise and manage risks to people. Staff received training in safeguarding and knew how to identify and report abuse and unsafe practice. Incidents were assessed and monitored by the registered manager to try to prevent and reduce potential reoccurrence.

Recruitment processes ensured new staff were assessed as suitable to work at the service. New staff members completed an induction on commencement of employment at the service. Staff received regular supervisions and appraisals and told us they felt supported by the management team in their roles. Training was monitored to ensure staff had relevant skills and knowledge to support people they cared for.

Peoples’ nutritional needs were accommodated and people were supported to access healthcare professionals and maintain good health. Comments from people, relatives and observations showed that staff were kind, caring and patient in their interactions with people. Staff offered choice and explanations to people whilst providing support. Care records contained information about people’s backgrounds so that staff had knowledge about people with which to form positive relationships. People were treated with dignity and respect and encouraged to maintain their independence when they were able to.

People’s care plans were reviewed regularly and we saw evidence of involvement of people and relatives within these. Staff demonstrated knowledge of people’s personalised care requirements. People told us about, and we saw, activities which took place during our inspection including trips out of the home.

Feedback was sought by the registered manager by way of relatives and residents meetings. There was a complaints procedure in place and we saw that complaints were investigated and responded to appropriately. People spoke positively about the registered manager and the staff team. Quality assurance systems were in place which identified areas for improvement. Incidents were routinely monitored and analysed for trends and themes to prevent potential re-occurrence.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We visited the service on 14 October 2013 as part of our scheduled inspection programme. We spoke with five people who used the service, one relative of a person who used the service, five staff and the registered manager.

We found that people were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

People who used the service told us they were happy living at the home. Their comments included, “I think it's very nice. Everyone is caring and helpful,” “I feel very much at home here and I couldn't ask for anything better" and “This place is outstanding."

We found that care and support was offered appropriately to people and that staff were skilled, in recognising the diversity, values and human rights of people who used the service.

During our inspection we conducted a tour of the premises and found it was clean, tidy and free of any unpleasant odours. There were systems in place to reduce the risk and spread of infection.

The provider had an effective recruitment and selection procedure in place and staff were appropriately qualified to do their job.

People who used the service told us their comments and complaints were listened to and acted upon.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said, "we get a lot of care and attention," "It's a wonderful home," and "I am very settled here."

Throughout our inspection we noted that staff spoke with people in a kind and respectful way and had a clear knowledge of people's individual likes and preferences. People told us, "the staff know just how I like things," and "this is a small friendly home and the staff know us very well."

People told us that they felt safe living in the home and if they had concerns they would speak with a family member or a member of the staff team.

Staff spoken with were positive about the fact that they were given opportunities for further training and personal development.

The provider and registered manager had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.

Sheffield Local Authority, Contracting and Commissioning team had visited the home and carried out a 'Care Home Quality Framework' audit. We saw a copy of their report. There were a number of actions to complete by January 2013. The manager confirmed to us that all the actions in the audit would be fully completed by this date.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included:

“I am very happy here”.

“It’s a nice home”.

“I would change nothing, I’m very happy”.

“There’s never any trouble here and a high standard is always maintained”.

One person explained that her daughter had chosen the home for her and that her daughter was happy with her mothers care.

In the entrance hall there was a comments book, where people visiting could record their view of the home. Relatives, friends and professionals had written comments, all were positive. Comments included:

“I am very impressed by everything I have seen and heard here. Excellent”.

“What a beautiful place, so well kept, friendly staff and a lovely environment”.

“I came to see a resident during the night and found the staff, very helpful. The ambience is fantastic, and people appear very happy”.

“Absolutely lovely place, grandma’s really happy and satisfied. Thank you”.

“Couldn’t be in a better place. Everyone is kind and loving and the food is excellent”.