.We inspected Doulton Court Care Home on 30 August 2016. This was an unannounced inspection. The service provides care and support for up to 41 people. When we undertook our inspection there were 39 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks, with some having loss of memory.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there were six people subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

A single inspector carried out this inspection. At the last inspection in January 2014, the provider was asked to take action to improve systems for the ordering and administration of medicines. At this inspection we found these issues had been addressed.

We talked with six people using the service and three relatives. We looked at five people’s care records and observed care being provided. We talked with four care staff, the cook, a housekeeper and the manager. We examined three recruitment files, the staff training database and the documentation relating to quality audits. This helped us to answer the questions below

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Is the service safe?

Processes were in place for the prevention and control of infection. The environment was clean and hygienic and the staff were conversant in the procedures required for their job roles.

There were appropriate systems in place for obtaining, storage, and safe administration of medicines. The provider had taken action to ensure the availability of required medicines and staff competency in medicines management had been re-assessed following the last inspection.

Individual risk assessments had been carried out for the people using the service and care was planned in response to these. This meant care and support was planned in a way that was intended to ensure people’s safety and welfare.

Appropriate processes were in place for the recruitment of staff and pre-employment checks were carried out to ensure staff were trustworthy and suitable to work with vulnerable people.

Is the service effective?

People’s health needs were assessed and care planned according to their individual needs. Specialist dietary, mobility and pressure ulcer prevention needs had been identified and equipment was in place to support people’s needs.

The service worked with other professionals to ensure care was effective and specialist support was sought when necessary.

Is the service caring?

People using the service described the staff as being like family. One person said, “They look out for us. We feel safe here.”

Visitors told us they were always greeted warmly and the staff were always cheerful. One commented, “They (the staff) do a lot of things for them (the people using the service) that they don’t have to do, because they care.” Relatives told us they were always contacted promptly if their relative was unwell and staff kept them informed of any changes.

Is the service responsive?

We saw there was a system in place for the management of complaints and action was taken to address the issues identified where possible.

The service held residents and relatives meetings and people who used the service spoke positively about the way the manager and other staff listened to them and acted promptly to address concerns.

Is the service well led?

A programme of quality audits were in place to monitor and assess the quality of the service provided and take action to improve.

Staff told us they enjoyed working at the home as everyone worked well as a team and any issues they had were dealt with professionally and sensitively by the manager and deputy manager.

We saw a wide range of clinical and managerial policies to support the delivery of an effective service.

We spoke with five of people living at the service and four visiting relatives. One person told us, “My (relative named) cannot communicate, so I rely on the staff to keep me up to date with all that goes on. I feel as though I know everything I need to know about (person named) which puts my mind at rest.” Another person told us, “Mum was a fussy eater at home, she has never complained here about the food, that says to me it’s very good and pleases her.” Another visiting relative stated, The food is out of this world, I visit regularly and see that it’s well presented on the plate, so it looks appetising.”

Care plans were detailed, and staff were aware of people’s needs and preferences. People received a varied diet and supplementary nutrition and fluids when required.

We observed staff talking with and assisting people throughout our visit, some of which were made indirectly and from a distance. Staff were seen to have undertaken tasks with peoples’ privacy and dignity in mind.

We looked at the medicines administration for people. We found that the home had run out of stock of a prescribed medicine for one person. That had the potential to have caused them distress due to breakthrough pain. We could not find any individual protocols for 'only when needed', or where they were to be used only under specific circumstances medicines.

We saw that the staff were employed in sufficient numbers to care for the needs of people.

People we met told us they felt respected and had choices in their lives. One person told us, "It's home. I love it." Another person told us," I always do what I want to do."

We were told by people and some relatives they thought the care was very good and the staff were kind to them. A visiting healthcare professional told us the care in the home was "Fantastic." However, we saw care plans were not easy to follow.

People told us they felt safe in the home and staff knew what to do if an incident occurred that meant people may be at risk of harm.

People felt supported by knowledgeable and confident staff. One person told us, “Staff seem to be trained properly.”

They also told us how they were involved in the running of the home and how to complain if anything was wrong.