Far Fillimore Rest Home is a ‘care home’, registered to provide support for up to 26 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 24 people were using the service. This unannounced inspection visit took place on 23 April 2018. The service did not provide nursing care.

At our last inspection 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. At this inspection we found the service remained Good.

People were protected from the risk of avoidable harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We saw that concerns were taken seriously and investigated thoroughly to ensure lessons were learnt. People received their medicines safely. Risks associated with people’s care and support were managed safely and visitors were confident their relatives were safe and well cared for. Sufficient staff were available to support people, and safe recruitment processes were followed.

People received support from staff who had received training to provide effective care. The manager had recognised that further training for staff in supporting people living with dementia would enhance staff’s understanding.

Staff supported people to maintain their physical health and wellbeing and people received meals which met their requirements and preferences. The home environment was adapted to meet people’s needs. 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.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People’s privacy was respected, and their dignity and independence promoted. Visitors were encouraged and people were able to maintain relationships that were important to them.

People’s preferences and wishes were taken into account and opportunities for people to take part in activities at home and in the community were provided to reduce the risk of social isolation. People and their relatives contributed to the assessment and development of their care plans and felt able to report any concerns they had.

Systems were in place to monitor the quality of the service, and these were used to drive improvements. People and their representatives were consulted and involved in the running of the service. The provider and registered manager understood their responsibilities and regulatory requirements and had resources available to them; including partnership working with other agencies that ensured people’s needs were met.

Further information is in the detailed findings below

This inspection took place on the 13 April 2016 and was unannounced. At our previous inspection in February 2014 the service was meeting the regulations that we checked.

Far Fillimore Rest Home provides accommodation and residential care for up to 26 people who may be living with dementia. On the day of our inspection 20 people were using the service.

A registered manager was in post at the time of this 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 we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Recruitment checks were carried out prior to staff starting work to ensure their suitability to work with people and the staffing levels in place met people’s needs. People were supported to take their medicine as and when needed. Staff received training and support to enable them support people effectively.

People received food and drink that met their nutritional needs and preferences and were referred to healthcare professionals to maintain their health and wellbeing. Capacity assessments had been completed where people lacked capacity to show how people were supported to make decisions. When people were being unlawfully restricted this had been considered and Deprivation of Liberty Safeguards (DoLS) applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

This inspection was unannounced which meant the provider and the staff did not know we were coming.

At our last inspection on 3 September 2013, we made two compliance actions. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in these areas.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

This inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with seven people living in the home, three visitors, two staff and the registered manager. Everyone spoke well of the home, one person using the service said, “Everything is wonderful here. We have Sunday roasts, nice meals and we are well looked after.”

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We found that medication was administered safely but the recording and storage of medications required some improvements.

We found people using the service received appropriate nutrition. People told us they enjoyed the meals provided.

We looked at the cleanliness and suitability of the environment and saw the home was clean, safe and well maintained.

The provider had systems in place to check on the quality of the care people received. The service was well led because the registered manager supported the staff team, had quality monitoring systems in place and managed risks effectively.

We carried out this inspection to check on the care and welfare of people using this service and as part of our schedule of planned inspections. The inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with seven people using the service, two visiting members of the clergy, two staff and the registered manager.

People told us they could express their views and were involved in decision making about their care. They said they were treated with respect and dignity. One person told us, “I am very happy with them all, I never feel embarrassed, they are patient and understanding.”

We were told by people using the service the staff team provided sensitive and flexible personal care support and they felt well cared for. The people we spoke with said they felt safe. They said they were happy with their care and the staff were responsive to their needs.

Staff had a good knowledge of the care needed and what people wanted. One person told us, “The girls let me do what I can, they don’t rush me and they understand my ways.”

We saw that all the necessary checks were made to ensure they were fit to do their job.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.

During our unannounced planned review in January 2011 people were satisfied with the service they received. They told us their needs were met and that they were consulted about the care they were provided with. People said they were given the opportunity to participate in activities that were of interest to them. They told us the staff always treated them well and that their privacy was respected. People were complimentary about the home's environment, the staff that worked at the home and the quality of the food.

During the review in January 2011 we made compliance actions in two areas, this means the home had to make improvements. We said that appropriate storage must be available for controlled drugs to ensure people were suitably protected. We also stated that people must be confident they received their medication as prescribed. We also informed the manager that bed rails used in the home needed to be assessed to confirm they were suitable to use so that people were safe.

During this review people told us their medication was well managed one person told us "The staff understand why I take my medication, I am more than happy with the arrangements." Another person said" I am happy with everything to do with my tablets."

We spoke with nine people who lived at the home. They told us their needs were met and that they were consulted about the care they were provided with.

People said they were given the opportunity to participate in activities that were of interest to them. They told us the staff always treated them well and that their privacy was respected. People were complimentary about the home's environment, the staff that worked at the home and the quality of the food.

People who use the service told us that they were happy with the care support in the home. They said the staff team were always available and responded promptly to any areas of concern or changes to the support they required. People told us the staff listened to them and spent time with them, talking and carrying out activities, as well as providing care.

Comments from people who use the service about the standards of care and support and their experiences included:

“The staff are good they come round and ask you what you want.”

“Staff are friendly and helpful.”

“We have a laugh here you can’t get bored, we please ourselves .”

“I came to look around before I moved here.”

“People here are very helpful.”

“I feel safe, staff always answer the bell when I call.”

“I feel safe, staff always answer the bell when I call.”

“When my family brought me to have a look I thought it was very nice, I don’t have to worry about things anymore”

“They staff team communicate well with me and they know how to handle X (person living at the home.) “