Figham House is a care home for up to 55 older people who may also be living with dementia. The home provides residential and nursing care. There are two floors and bedrooms are located on both floors. On the day of the inspection there were 50 people living at the home and one person having respite care.

At the last inspection in February 2015, the service was rated as Good. At this inspection we found that the service remained Good.

There continued to be sufficient numbers of staff employed to make sure people received the support they needed, and those staff had been safely recruited. People told us they felt safe living in the service.

Staff continued to receive appropriate training to give them the knowledge and skills they required to carry out their roles. This included training on the administration of medicines and on how to protect people from the risk of harm.

People were supported to have maximum choice and control over 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, compassionate and patient. They respected people’s privacy and dignity and encouraged them to be as independent as possible. Care planning described the person and the level of support they required. Care plans were reviewed regularly to ensure they remained an accurate record of the person and their day to day needs.

People and their relatives told us they were aware of how to express concerns or make complaints, and that any complaints they had made had been dealt with in a satisfactory manner. People were also given the opportunity to feedback their views of the service provided.

The feedback we received about the registered manager was positive. We were told they led the team with a pro-active and transparent style of management and that they went ‘over and above’ their duties and responsibilities. They carried out audits to ensure people received good quality care that enhanced their general well-being.

Further information is in the detailed findings below.

This inspection took place on 19 February 2015 and was unannounced. We previously visited the service on 19 September 2014 and made three compliance actions in respect of shortfalls identified. These included: concerns about staffing levels, the lack of an emergency contingency plan, gaps in staff training, insufficient recording on food and fluid charts and the lack of an effective quality assurance system. We received an action plan from the provider stating they would be compliant with these identified shortfalls by 31 December 2014.

The service is registered to provide accommodation, personal care and nursing care for a maximum of 55 people, some of whom are living with a dementia type illness. On the day of the inspection there were 49 people living at the home. Most people are accommodated in single rooms with en-suite facilities. The home is in Beverley, a town in the East Riding of Yorkshire. It is close to local amenities and has a car park.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was not yet registered with the Care Quality Commission (CQC). 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. The manager told us that she intended to apply for registration very soon.

People told us that they felt safe living at the home. Staff had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety. They said that they were confident all staff would recognise and report any incidents or allegations of abuse.

The arrangements for ordering and storing medication were robust and medicines were administered safely by staff who had received appropriate training.

The manager was aware of good practice guidance in respect of supporting people living with a dementia type illness and had introduced signage in the home to assist people with orientation.

We observed good interactions between people who lived at the home and staff on the day of the inspection. People told us that staff were caring and compassionate and this was supported by the relatives and health / social care professionals who we spoke with. People also told us that staff were effective and skilled. Staff told us that they were happy with the training and support provided for them.

People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct documentation was in place to confirm this had been authorised.

We saw that there were sufficient numbers of staff on duty to meet the needs of people who lived at the home. New staff had been employed in line with the home’s recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people had been employed.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home. People were supported appropriately by staff to eat and drink safely and their special diets were catered for.

There were systems in place to seek feedback from people who lived at the home, relatives, health and social care professionals and staff. People’s comments and complaints were responded to appropriately.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by the manager were designed to identify any areas of concern or areas that were unsafe, and there were systems in place to ensure that lessons were learned from any issues identified.

This inspection was carried out as part of our programme of scheduled inspections.

Our inspector visited the service and the information they collected helped answer three of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff had not received appropriate training and development that equipped them to carry out their role safely and effectively and to meet the needs of the people who they supported.

Is the service effective?

Not applicable.

Is the service caring?

We saw that staff were caring and compassionate, and that there was good interaction between people who lived at the home and staff. People told us that staff protected their privacy and dignity and that any assistance with personal care was carried out sensitively.

Is the service responsive?

Not applicable.

Is the service well-led?

There was a manager in post but they were not registered with the Commission. There was no effective quality assurance system in place. Whilst the manager carried out audits to identify shortfalls, appropriate action had not been taken to address these.

We did not speak with people who used the service during this inspection as it was a return visit to look at the progress made with regard to record keeping. At our previous visit in November 2013 we found people were being looked after by friendly and supportive staff.

We found that improvements had been made with regards to record keeping. Care plans and wound care records were seen to be up to date and had been evaluated on a regular basis.

We did not speak at length with people who used the service during this inspection as it was a visit to look at the progress made with regard to record keeping. At our previous visit in August 2013 we found people were being looked after by friendly, supportive staff within a warm and homely environment. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

Our brief chats with people at this inspection indicated they were happy in the service and from what we observed people were settled and relaxed with the staff and other people who used the service.

We found that some improvements had been made with regard to record keeping. However, the manager told us that they appreciated further work had to be done to further develop the care files, making them person centred and reflect the individual needs of each person who used the service.

People received care in a manner that respected their choices and decisions. One relative told us “My partner is very well looked after. The food is good quality and staff respect my partner’s dignity when feeding them. The care is excellent and I have full confidence in the staff as they keep me well informed on my partner’s health and wellbeing."

People were cared for in a clean and hygienic environment. Two people who spoke with us said they were satisfied with the cleanliness of the home and pleased with the laundry service.

The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose.

Robust employment and recruitment practices were in place. One person who spoke with us said “The manager must use good recruitment techniques because I receive care from a number of staff and they are all excellent and are extremely pleasant towards me”.

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary.

We found that the care files did not always contain sufficient written information about people’s specific care needs and the support being offered by the staff to meet their needs. However, people told us they got regular baths, were turned in bed if needed, were given plentiful meals and drinks and received their medication on time

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

During lunch we completed a detailed observation called a, ‘short observation for inspection’ (SOFI). This enabled us to observe people who were unable to tell us about their care due to their dementia care needs. We completed the SOFI for 45 minutes and recorded observations of four people at three minute intervals. This enabled us to record signs of wellbeing and the interactions people had with their surroundings, staff and other people who lived in the home.

The inspection team was led by a CQC inspector joined by a practising professional.

People told us they were spoken to in a manner they preferred. They said they could make choices about aspects of their daily life such as the times of rising and retiring, where to sit during the day, what activities to participate in and what to have for their meals. They also told us they could request a male or female care worker. We were told that relatives and friends could visit anytime. One person said, “I like to have breakfast in my bedroom – it’s peaceful.”

We were told by people that there was a choice of warm food at every meal and there was always enough to eat and drink. Snacks were available throughout the day. One person spoken with told us they would be offered a meal outside of the usual meal time if they had missed it for any reason such as an appointment or a lifestyle choice of rising late. Comments included, “The food is very good – I never leave any” and “I can’t grumble at the food at all – I have never had to send any away.”

People told us they were able to raise concerns with staff or the manager.

People spoken with said staff treated them kindly and were available to talk to. One person said, “I have never heard one say they are busy and cannot talk to you.”

People told us they felt well cared for and the staff were kind and helpful. They told us they had been involved with reviews and had been involved with their care plans.

People told us they felt confident that the manager would investigate any concerns they had properly and would take them seriously; they had confidence in the staff and trusted them.

People told us they had attended meetings and could air their views. They felt their views were taken seriously.