This inspection was unannounced and took place on 20 December 2016

Fletcher House is registered to provide personal care and accommodation to up to 57 people. The home specialises in the care of older people, including people living with dementia. The building has recently been divided into two separate units. The part known as the Avalon suite provides care for up to 15 people living with dementia and the main part called Pen Hill provides care to 42 older people with personal care needs. At the time of the inspection there were 53 people living at the home.

The last inspection of the home was carried out in January 2014. No concerns were identified at that inspection.

There is 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.

The registered manager had been in post for under a year and had an action plan in place to ensure on-going improvements were made.

During this inspection we found that staff did not have a good knowledge of how to support people who lacked the mental capacity to make decisions for themselves. The registered manager informed us that training for all staff in the Mental Capacity Act 2005 was planned for early in the new year which they hoped this would address this shortcoming.

Comments about the food at the home were mixed and there were limited choices about vegetables and condiments to accompany meal choices for some people. Although people received the support they required to eat their meals this was not always clearly recorded in their care plans.

People felt safe at the home and with the staff who supported them. The provider had a robust recruitment procedure which helped to minimise the risks of abuse to people.

People told us staff were kind and considerate to them. They said they were treated with respect and dignity. Each person had a single room where they could spend time alone or see visitors. Visitors were always made welcome.

People spoke highly of the staff who supported them. One person said “I cannot speak too highly of the staff. I have never heard an unkind word and they seem to have endless patience.” Another person said “There are some exceptionally caring staff here.”

People had opportunities to take part in a variety of social activities and to pursue their hobbies and interests. The home had good links with the local community which increased people’s opportunities for social activities.

People’s care needs were assessed and kept under review to make sure they received care and support which was responsive to their needs and wishes. Staff monitored people’s health to make sure they had appropriate care and treatment when required. People received their medicines safely from staff who had received specific training to carry out the task.

People told us they would be comfortable to make a complaint. They said the registered manager was very open and approachable and they could speak with them about any concerns.

We found that the people who lived at the home were happy with the support they received and that they were consulted and involved in how they wished to lead their lives. People's health and welfare needs were being met and the support they received was appropriate to their needs. We found that people were being well treated and there were systems in place to protect them from possible abuse.

People we spoke with told us their nutritional needs were being met.

One visitor we spoke with told us that there had been issues with the cleanliness of the home and they had found a corridor smelled a little offensively, the home manager informed us she was aware of this and that carpet had recently been replaced. Other visitors we spoke with said the “home is always clean, staff work very hard and we are very happy with the care here”.

The home monitored the quality of care it provided by using feedback forms, home meetings, visitors meetings and feedback from a comments box. This information was on display within the home.

We reviewed care records that showed how consent was obtained and respected by the care staff.

We spoke with people who live at Fletcher House who told us that they were asked about how they wished care to be delivered. We observed choices being offered at meal times and people told us that "I can choose what I do during the day, whether I stay in my room or go to the lounge".

We saw case records which showed us that consent was obtained for any care and support delivered. We also saw that care plans were reviewed monthly by the key worker with the people who received the care.

We saw that the medication system was well managed and that medication was administered safely. People told us that "I always have my medication on time".

We spoke with staff who told us that their induction training was good and that they felt well supported. We saw staff files which showed us that the there was a safe recruitment process in place at Fletcher House.

We saw a clear complaints procedure and examples of the manager listening to concerns raised and producing two written notices which identified "You said, we did". We saw a record of compliments received which showed us that the manager was listening to comments about the quality of the service provided.

People who lived at the home were very happy with the care that they received. One person said “Everything is lovely and we are so well looked after.” Another person told us “I’m a very fussy eater but they make sure I get lots of glasses of milk, which I like.”

At the previous inspection some concerns were raised about the time it took for staff to answer call bells. At this visit we did not hear call bells ringing for extended periods of time. Everyone asked said that if they rang their call bell staff came quickly. One person said “They always come very quickly if you ring.”

People said that they always felt listened to by staff and that the manager welcomed suggestions about the running of the home. One person said that the manager had told them “Come and see me anytime if there is anything that you think we could do better.” Another person said “I made a complaint once and it was sorted out immediately.”

People told us that staff were kind and caring and always treated them respectfully. One person told us that “you can’t fault the staff, nothing is too much trouble”. Another person told us “staff are so kind they take care of me so well”. People told us that on the whole they felt there was enough staff on duty to support and care for them. Some said that staff always had time to chat with them and took their time delivering their personal care. Other people said they did not feel staff had enough time to sit and chat with them. Some people said they would like more opportunities to go on trips out.

During the inspection we observed staff being friendly, patient and kind. The atmosphere was cheerful and people responded well to staff. We observed staff reacting quickly, in a calm and professional manner, to an emergency situation that occurred.

When we asked people if were involved in decisions about their care people were unsure. When we spoke with staff about this, they told us they had a key worker system. This means that each staff was responsible for reviewing two or three people’s care plans on a monthly basis. Staff told us, to do this, they sat with each person and went through the care plan with them and discussed their needs and any changes. Reviews were recorded on the home’s secure electronic care planning system.

Some people said they attended regular house meetings where they can suggest changes to how the home is run, for example they can be involved in decisions about menu choices, activities provided and the decoration of the home.

Relatives told us they found the home to be welcoming and found staff to be cheerful and kind. Relatives told us they were invited to yearly care reviews where their relatives also attended. They said they were always informed of any changes to their relatives needs.

We observed people spending time talking to each other in the various communal areas of the home. Some people told us they had formed good friendships.

People told us that on the whole, when they rang their call bells for assistance staff answered fairly quickly. Prior to the inspection we had received information that suggested call bells were left to ring for too long and staff were outside taking breaks while the call bells were ringing. During this inspection we heard call bells going off and found, on at least two occasions they took over five minutes to answer. However, we did not find staff we out having a break on these occasions. The manager showed us how the call bell system records how often the bells ring, how long they take to answer and who has called it. Despite having this information the manager admitted that she did not use this as a monitoring tool.

Prior to the inspection we had received information that suggested that fruit juice drinks provided at meal times were watered down. We did not find this to be the case when we inspected the home. We observed the lunchtime period. We found that although the dinning room was a little noisy and over crowded, the atmosphere was cheerful. One person told us that they would not go into the dinning room until everyone was sat down. They said it was too chaotic and there were too many wheelchairs around. They said they were frightened of falling so felt it was better to wait. We saw that people were provided with choices of food and a variety of fruit juice drinks that were not watered down and squashes. When asked, people told us this was the normal choices of drinks they received. People were able to help themselves to vegetables from a serving dish provided on each table.

We observed a staff member assisting a person to eat in a respectful and patient manner ensuring the person was comfortable throughout the meal. We spoke with the chef who told us they had a list of people who required specialist diets. The chef told us they were always informed of any specialist diets required when a person was admitted to the home. During lunchtime the chef was preparing additional meals because people had opted for an alternative to the menu choices. We observed that some people had omelettes, sandwiches and soup.

We observed information on notice boards about the various activities for example, painting, knitting, bingo, quizzes, sing songs and a cinema trip. There were two activity coordinators that arranged the activities. The home had an activities room where there was a shop for people to purchase personal items, carry out activities and access skype.

We observed there was a public telephone for people to use and some people had their own private telephones in their bedrooms.