This inspection visit was unannounced and took place on 17 September 2017. At our last inspection visit on December 2015 we asked the provider to make improvements to the medicine auditing process and for the manager to compete their registration with us. At this inspection, we found improvements had been made, however in our effective section we require the provider to make some further improvements. The service was registered to provide accommodation for up to 50 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 46 people were using the service. The home is situated in a small village and is adjoined to a convent with a small working chapel; sisters support the management and running of the home.

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.

People were supported to make choices, however the assessments did not always reflect the person’s level of understanding in different situations. We saw that staff knew how to keep people safe and raised any concerns if necessary. Risk assessments had been competed to reduce risks or provide guidance. There was enough staff to support people’s needs and this was supplemented by the sisters from the adjoining convent. People received their medicine to support their health conditions.

Staff had received a range of training for their roles and this enabled them to provide care in a supported and enabling way. There was a friendly atmosphere and staff had established relationships with people. People enjoyed a positive meal experience and their nutritional needs had been catered for. When required health care professionals advice had been sought had their guidance followed.

Peoples care plans were individual and recorded preferences in relation to their daily routine and their interests and hobbies. We saw these had been reflected in the stimulation on offer. People’s dignity was respected and this included their choice of faith.

Staff felt supported by the provider and the manager. A range of audits and quality measures had been implemented to consider improvements and ongoing developments to the home. People had an opportunity to comment on the service they received and their comments had been reviewed and considered. Complaints had been acknowledged and responded to. We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

Footherley Hall is registered to provide care and support for up to 50 people. At the time of our inspection 48 people were using the service.

The registered manager was no longer working for the service. A new manager had been appointed and they were going through our registration process to become the registered manager. 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.

We found there were some omissions in the way people’s medicines were recorded but people were supported to take their medicines safely.

There were arrangements in place to keep people safe from harm. Staff understood how to recognise abuse and the actions they should take to protect people. People’s risks associated with their care were identified, assessed and managed to reduce the risk. People who, because of their dementia, sometimes presented with behaviours that challenged their safety were supported in a consistent manner designed to reduce their anxiety.

The level of staffing had been increased and shift times altered to reflect people’s needs. There were suitable processes in place to recruit staff and maintain the environment.

Staff had access to training to improve their knowledge of care and enhance their skills. Staff sought people’s consent before providing care. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. The MCA and the DoLS are in place to protect people who cannot make decisions for themselves or lack the mental capacity to do so.

People had a choice of nutritious food and adequate drinks which met their individual needs. People were supported to enjoy their food in a pleasant and unhurried manner. Whenever necessary specialist advice was sought from other health care professionals to support people’s health and wellbeing.

People received kind and compassionate care. Staff supported people to maintain their dignity, independence and privacy. People were able to maintain their important relationships, as relatives and friends could visit at any time.

Staff gained information about people so that they could provide care which met their preferences. People enjoyed a varied programme of entertainment and support with their hobbies to prevent them from becoming socially isolated. People told us they had no complaints about their care but felt empowered to raise concerns if they needed to.

There was a programme of audits in place which were used to monitor the quality of the service. Everyone felt there was an open and transparent atmosphere in the home because people, relatives and staff were asked to share their views on the service.

This inspection took place on 7 October 2014 and was unannounced. This meant the provider and staff did not know we were coming.

Footherley Hall provides care and support for up to 50 people. On the day of our inspection 49 people were using the service.

The registered manager was no longer working for the service. A new manager had been appointed and they were going through our registration process to become the registered manager. 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.

We found the service had processes in place to ensure people received medicine prescribed for them in a safe manner.

We saw people who used the service received care which was regularly reviewed to ensure their current needs were met and meant their care could be delivered safely.

People received care which reflected their preferences because the service had consulted them about their likes and dislikes.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Staff understood their role in protecting people’s human rights,

People who used the service were happy with the care provided and we observed staff helping people with kindness and compassion.

People and those important to them were consulted about the home and we saw this feedback was used to improve the care experience for people living at Footherley Hall.

The manager regularly assessed and monitored the quality of the service to identify if any aspects of care required improvement.

We inspected Footherley Hall on a planned unannounced inspection which meant the service did not know we were coming. We were supported throughout the inspection by the new manager. The manager’s name on this report does not reflect the current manager as notification of cancellation of the previous manager had not yet been received.

We spoke with people who used the service, their relatives, staff and a visiting health professional on the day of our inspection. People told us they were happy with the quality of care being delivered at Footherley Hall and they had consented to their care, treatment and support. A relative told us: “I cannot fault it”.

We found that the service was clean and had systems in place to prevent the spread of infection.

We found that the service followed the correct procedures when recruiting new staff.

We saw that the service had a complaints procedure which was available for people who used the service or their representatives to raise any concerns they might have had.

Our inspection was unannounced which meant that no one knew we would be visiting. There were 49 people living at Footherley Hall on the day of our visit. We spoke with four people who lived there, visiting relatives, staff on duty, the registered manager and the care manager.

We found that staff understood people's individual and personal needs. We saw that staff treated people kindly and respectfully. Information from one person who lived at the home told us, “It’s a good place to live. The staff are very caring and friendly”. A relative we spoke with told us, “We looked at a few homes this is the one we felt most comfortable with”.

We looked at the care records for four people living at the home. We saw that their care needs were well documented. We spoke with two care staff who demonstrated they were aware of people's care and support needs. Staff said they had received training to help them understand how to meet the needs of people in their care.

We received concerns that there were not enough staff working at the home. We found at this visit that there were sufficient staff to meet the needs of people living at the home.

We received concerns that safeguarding concerns were not reported. We found that the manager had taken action to ensure that they worked closely with the local authority on concerns related to safeguarding. We found that systems were in place to monitor the quality of the services provided.

We visited the service in May 2012 and found that there was a lack of information in care records. At our visit in May we saw that full care plans and risk assessments had not been written for people that lived in the home. For example we saw that the care files for a person recently admitted to the home contained very little information on how the person’s care needs would be met. We made a compliance action for the service to tell us what action they would be taking to ensure that information in care files was appropriate and accurate to make sure people’s wellbeing and safety would be maintained.

The provider sent us an action plan to tell us what action they would be taking. We carried out this visit to make sure the service had complied with these actions.

At this visit we spoke with the registered manager, senior care staff and four care staff. We looked at the care files of three people who lived in the home. We saw that care files contained information that would help to ensure people received appropriate care. Evidence available showed that the standard of care provided in the home would be supported by up to date and personalised care records. The care records showed how people would prefer to have their care needs supported and met.

We visited this service because we received anonymous concerns about the progress being made with meeting the safeguarding needs of people who used the service. We had visited the service in April 2012 and found that suitable arrangements were not in place to always respond appropriately to allegations of abuse or concerns.

Our plan for this visit was to look at the areas where we had asked the home to make improvements. The lack of information we saw in care records led us to look at three other outcome groups. We choose to look at some of the care records in more depth.

We did this because we found that full care plans and risk assessments had not been written for a person recently admitted to the home. We saw that one person’s care file contained very little information on how the person’s care needs would be met. We wanted to make sure that people were receiving appropriate care that met their care needs in the absence of information.

Evidence available showed that people received appropriate care to meet their needs. The standard of care was not supported by the home making sure that accurate personalised care, treatment and support records were maintained.

We spoke with people who used the service who told us that they were happy with the service and had no concerns. People were positive about their experiences of living at the home and the care they received. People looked happy in the home. We saw that people were smiling and looked comfortable. The four people we spoke with told us that they were “Very happy here" and “The staff look after me well they are always polite.”

People told us that if they had any concerns they would speak to a member of staff. Two of the people we spoke with said they could speak to any of the staff working in the home, especially the manager. People told us that they felt confident to raise their concerns and they would be listened to. One person told us that they had made a complaint and this was acted on quickly. This person said “I have never put my complaint in writing. If I have a problem the staff usually sort it out straight away."

People told us that they felt safe in the home. In conversation with people that lived in the home they told us that the care staff were kind and gave them support when they needed it. One person told us “They (care staff) are always kind to me” and “Care staff are always there when I need them.”

People told us they were involved in making decisions about their care and their views were taken into account. People could also decide their daily routine and whether to be involved in activities taking place in the home or the community.

We observed that care staff treated each person as an individual. There was a good atmosphere in the home. There was good interaction and a positive relationship between people living in the home and staff working in the home. People who had good mobility were seen to move around the home freely.

We visited this service because we had concerns about how the service managed complaints from people who used the service, and staff knowledge of safeguarding adults’ procedures. These are agreed procedures to follow if there are concerns that people may be abused, or are at risk of abuse.

We spoke with people who used the service, who told us they were happy with the support they received. The people we spoke with said they did not have any reason to complain about the service or staff.

We saw the home was warm, comfortable, clean and welcoming. The staff were kind, respectful and polite. They gave support in ways that respected people's dignity and privacy. For example we saw the staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

Family and friends could visit the home whenever they wanted to, and family members were able to continue to provide care for a relative and spend time in the home. People told us that they go to their families’ homes and continue to enjoy family events, and relatives could accompany them on medical appointments.

We found that the systems to report allegations of abuse had not been developed. Where concerns had been identified, appropriate referrals, investigations or disciplinary action had not always been taken. This means people could be placed at risk of harm.

We visited the service in April 2011 and assessed the quality of care provision in all outcome areas. We made one compliance action to demonstrate how decisions had been made in relation to the care and treatment provided by people, and an improvement action for prevention and control of infections and recording. We carried out this visit to ensure the service had complied with these actions.

During our visit people told us they were happy with the care and support they received and there were sufficient numbers of staff on duty to respond to people’s needs and provide agreed care. Staff listened to people and spent time with them, talking and carrying out activities, as well as providing care. People were confident about whom they could raise concerns with and that their concerns would be addressed.

People told us they were involved in making decisions about their care and their views were taken into account. People could also decide their daily routine and we asked people about the support they received; they told us they could decide how to spend their time, and could choose what support to receive.

People told us;

“The staff are very good in all areas, they have very high standards.”

“We can choose who helps us and if the staff are male or female.”

“We can tell the staff anything, and they listen to us.”

“I wouldn’t hesitate to tell the staff if I didn’t like things or was unhappy, but I’ve never had a reason to, they’re very good.”

We saw that people were dressed in their own style and people were encouraged to continue to take a pride in their appearance. Staff provided any personal care where required and people in the home were well presented.

People and their relatives were happy with the care and support they received and there were sufficient numbers of staff on duty to respond to people’s needs and provide agreed care. Staff listened to people and spent time with them, talking and carrying out activities, as well as providing care. People told us;

“The staff are always very kind and respectful and they always ask what you want, nothing is too much trouble”,

“The staff here are very respectful”,

“The staff are always sensitive and very good” and

“The staff here have a good sense of humour and go out of their way to make people happy.”

People were dressed in their own style and if they need support, staff help individuals to apply make-up or to have a manicure; people were encouraged to continue to take a pride in their appearance. Staff provided any personal care where required and people in the home were well-presented.

People told us they were involved in making decisions about their care and their views were taken into account. People could also decide their daily routine and whether to be involved in activities taking place in the home or the community.

People were assisted to obtain health care support from professionals and this meant people may be able to stay in the home and not be admitted to hospital. Where people were in pain they were able to have prompt treatment from health care staff and medication to help with pain management. People told us they could always see their doctor and could look after their medicines if they chose to.

People were confident about whom they could raise concerns with and that their concerns would be addressed. People could raise their concerns at any time or at the relatives and carers meetings. We were told “If anything was wrong I’d speak up, but there’s nothing to grumble about here.”

The home was clean and tidy and people could personalise their rooms and bring in small items of furniture and personal possessions. Domestic arrangements were in place to keep all areas clean and we were told “the staff are very good, they always check to see if it is convenient to do our rooms, and they’re spotless.”

We spoke with 5 people who use the service and 3 people who were visiting friends and relatives on the day of the visit. People’s comments included;

“I used to look after my medicines before I moved into the home, so still like to do this.”

“The staff always give me my tablets and I can have more if I need to, I only have to let them know if the pain is bad.”

“The food here is lovely; the standard is always very high.”

“We have breakfast in bed brought to us on a tray”

“The food is great couldn't ask for more.”

“We are able to have a drink throughout the day and snacks are always available if we are hungry.”

“The staff here are wonderful you can always talk to any of the staff is anything is worrying you, and nothing is too much trouble for them.”

“They always make sure you have everything you need.”

“I know the staff here look after me and keep me safe.”

“Staff always let us know what is happening.”

“I have never had a reason to complain, the staff here are wonderful. “