This inspection took place on 6 and 11 June 2018. The first day of our inspection was unannounced.

Fourways is a care home registered to provide personal care and accommodation for a maximum of 47 people. People in care homes receive accommodation and 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. The home is located in a residential part of Lillington with access to shops and local amenities. There were 45 people living at the home at the time of our visit, some of who were living with dementia.

The service had a registered manager. This is a requirement of the provider’s registration. 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. However, the registered manager was no longer working at the service, and a new manager had been appointed. The provider told us the registered manager was still providing support to the new manager, but acknowledged they needed to notify us of the changes in the day to day management of the home.

We last inspected Fourways in September 2015 when we rated the service as 'Good’ overall. However, the key question of safe was rated ‘Requires Improvement’ because people did not always receive their medicines as prescribed.

At this inspection we found further improvements were required because staff were not consistently demonstrating the provider’s values and ethos of care in their everyday practice. Improvements were required in staff’s understanding of people’s individual needs for support. People did not always receive support that was responsive to their social and emotional needs.

There were enough staff to keep people safe and people told us they felt confident with the staff who supported them. However, the deployment of staff meant they were not always responsive to people’s needs.

People’s individual risks were assessed and their care plans explained the actions staff should take to support people safely. However, staff did not always act consistently to mitigate people’s assessed risks or follow the provider’s guidance for managing medicines safely.

Staff went through a series of recruitment checks to ensure their suitability to work at Fourways. The induction, training and support given to staff ensured they had the skills, knowledge and confidence to carry out their duties and responsibilities effectively and understand their responsibilities to report any abuse or discrimination.

People were encouraged and supported to eat and drink enough to maintain their health. People told us they received good healthcare and were supported to access healthcare services when needed. The provider encouraged good working relationships between their own staff and community health professionals so information could be shared effectively.

The provider had made appropriate applications to the local authority in accordance with the Deprivation of Liberty Safeguards and ensured staff worked within the principles of the Mental Capacity Act 2005.

People felt cared for by staff who were kind and respectful of their wishes. Staff had training in equality and diversity and understood people were entitled to privacy and to express their views and opinions. Staff were respectful of people’s relationships with their family and friends.

The provider used a recognised activity programme to ensure people received mental and physical stimulation every day of the week. However, people who were less able to express themselves verbally, or who did not want to join in the group activities, did not experience the same quality of engagement or interaction with staff.

People and relatives were encourage

We carried out this inspection on 15 September 2015. The inspection was unannounced.

Fourways is registered to provide accommodation and personal care for a maximum of 44 people. Some people have a diagnosis of dementia. At the time of our inspection there were 40 people living at the home with accommodation over three floors. The service also offers a respite and day centre facility.

A requirement of the service’s registration is that they have a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post.

People told us they felt safe living at the home and could raise any concerns they had with staff. Staff were trained in safeguarding people and understood how to protect people from abuse. There were processes to minimise risks to people’s safety.

People received their medicines from staff trained to administer them, however this was not always given in a timely way and as prescribed. Medicine audits had not identified these issues. Overall there were enough staff to support people, however people did not always receive support at times they preferred, especially at the start of the day.

Checks were carried out prior to staff starting work to ensure their suitability to work with people who lived in the home. Staff received training which gave them the skills and understanding to support people with their health and social care needs.

People who were considered to lack capacity did not have formal capacity assessments, however, staff had some knowledge and understanding about this and further training was being arranged by the provider. Staff obtained consent from people before supporting them, and records reflected this.

People told us staff were kind and respectful and had the right skills to provide the care and support they required. Staff treated people with dignity and respect. People told us they enjoyed the food at the home and had a choice of meals and drinks which they could have at times to suit them. Different dietary needs were catered for.

People were referred to other health professionals when required and care records contained relevant information to help staff provide people with personalised care. People were involved in their care and were asked for their views and opinions about the support they received. People told us they enjoyed the activities on offer at the home.

People told us they could raise any concerns with the registered manager, and these would be listened to and acted upon. People, relatives and staff told us the management team were approachable and responsive. There were processes to monitor the quality of the care provided and understand the experiences of people who lived within the home. This was through regular communication with people and staff and a programme of other checks and audits.

People told us they liked living at the home. People said, "It's nice here" and “They look after us very well.” People or their relatives had signed to say they consented to receiving care and support from staff. We saw that staff treated people with kindness and respected their right to make everyday decisions for themselves.

In the care plans we looked at, we saw that the manager assessed people's needs and abilities before they moved into the home. People’s care plans identified risks to their health and well-being. Instructions for staff minimised risks and promoted people's independence. Care staff we spoke with told us they regularly reviewed people’s plans and made changes when they were needed.

The home was clean and well-organised because the provider followed the Department of Health guidance for infection prevention and control.

The manager checked staff’s suitability to work with vulnerable people before they started working at the home. Staff told us about their induction and training programme when they started working at the home. Staff told us the manager was approachable and they could talk to her about anything. In the staff files we looked at, we saw that the manager kept a record of their regular one-to-one meetings with staff.

We saw that records of care and staff records were detailed and were kept securely in lockable cabinets. Staff could access the information they needed to deliver care safely and effectively.

We visited Fourways 19 July 2012 and we spoke with four people using the service, one relative, two members of care staff the manager and a visiting health professional.

We spent time observing staff interaction and talking with staff about how they meet the needs of the people they support. Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner.

People using the service told us they liked living at Fourways and felt well cared for.

One person told us, "staff are nice, good and caring" and another person told us “staff are very good and excellent.”

We received positive comments about the staff from the health care professional we spoke with and the visiting relative. We were told “staff are good with people” and “care was excellent.”

People who lived in the home told us they felt safe and would be able to talk with staff if they felt concerned about their care. Some people were not able to tell us about their care, so we observed staff interaction and the people appeared relaxed and happy in the company of the staff.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. One person told us, "food was excellent." However, some people were not as happy with the choice of food available to them.

We saw people's bedrooms were clean, warm and well furnished. People had brought in some personal items with them into the care home and this made their rooms "homely."

The majority of the communal rooms in the home were also clean and tidy and during our visit we saw a timetable for activities were displayed in the corridors.

We saw that people’s needs had been assessed before they moved in to the home. Care plans had been devised to describe how people liked and needed to be supported. Risks to people’s health and well being had been identified and measures had been put in place to protect people.

We saw there were quality assurance systems in place which measured people’s satisfaction with the service provided by the home.

During this review we visited five of the provider's care homes. We visited The Limes on 14 June 2011, we visited Westlands on 15 June 2011, we visted Fourways on 16 June 2011, we visited Woodside on 21 June 2011 and we visited The Sycamores on 22 June 2011.

We spoke with 17 people using these services and eight relatives who were visiting at the time. People told us they liked living at the care home and felt well cared for. One person told us 'we like it because staff 'speak nicely' and said staff were ‘friendly’ towards them. People told us they were happy with the care they received and encouraged by staff to maintain as much independence as possible. We saw people making their own drinks when they wanted to and helping with the washing up after lunch. People told us they liked doing this. Each person we spoke with told us they felt safe and would be able to talk to staff if they felt concerned about their care. Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice.

Relatives told us they had no concerns about how their family member was being cared for. They told us that care given was 'respectful' and 'nothing was to much trouble'.

Relatives we spoke with at each care home told us that staff had ‘time for everybody’ and the managers were very approachable. Relatives liked the way that they could be involved with the care of their family member and join in with activities if they wanted to. Relatives made particular comments about how well the staff kept them informed about their family member's care needs.

Relatives told us the food looked good and people always had sufficient to eat and drink. They told us that snacks and drinks were always ‘available' and they could make a cup of tea for their family member whenever they visited.