The inspection took place on 03 October 2018 and 06 November 2018 and was unannounced.

Friars Mead is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 there were 18 people living at the home.

At our last inspection on 05 April 2016 we rated the service Good. At this inspection we found that there were some areas in need of improvement.

There was a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us they felt safe in the home. Staff had safeguarding training and knew how to report their concerns internally and externally. People and staff told us at times there was a shortage of staff in the afternoons. Staff were recruited safely.

Potential risk to people`s health and well-being were assessed and plans were in place to mitigate these, however plans were not always detailed about the measures implemented to mitigate risks.

People praised staff and told us they were kind and caring. Staff received training in areas considered mandatory by the provider, however some refresher training had lapsed. Staff told us they felt supported by the managers to carry out their roles.

Where people had a diagnosis of dementia their capacity to take certain decisions was not assessed and not all staff we spoke with were knowledgeable about the Mental Capacity Act 2005 principles. Following the inspection the registered manager told us that people were free to leave the building when they wanted, however at the time of the inspection they told us that not every person was able to leave the building. Deprivation of Liberty Safeguard applications had not been sent to local authorities.

Staff asked for people`s consent before they delivered any aspects of personal care. People`s care plans were not always up to date and the information recorded was at times inconsistent throughout the records. People we spoke with had no knowledge about their care plan and did not remember being involved in any reviews of their care needs.

Staff knew what to do in case of an emergency like fire, however fire risk assessments were carried out and updated by the registered manager yearly. The last external fire risk assessment had been carried out in 2015. The registered manager told us this had been planned for November 2018 and they sent us a copy of the report following the inspection.

People told us that staff knew them well, respected their privacy and promoted their dignity. We saw that staff provided care and support in a patient, calm and reassuring way to meet people’s individual needs.

People told us that activities were provided in the home, however these were not always interesting and they wished to go out more.

People told us they liked the food provided to them, however they told us they were limited to cereals and toast in the morning and they could only have a cooked breakfast once a year.

Complaints were recorded, investigated and where needed actions had been put in place to improve the service and lessons were learned.

The registered manager carried out audits to check on the quality and safety of the care provided, however some of the governance systems needed further developing to ensure that the registered manager could effectively monitor the quality of the service.

The inspection took place on 05 April 2016 and was unannounced. Friars Mead is a care home without nursing that provides accommodation and personal care for up to 27 older people. At the time of our inspection there were 22 people living at the home. At our last inspection on 22 May 2014, the home was meeting the essential standards that we looked at.

There was a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

People told us they felt safe at the home. Staff received training in how to safeguard people against the risks of potential abuse and knew how to report concerns if the need arose.

Safe and effective recruitment practices were followed to make sure that staff were of good character and suitable to perform their roles. There were sufficient numbers of staff available to meet people’s individual needs at all times.

Potential risks to people’s health and well-being were assessed, monitored and reviewed on a regular basis. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies.

People were positive about the skills, experience and abilities of the staff team. Staff received training and refresher updates relevant to their roles and had supervisions to discuss and review their performance and professional development. Medicines were managed, stored and administered in a safe way by staff who had been trained and had their competencies assessed.

Staff obtained people’s consent before providing the day to day care they required and this was reflected in their individual plans of care. People’s health needs were met in a safe and effective way that met their individual needs. They had access to health and social care appointments when necessary.

People were positive about the standard and choice of food provided at the home. We saw that the meals, served in pleasant and homely surroundings, were hot and appetising. People were regularly offered a choice of hot and cold drinks by staff who were familiar with their dietary needs and preferences.

People were cared for in a kind and compassionate way by staff who knew them well, respected their privacy and promoted their dignity. We saw that staff provided care and support in a patient, calm and reassuring way that best suited people’s individual needs.

Personal information contained in records about people’s medical histories was held securely and confidentiality was maintained. People and their relatives told us they were fully involved in the planning, delivery and reviews of the care and support provided.

People received personalised care that met their individual needs and took account of their preferences. Staff knew people well and were clearly knowledgeable about their likes, dislikes and personal circumstances. Opportunities were available for people to pursue social interests relevant to their individual.

Complaints were recorded, investigated and personally reviewed by the registered manager. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way. They were positive about the registered manager and how the home operated.

The inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 who used the service, some of their relatives, the staff who supported 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?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The provider had procedures in place to deal with emergencies to ensure the safety and welfare of the people who used the service.

The service was safe, clean and hygienic and maintained strict cleaning schedules.

Is the service effective?

People’s health and care needs were assessed with them and their relatives where possible and they were involved in discussing any changes to their care plan on a monthly basis. Any special needs such as use of equipment and dietary requirements had been identified in the care plans. All the staff we spoke with felt supported in their roles and had undertaken relevant training to support the knowledge required to operate safe practices and meet people's needs.

Staff training had been put in place to support the needs of the people who used the service, for example, end of life care. The provider had made suitable arrangements to work in cooperation with others to ensure appropriate care took place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed respect and demonstrated a caring nature. Feedback from relatives was extremely positive as regards the care given by the team. A relative said "My relative had their dignity and was treated with the utmost humanity to the end of their life." People’s preferences, interests, aspirations and diversity of needs had been recorded and care and support had been provided in accordance with people’s wishes. We observed one person who used the service returning from a trip to the bank. They liked to live as independently as possible and the staff ensured that they were safe and supported to do so.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were not happy. We looked at the complaints policy but there had been no complaints made since our last inspection. Staff we spoke with were aware of the complaints policy and procedures. We were reassured that people would have their complaints investigated and action taken as necessary.The provider responded to people's needs, for example, organising a regular hairdresser and chiropodist to attend the home.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way and continuous way. The service had a good working relationship with other care providers such as the local GP and district nurse team. The quality of the service was continuingly monitored by both the manager and the provider. Any actions to make improvements were taken swiftly. Staff told us they enjoyed their job and felt well supported by the managers. This helped to ensure that people received a good quality service at all times.

During our inspection, we spoke with eight people who use the service. They were complimentary about the care and service, and the respect shown by staff.

One person commented, "The staff are excellent. They are very good." Another person said, " I am well looked after. The staff are very helpful and caring." This was echoed by another person who said, "I am very happy with the care. Both day and night staff are very helpful. I have no complaints."

We checked the care plans and other records and noted that they had been kept up to date and stored securely. Staff had current information available to assist them in providing appropriate care and treatment. We saw consent forms and care plans that had been signed and dated by the people using the service. This showed that people had been involved in their care, and their consent had been obtained before treatment was given.

During our visit, we spoke with several people who said they were happy living at Friar's Mead. A person commented, "The staff are very helpful, and if you need anything, you just need to ask and they will sort it out for you. I am happy living here." Another person said, "The whole place is very comfortable. They provide very good service and the staff are excellent."

People told us their wishes and preferences were respected, and they had a good choice of activities and menu to choose from. A person said that the food was of a high standard. This was echoed by another who said, "Lunch is very good, and there is plenty to eat."

During our visit, we observed staff interaction with people during an activity session and at lunchtime. We observed that people were treated with respect and dignity, and there was positive interaction between staff and the people using the service.

People we spoke with were pleased with the service and care provided. A person commented, “The service is good. I am happy with the service. I have no complaints.” This was echoed by another person who said, “Very good service. Staff are very kind and understanding.” Another person said, “Staff respond immediately when you need help.”

When asked about choices, a person commented, “I have my own interests. I have the freedom to do what I want.” Another person said, “There is a choice of menu. The food is quite good. There is plenty to eat.” This was echoed by another person who said, “Food is good. We have choices.”

People confirmed that they have a choice of activities. A person said, “We do have activities. There is a fête twice a year and trips.” Another commented, “There are activities every afternoon: quiz, music, exercise. I can’t remember them all but they are written on the notice board daily.” This was echoed by another who said, “I join in all activities every day. I join in outings and trips like a visit to a garden centre and a canal boating trip.”