About the service: Gateford Hill Care Home is a care home that provides accommodation with nursing and personal care for up to 66 older people and younger adults with physical disabilities. On the day of our visit there were 52 people using the service.

People’s experience of using this service: People told us they were happy living at the service. Relatives were also positive. One family member told us, "The staff here are really good. They try their best and visitors are made welcome as well. I’ve only ever seen kindness."

Staff recruitment was safe. There was enough staff on duty at the right time to enable people to receive care in a timely way. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. They understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm.

People told us care staff were caring, supportive and kind. We observed staff members supporting people in a dignified and confidential manner. There was also lots of laughter and fun and people and their relatives said they enjoyed positive relationships with the staff team. The environment was tired in some areas and the registered manager explained there was an ongoing refurbishment programme in place.

People told us they were happy with the food. We saw that people with specific dietary needs were well catered for and the chef had detailed records to ensure people's needs were met. The registered manager agreed to review the use of TVs and radios at mealtimes.

Care plans were detailed but focussed on healthcare needs. We discussed with the registered manager how plans could be made more person-centred, meaning people were at the heart of how they wanted their care and support to be provided. There was a lack of life history information and goals and outcomes people wanted to achieve. The registered manager agreed to explore this further with their regional director.

We saw staff upheld and promoted people’s rights relating to equality and diversity. People told us that staff treated them respectfully and without judgement. People participated in a range of activities that met their individual choices and preferences.

The service was well run. The management carried out lots of checks to make sure that the service was safe and of a good quality. People had good relationships with the staff team. The registered manager and senior team led the staff team in their roles and ensure people received a good service. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to make continuous improvements to the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at the last inspection: The service was rated as good and the report was published in August 2016.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We performed the unannounced inspection on 7 and 8 July 2016, Gateford Hill Care home is run and managed by Countrywide Care homes Ltd. The service provides residential and nursing care for 65 people over the age of eighteen. On the day of our inspection 54 people were using the service. The service is provided across three floors divided into four units.

The service did not have a registered manager in place at the time of our inspection, the present manager was in the process of registering with the Care Quality Commission. 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 and associated Regulations about how the service is run.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager shared information with the local authority when needed.

The risks to people’s safety were assessed and reviewed on a regular basis. These risks were managed in such a way as to both protect people and allow them to retain their independence both in the home and out in the community.

Staffing levels in the home were sufficient and the manager regularly reviewed and maintained safe staff levels dependant on the needs of the service. People received their medicines safely from suitably trained staff. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition. Specialist diets were provided if required. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care, they were treated in a caring and respectful manner. Staff delivered support in a relaxed and considerate manner.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their care and their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

The inspection team who carried out this inspection consisted of two inspectors to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with four people who used the service to help us understand their experiences. We also spoke with one person’s relative.

We spoke with two representatives from the management team and two care staff. We also looked at some of the records held at the service which included support plans and staff recruitment records.

Is the service safe?

We spoke with four people who used the service and asked them if they felt that they received their care and support in a safe manner. One person told us, “I am more independent because I am here. I would not have wanted to live on my own. Being here means I don’t have to worry about things and I’m safe.” Another said, “The staff have made a real effort to get to know me and all about me. They come and talk to me throughout the day. It is very nice here and I’m not worried about anything.”

Records showed an effective recruitment system was undertaken to ensure staff employed to work at the home were suitable. We also found that staff were able to participate in training events pertinent to their roles and responsibilities at the home.

We saw up to date policies and procedures were available, these included a whistle blowing and safeguarding adult’s policy. Staff told us the policies were accessible at all times and they felt confident that they could initiate the whistle blowing policy without fear of recrimination.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted the manager told us that as the lead clinician, they had received training to understand when an application should be made, and how to submit one.

We found that an on call system was in operation to ensure a member of the management team would be available at all times should an emergency situation arise.

Is the service effective?

Systems were in place to ensure that the individual needs of people could be identified and met. People told us they were happy with their care package as it met their individual needs and preferences. They also told us they felt the staff were knowledgeable about peoples individual needs.

Is the service caring?

We observed staff speaking with and supporting people in a sensitive and caring manner which promoted people’s respect and dignity at all times.

We asked people about the quality of the care they received. One person told us, “The care and support I receive has always been very good and I am happy with the way staff assist me." Another person said, “I know all about my care plan. The staff always talk to me about what I want and how I would like them to help me."

A visitor to the home also told us, “I don’t think there is a better place for my relative. Everything they need is provided and the staff are like our extended family. I never have to worry about my relative because these people really do care.”

Is the service responsive?

We found that systems were in place to ensure that effective assessments could be performed to determine the holistic needs of people. We also found the manager had used information from people’s relatives and professionals, such as social workers, when available so as to build a comprehensive picture of people’s individual needs and how they were to be met.

We found people's care planning documentation was reviewed on a regular basis to ensure it was up to date and reflected people’s individual needs.

Is the service well-led?

We found the management team were fully aware of their roles and responsibilities and what was expected of them. They demonstrated a commitment to deliver a good standard of care to people residing at the home.

Staff told us they received appropriate support and direction from the management team, both informally and at formal staff supervision sessions. Staff told us they felt they could express their views and discuss any developments within the home.

We found the manager was conducting annual satisfaction surveys which were designed to highlight the views of people who used the service, their relatives, staff and other stakeholders such as healthcare professionals. We also saw the results of the surveys were being used to make improvements to the services provided.

Records showed people had attended meetings arranged by the manager. These enabled them to discuss and share their views about the service. The records showed that people were encouraged to contribute to the development of the service in relation to the provision of social activities and food, together with decisions about the décor within the home.

We found that auditing procedures were in place to determine if the home’s environment was fit for purpose. The manager showed us how they had used information gleaned from the auditing process to identify shortfalls in in some of the communal bathrooms and how actions were being taken to upgrade these areas. We also found that an extensive environmental improvement plan was underway which included the redecoration of bedrooms and the replacement of worn carpets. This showed that the manager was proactive in auditing the homes environment and improving the quality of the environment for people residing at the home.

During this inspection there were 62 people using the service. We spoke with five people who used the service, two care staff, the registered manager and the maintenance person. We also spoke with three relatives who were visiting family members.

All of the people we spoke with who used the service told us that they were happy with the care and support they received. One person told us, “I’m delighted to have found such a great place in which to recuperate.” Another told us “I feel safe here”.

The people we spoke with told us that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed. All of these told us they felt safe, knew how to raise any concerns they might have, and that staff treated them with respect.

Staff we spoke with told us the provider was good in terms of ensuring that training was up-to-date and that the provider had given them a lot of support in their professional development enabling them to undertake further, more advanced, professional training. Also that they really enjoyed working at the service, some of who had worked there for many years.

The relatives we spoke with who were visiting family members told us they were happy with the care and support their family members received. One relative told us “I am delighted with the care they [care staff] have given to [relative’s name].”

During our visit we spoke with four people who use the service, four staff and with the Manager of the service. We also spoke with three people who were visiting family or friends currently living at the service.

All of the people we spoke with who use the service told us that they were happy with the care and support they received. One person told us “Staff are very caring.” Another said “I feel safe here”. Another person told us “I enjoy being here because I can do things I like to do”.

People told us that staff supported their health and personal care needs and took prompt action to get them medical attention when it was needed; said they felt safe in the service and knew how to raise any concerns they might have; and that staff treated them with respect.

All of the staff we spoke with said the provider was very good in terms of ensuring that training was up-to-date. Staff also told us the provider had given them a lot of support in their personal and professional development enabling them to undertake further, more advanced, professional training. All of the staff we spoke with told us they really enjoyed working at the service, some of which had worked there for many years.

The visitors we spoke with who were visiting family or friends all said they were very happy with the care and support they had witnessed on their visits. One of these visitors told us “I think staff have a difficult job, but they really do go out their way to do their best”.