Gifford House is a care home providing nursing and personal care for up to sixty-one elderly people. The service is divided into three units. Betts unit on the ground floor provides nursing care including palliative care. The Linford and Radcliffe units on the first floor provide care for people living with dementia. There were 58 people using the service at the time of our inspection.

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were safe at the service. Staff knew what to do to protect people from abuse. Risk was well assessed and managed so that risks to peoples’ safety were minimised. There were enough nursing and care staff to meet people’s needs. People were supported to take their medicines as prescribed

Staff had been safely recruited and had the necessary skills to meet a wide range of needs. We found however they did not consistently have the skills or guidance necessary to support people with dementia in line with best practice guidance. We have therefore made a recommendation about improved staff training and care planning in the area of dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff supported people to maintain good health and wellbeing and enabled them to access other health and social care professionals when required.

Staff knew people well and treated them with kindness and respect. People’s privacy and dignity was maintained.

The care provided was personalised and responsive to individual needs. People had access to variety of activities and pastimes. Detailed care plans were in place. The manager had put plans in place to improve the quality of the care plans. Complaints were responded to well and people felt enabled to share any concerns they had about the service.

There was a strong and effective manager in place who dealt pro-actively with concerns. They supported staff and promoted a positive culture and atmosphere which benefitted people who used the service. Whilst there was a need to improve the checking of care plans, we found all other checks on the quality at the service were robust and led to improvements. The provider and manager worked well together and had a joint vision for the service.

Further information is in the detailed findings below.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was unannounced which meant the provider and staff did not know we were coming. At the last inspection on 8 February 2014 the provider met all the requirements we looked at.

Gifford House Care Home is a purpose built care home that provides a service for up to 61 older people who may have care needs associated with dementia. Nursing care is provided. The home offers accommodation over two floors, and is divided into three units. Betts Unit on the ground floor provides palliative care. Linford and Radcliff Units on the first floor provide care for people living with dementia. All bedrooms are for single occupancy and have an en-suite facility. There were 58 people using the service at the time of our inspection.

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were happy with the service they were receiving and we received many positive comments about the service, the management and the staff team.

We saw that there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. We saw from the records we looked at that the service was applying these safeguards appropriately. This was through assessing people’s capacity and making appropriate referrals to the supervisory body, (the local authority,) if people’s liberty was being restricted.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way. From the six people’s plans of care we looked at we found that the information and guidance provided to staff was clear. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe.

During our observations throughout the day we saw that staff clearly knew how to support people in a ways that they wished to be supported. On the day we inspected we found that sufficient numbers of staff were being provided to meet people’s needs.

Staff had the knowledge and skills that they needed to support people. They received training and on-going support to enable them to understand people’s diverse needs and work in a way that were safe and protected people.

We saw that staff respected people’s privacy and dignity and worked in ways that demonstrated this. Staff knocked on people’s doors and asked for permission before providing any personal care.

Records we looked at and people we spoke with showed us that the social and daily activities provided suited people and met their individual needs. People could make their own decisions about if they undertook activities or not. People’s preferences had been recorded and we saw that staff respected these.

Records viewed showed that people were able to complain or raise any concerns if they needed to. We saw that where people had raised issues that these were taken seriously and dealt with appropriately. People could therefore feel confident that any concerns they had would be listened to.

The provider used a variety of ways to assess the quality and safety of the service that it provided. People using the service and their families were consulted with. The organisation undertook a range of monitoring and areas such as health and safety and medication were regularly audited.

The management team at the service were well established and provided good and consistent leadership.

We spoke with seven people who were using the service and/or their relatives. The majority of comments we received were very positive about the care offered and facilities. One relative said that the care was "excellent" and that staff knew the people they cared for and their needs. They said their relative had recently has a heart attack and that staff had noticed that they were unwell and acted before the heart attack happened. Another person and their spouse said they would give the home "ten out of ten".

We spoke with two relatives who had some concerns. One person said they often came in to find their relative sat awkwardly in their bed or chair and that they had to make them comfortable. They said that staff were very good, but they felt there were not enough on duty. They were happy for us to raise this with the manager, which we did. The manager also said that they would speak with the relative to discuss their concerns in more detail.

Another relative said they were happy with the care but sometimes felt that staff could attend to their relative’s personal hygiene needs better. Again, we raised this with the manager who gave assurances that this would be investigated.

We found that Gifford House was meeting all of the essential standards we looked at. People's care was individualised and met their needs; medication was well managed; staff were properly recruited; the premises and facilities were well maintained and complaints were properly handled.

We used a number of different methods to help us understand the experiences of people living at Gifford house. We spoke to the relatives of eight people, who told us they were kept informed through written information, relatives meetings, news letters and discussions with staff regarding the care and treatment choices available to people who lived at Gifford house.

An anonymous concern had been raised recently with the Care Quality Commission (CQC) about support and care provision for people with dementia within the home. We spoke to eight staff, four people who use the service,nine relatives and a social worker, looked at care plans, observed care services in the home and found no significant concerns.

All the information we have indicates that safeguarding procedures were well understood by management and staff at the home. People and visitors we spoke with told us that they felt that the staff had the necessary skills and experience required to meet the needs of the people living there. People told us that they were well looked after by the staff. One person with whom we spoke said "The staff were lovely and willing to help you if you need it.”

The records we viewed showed that training and supervision processes were in place.The majority of people we spoke with were positive about the quality of service provided by Gifford house, the only concern remains the retention of staff which the provider is aware of.

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit on 10 November 2011 we were able to hold a conversation with three people and two relatives. Most of the information about people's experiences of Gifford House was gathered through our observations.

One person we spoke with told us “I am quite happy here.” I have a bath three times a week.” A relative we spoke with told us ”The care staff are lovely, very motivated. The personal care is very good; I feel X is safe and that X is reassured by them.” One person told us “I can go away from here and know X is in good hands. If anything happens, you’ll always get a phone call.”

People living at Gifford House told us that they liked their rooms. One person said “I am quite happy here.” A relative told us that the cleaners are always in the home and there are no issues with the standard of cleaning. Another person told us “I requested the carpet to be cleaned and they did it.”

People we spoke with told us that there had been a high turnover of staff in recent months and agency staff had been employed. They told us that during that period there had been some issues with the attitude of some staff and the quality of care provided.