Goatacre Manor Care Centre is a nursing and residential care home for up to 48 older people. At the time of the inspection, there were 31 people living at the service.

At our last inspection we rated the service as good overall, however the service required improvement in Safe. At this inspection we found the service continued to require improvement in Safe. The service requires improvement in safe because of issues with the documentation for the administration of medicines. In all other domains the service remained good and therefore is rated good overall.

This inspection report is written in a shorter format where the domain remains good.

Two recommendations have been made in safe. The recommendations are regarding the information recorded in protocols for medicines administered on an 'as and when required' (PRN) basis. Also, for the consistency in recordings of administration for prescribed topical medicines, such as creams and lotions.

One recommendation has been made in effective. The recommendation is regarding the recoding of best interest decisions.

One recommendation has been made in responsive. The recommendation is regarding the quality of information recorded in behavioural support plans.

People and their relatives spoke positively about the staff and management. Relatives praised the staff for the support they received while their loved ones received end of life care at the service.

Staff had a good understanding of the Mental Capacity Act (MCA) and applied the principles of the act to the care they provided. However, the assessments for the MCA lacked detail and did not include details of a best interest decision.

There was a friendly and relaxed atmosphere and people were comfortable in the environment. People and staff spoke with one another as though they were good friends.

The registered manager was passionate about continuing to improve the service and had long term development plans for this. This included building a cinema room.

Further information is in the detailed findings below.

Goatacre Manor Care Centre is a family run home and is registered to provide accommodation for up to 48 older people who require nursing and personal care. On the day of our inspection there were 32 people living in the home.

We carried out this inspection over two days on the 29 and 30 April 2016. The first day of the inspection was unannounced. During our last inspection of the service in July 2014, we found the provider satisfied the legal requirements in all of the areas we looked at.

The service had a registered manager in place. 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. 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 to be well led.

People and their relatives spoke positively about the overall care and support provided. This included positive comments about care staff and the management team.

Interactions between staff and people showed positive relationships had been established and staff knew people well. Staff were consistently caring, respectful and attentive in their approach to people. People looked relaxed in staff’s company and did not hesitate to ask for support and help. People were supported to take part in activities and there was involvement with the community with people attending local events and hosting events within the home.

People’s medicines were managed safely to ensure they received their medicines as prescribed and at the correct time. People received support to meet their health needs which included being supported to attend appointments. Feedback we received from health professionals stated that people’s health needs were met appropriately and concerns were raised in a timely fashion.

People had access to a range of foods and drinks, with their preferences being noted and shared with kitchen staff. Where required specialist diets were available such as pureed or fortified foods. People spoke positively about the food choices explaining alternatives were always available should they not want what was on the menu.

The planning and delivery of people’s care and support was developed with them or those acting on their behalf. Risks had been identified and plans developed to say how these would be managed and reviewed. People had comprehensive care plans that informed staff of their needs and how they wished to receive care.

There were enough competent staff on duty who had the right mix of skills and experience to ensure they could safely meet the needs of people using the service. Staff received regular training in relation to their role and the people they supported. Staff received regular supervisions and appraisals, where they could discuss personal development plans. This meant that staff were properly supported to provide care to people who used the service. Staff told us they felt very well supported and understood the home’s ethos and values.

The registered manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have the capacity to make decisions themselves, mental capacity assessments were in place and records showed that decisions had been made in line with best interests. Where required Deprivation of Liberty Safeguarding applications had been submitted by the registered manager.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours. Regular maintenance of the home was undertaken to ensure the safety and suitability of the premises. A call bell alarm system was in place to ensure people who use the service could call for help w

One inspector visited the home and answered our five questions, is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 two people using the service, their relatives, four staff, the manager and the provider. We reviewed six care plans and other relevant records. Additionally we used the Short Observational Framework for Inspection (SOFI) observation for a forty minute period.

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. They were detailed and ensured staff cared for people in a safe way.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home liaised effectively with the local authority DoLS team and had made applications as appropriate. The home had made two DoLS referrals in 2014.

The home’s staff were trained to recognise any signs or symptoms of abuse and knew how to report any concerns. The service investigated any unexplained bruising or injuries thoroughly to be sure that they did everything they could to prevent repetitions.

The home had enough well trained staff to enable them to work safely with the people who lived in the home. The home took the appropriate disciplinary procedures if staff were not giving people care to appropriate and acceptable standards.

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to the people who lived in the home, staff and visitors.

People told us they felt very safe in the home. Families told us that they had: ‘‘no concerns with regard to abuse of any sort’’

Effective?

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people’s needs and how they should be met. They were reviewed regularly and changes were made to meet people’s changing needs. We saw that staff gave support as described in individuals’ care plans.

We observed staff meeting people’s needs in an effective way and people told us they felt the home met their needs. They told us that staff were helping them to gain confidence and made them feel they could look after themselves safely. We noted that some people were enabled to return home or to live more independently after a period of rehabilitation.

Caring?

People were supported by kind, caring and patient staff. We saw that care staff were attentive, encouraging and positive. Throughout most of the visit we observed that staff communicated with people and encouraged interactions between people using the service. However, some communication issues were noted during the SOFI observation.

People's diversity, values and human rights were respected. Care plans were individualised and person –centred. We saw that people were treated with respect and dignity by the staff team.

Responsive?

We saw that health care was sought in a timely way and the home co-operated with other health care professionals to make sure their healthcare needs were met.

The home had made changes and improvements as a result of ideas and discussions with people who lived in the home and their relatives.

We saw that the manager responded quickly to any complaints, especially those relating to the standard or quality of care people received.

The home demonstrated that they learnt from incidents and the investigations they completed.

Well led?

We saw that staff were well trained and meeting the needs of people was a priority of the staff team. We saw that communication amongst the staff team was, generally, good. Staff told us they felt valued and their opinions were listened to and acted upon, as appropriate.

The service had an effective quality assurance system. We saw records which showed that identified shortfalls and ideas people put forward were addressed. Several examples of changes made as a result of the regular satisfaction surveys were provided by the manager and the provider. As a result the quality of the service was being maintained or improved.

The inspection took place over two days and was in response to information regarding people's care not being met during the night and early morning. We spoke with eight people who used the service, three relatives and ten members of day and night staff. We looked at six people's care records and daily record of a further two people to follow through on observations we had made during the inspection.

The people we spoke with told us they were satisfied with the care they received. One person told us " all very nice here. Staff especially. They know what's good for you." Another person said "This is a real home. Staff are very good."

We observed staff who were patient and kind. The care we observed was safe and effective. People's care records included sufficient information to enable staff to support people with the care they needed and wanted. Care records were updated regularly.

Staff we spoke with told us they felt well supported. We saw from training records staff attended regular training. We looked at staff rotas for and noted the staffing levels met the provider's requirements. Staff we spoke with told us they felt overall there were enough staff to meet people's care needs.

The provider had systems in place to monitor the quality of the service. The provider maintained up to date records of maintenance and equipment checks.