The inspection took place on 30 October 2018 and was unannounced. This meant the provider did not know we would be visiting.

At our last inspection in May 2016 we rated the service good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the evidence continued to support the rating of good.

Half Acre House is a 'care home'. People in care homes receive accommodation and nursing or 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. Half Acre House can accommodate up to 29 older people. At the time of our inspection there were 27 people using the service.

A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. At the time of our visit, the manager had been in post only three weeks although they had worked at the home several years previously. The manager told us they would be applying to register with CQC.

People we spoke with told us they felt safe at Half Acre House. Staff had been trained in safeguarding issues and knew how to recognise and report any abuse.

People’s medicines were managed and stored safely. We saw the environment was clean and well maintained.

There were enough staff to meet people's needs. Any new staff were appropriately vetted to make sure they were suitable and had the skills to work at the service. The staff were given support by means of regular training, supervision and appraisal.

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 supported this practice.

Peoples dietary needs were well recorded and supported.

There were friendly relationships between people and staff. People told us that staff treated them with dignity and respect and their wishes were listened to.

People’s health and mental well-being was well monitored. Staff responded promptly to any changes in the person’s health or general demeanour.

A new activity co-ordinator was in post and they were being mentored by an experienced co-ordinator from another service who was sharing their ideas and knowledge about activity planning.

Care records were all maintained although some work needed to take place to ensure people's end of life wishes were captured. The manager had begun to address this on the day of our visit.

People told us they knew how to raise a concern if they were unhappy with anything and we saw people were asked about their views of the service through meetings.

Systems were in place for auditing the quality of the service and for making improvements. We saw the manager was keen to share learning from incidents and to take forward improvements they had identified through their quality assurance process.

Half Acre Care Home is purpose built with accommodation on three floors. It is registered to provide accommodation for up to 32 older people who require personal care.

The service were last inspected in July 2014 when the service met all the regulations we inspected.

We undertook this inspection on 11 and 12 May 2016. This comprehensive inspection was unannounced and conducted by one inspector.

The service had 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.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

People who used the service told us the food was good. We observed one mealtime, which was served in the garden at the request of people who used the service. The meal was a social occasion and ten people took advantage of the good weather.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record kept of any complaints and we saw the manager took action to investigate any concerns, incidents or accidents to reach satisfactory outcomes. There had not been any complaints since the last inspection.

Staff, people who used the service and family members all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

People who used the service and their relatives were asked about their views of the service and action was taken to make any improvements suggested.

There were sufficient activities to provide people with stimulation if they wished to join in.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• 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 and with their relatives, speaking with the staff supporting them, and from looking at records.

Is the service safe?

People were protected against the risk of unsafe or inappropriate care. This was because their care records provided good information to guide staff on the care, treatment and support required.

The staff we spoke with showed they had a very good understanding of the needs of the people they were looking after.

People were provided with a choice of suitable and nutritious food and drinks to ensure their nutritional needs were met. People we spoke with told us, “The food is good and we get enough”.

The management and administration of people's medication was safe. Medicines were stored securely and people received their medicines when they needed them.

Is the service effective?

People's health and care needs were assessed before they were admitted to the home to ensure their individual needs could be met.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

We saw there was a system in place for sharing essential information, for example if a person required admission to hospital in an emergency.

Is the service caring?

The people we spoke with were complimentary about the care provided. Comments made to us included; “They are all very nice, no problems” and “I am fine but I do get a bit bored sometimes". Also, “The staff are very attentive, very caring and they keep me informed” and “The staff are really very good”.

Is the service responsive to people's needs?

Information in the care records showed the staff at the home involved other health and social care professionals in the care and support of the people who used the service.

People who used the service were offered opportunities to comment on the care and support they received.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and had the necessary skills and experience to undertake the role.

There were a number of quality assurance systems in place to ensure people were cared for safely.

Meetings were held regularly for staff and people who used the service to give them the opportunity to be kept informed of any developments within the service and also to express their views about the service and facilities provided.

During our visit to the home we spoke with four people using the service, two relatives and three staff. People using the service were asked if they felt they were being looked after properly. Comments made included; “Staff ask me regularly how I am and I feel safe and well cared for” and “They know you and look after you when you feel a bit off”. The relatives we spoke with told us they were very happy with the care provided. They told us, “It’s a really good place to be, the staff are great” and “I can’t fault it”.

People's care records contained enough information to show how they were to be supported and cared for. They also showed that, where they were able to, people gave consent to their care and treatment. Systems were in place to protect people who were not able to make decisions about their own care and support.

People using the service, relatives and staff told us they felt there were enough staff on duty at all times to care for people safely. People told us they were never kept waiting when they needed help. During our visit, we found that people were provided with the support they needed when they needed it.

A satisfactory system was in place for checking the quality of care and the facilities that the service provided.

People were protected against the risk of unsafe or inappropriate care and treatment because records required to protect their safety and wellbeing were accurate and up to date.

During our visit to Half Acre Care Home we spoke with four people using the service. They were complimentary about the staff and the care provided. People told us that the staff were kind, they were well looked after and they were given their medicines when they needed them.

Some of their comments were:

"They are all very nice".

"I have been here for several years and the staff are just fine".

"I have no complaints, they look after me well".

"They are lovely, very nice indeed".

“They know what I need”.