The home was last inspected on 25 January 2016. At that inspection the home was rated as Good overall. At this inspection we found the service remained Good.

The inspection took place on 22 June and was unannounced.

The home provides accommodation for a maximum of 56 people requiring personal care. There were 36 people living at the home when we visited. A registered manager was in post when we inspected the service. 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 told us they felt safe around care staff and did not have any concerns for their safety. Relatives told us they had no concerns and that care staff understood how to keep their relatives safe. People were supported by staff that understood people’s health needs and the risks to people’s health that people lived with. Information was given to staff to help them to support people appropriately. People received help to take their medicines and people medicines were safely administered and stored. The registered manager made regular checks to ensure people received the correct support.

People were cared for by staff who had access to regular supervision and training. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Whilst people’s ability to make decisions was recorded and processes were followed to ensure people were not restricted unnecessarily.

People were offered a choice of food and drink and people requiring support were offered this at mealtimes. Staff kept families up to date about their relative’s care and encouraged them to visit whenever they chose to. People felt respected by staff that understood how to protect their dignity and maintain their respect. Staff demonstrated this knowledge by supporting people in a way that reinforced to people that they were being cared for in a respectful manner.

People were supported to take part in a wide variety activities they liked or had an interest in. People’s personal preferences were incorporated into their care. People and their families felt able to contribute their thoughts about their care. People understood they could complain if they chose to and felt assured their complaint would be responded to.

People liked the registered manager who they found approachable and willing to listen to them and discuss their care needs. Staff were positive about the registered manager and felt part of a team. People’s care was regularly checked and reviewed by the registered manager. However, some of the systems for ensuring people received the care they needed were still in the process of being updated and we could not be assured that the processes were fully embedded. We saw that whilst staff had received training and guidance on the MCA, staff did not understand who was affected by a Deprivation of Liberty. However, the registered manager took immediate action when this was brought to her attention.

Further information is in the detailed findings below.

The inspection took place on 25 January 2016 and was unannounced.

The home provides accommodation for a maximum of 56 people requiring personal care and nursing care. There were 31 people living at the home when we visited. A registered manager was in post when we inspected the service. 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 had confidence in the staff that supported them and felt staff received the appropriate training to care for them. Staff told us they were able to access regular supervision which provided them with feedback on their performance. People received their medicines on time and as prescribed.

Staff understood what it meant to obtain a person’s consent and the registered manager had acted in accordance with the law. People were offered choices in the food they ate and were offered support with their meals and drinks if needed.

People liked the care staff supporting them and felt relaxed around them. Care staff understood how to care for people by spending time with them and getting to know their needs.

People told us care staff treated them with dignity and helped to promote their independence. Friends and relatives visited whenever they needed to. People spent time with their relatives and were given space and privacy.

Although not everyone knew the registered manager, people felt assured that someone from the management team would be available to speak to them and discuss any concerns they may have.

Care staff enjoyed working at the home and felt able to discuss any issues they had with the registered manager. Care staff were able to attend staff meetings and raise issues that affected them.

The registered manager used feedback to help influence services at the home. A number of means of communication were used to help advise people about how services had changed based on feedback they received.

The registered manager made regular checks of the service to ensure people received the care they needed. The registered manager updated the registered provider frequently about the home. This ensured the registered provider understood and had an oversight of the quality of care being delivered at the home.

39 people were living at the home when we visited. We talked with three of them as well as four people who were visiting relatives. We also spoke with the manager and four members of staff including nursing, care and catering staff.

The people we spoke with told us they were happy with the home and the staff. One person told us: “The staff are very good, very kind.” One of the visitors told us: “All of the staff are fantastic.” Another visitor said: “We are really happy, the staff are lovely.”

We watched staff as they cared for people. They provided care and support that met people’s needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for five people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found that the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were supported to be trained to an appropriate standard and we looked at records which showed that the provider was regularly monitoring the quality of its service.

The manager of the home was not registered with CQC at the time of our inspection. We discussed the requirement to register with the manager and have escalated this to the registered provider.

People we spoke with told us they were happy. They told us staff included them in their treatment and they knew what to expect from it. People also told us staff treated them with respect and they appreciated the support they were given. Some relatives who were visiting the home told us they were kept informed of any changes in their relative’s condition and that they were involved in making decisions about that care.

We saw how the staff interacted with people living in the home. We saw some positive interactions and staff being attentive to people’s needs.

One person told us, “the staff here are golden and they can’t do enough for me”. Another person said “I do worry about the staff because they seem busy but they never rush me”.

However, we also saw staff using terms of endearment towards people who used the service; this included calling people “beauty”, “precious” and “little man”. On one occasion we saw staff hug and give a kiss on the cheek to two people using the service. It was clear from the facial expressions of these people that one person had enjoyed the interaction, the other person had not. They demonstrated this by screwing their face up and turning their head away. We spoke with the registered manager about what we had seen. The registered manager agreed that this was an area for improvement and would be acted upon.

We spoke with two people who used the service. They told us they felt safe and well cared for in the home. One person said, “I have always felt safe here”.

The atmosphere in the home was very homely and relaxed. People we spoke to appeared physically well cared for and comfortable in the environment.

Visitors were welcomed into the home and we saw that staff on duty had developed good relationships with them.

When we walked around the home in the morning we saw staff serving breakfast to people. People were being offered both hot and cold options as was their individual preference and were able to make choices about whether they wished to have breakfast in bed or to sit out in a chair.

People told us that they were able to make choices about where to spend their time and whether they want to have a bath or shower. They said staff helped them to meet their personal hygiene needs where necessary.

When we spoke to staff they had a good understanding of peoples current care needs and preferences however this information was not reflected in the care documentation we saw. During our visit we looked at range of records which included reviewing the care records for three people who used the service. Not all of the records we saw were up-to-date and accurate.

At the time of our visit the home had one part time activities coordinator and was recruiting for an additional full time activities coordinator.

On the afternoon of our visit a Christmas party was being held in the home led by the home’s activity coordinator. Some staff who were not on duty had come in to provide additional support and join in the event along with people’s friends and family members. Staff were taking care to ensure that people who were being cared for in their rooms or who had chosen not to attend the party were offered party foods and drinks like everyone else.

Since our last visit work had been taking place to refurbish a bedroom on the first floor as part of ongoing plans which would see the creation of a communal lounge for people living on that floor.

People told us that staff cared for them well. One person told us that day staff were very good to them and respond promptly when they called for assistance. They said that if they called for help during the night staff could sometimes take longer to respond.

When we spoke with staff they told us that staffing levels were variable and that mealtimes were particularly busy. They felt that more staff were need to care for people living on the ground floor as dependency levels had increased although they said people did not generally wait long periods for help.

Staff also reported that they had very limited time to sit and socialise with people living in the home although they recognised that people liked them to do this and it was good for their social and emotional well being. They said that most of their time was spent on personal care tasks which had to be undertaken.

The same issues were highlighted by a visitor to the home who commented that staff were very busy and the home was sometimes short staffed and that people who spent time in their rooms rather than accessing communal areas could spend long periods alone with no stimulation.

Staff told us that they felt that people were kept safe and well cared for. They said that if they should ever witness anything which may be considered as abuse they feel they would be able to report this to senior staff who were aware of the procedures that they should follow.