About the service: Hickathrift House is a residential care home that provides care and accommodation for up to 57 people, some of whom are living with dementia. At the time of our inspection, 49 people were using the service.

People’s experience of using this service:

There were enough staff on duty to enable people to remain safe and receive care in a timely way. Accidents and incidents were analysed to prevent re-occurrence. The environment was safe, and people had access to appropriate equipment where needed. The premises were clean and followed infection control guidelines. People were supported to take their medicines in a safe way. Staff were safely recruited, they knew how to keep people safe from avoidable harm.

Staff were kind, caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

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. People were supported to pursue their hobbies and interests.

People and relatives told us that the service was caring and well led. The registered manager provided staff with leadership and was visible and approachable. Staff were motivated and enjoyed strong team work. Information from audits, incidents and quality checks was used to drive continuous improvements to the service people received.

Rating at last inspection: Good (Published July 2016)

Why we inspected: This was a scheduled inspection based on our previous rating.

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.

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

The inspection took place on 25 and 26 May 2016 and was unannounced.

The home is registered to provide accommodation with personal care for up to 52 older people. On the day of our visit there were 48 people living at the home, some of whom were living with a dementia.

There was a registered manager at the service, who was permanently based onsite. 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 2008 and associated Regulations about how the service is run.

People told us that they felt safe living at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspicions of abuse.

There were sufficient staff numbers on duty to keep people safe and to meet people’s needs. Safe staff recruitment procedures were in place, which ensured only those staff suitable to the role were in post.

The home followed procedures to identify risks and protect people from harm. Risk assessments were in place and regularly reviewed. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to relevant health care professionals.

Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were knowledgeable about MCA and DoLS and had received training. There were appropriate referrals and applications had been submitted to the relevant body. Staff sought consent from people regarding their care and from relatives where appropriate.

Staff showed good knowledge of working with people living with dementia and had received appropriate training to deal with all elements of care delivery.

People health care needs were assessed, monitored and recorded and referrals for assessment and treatment were made. Where people had appointments within healthcare services, staff supported them to attend these.

Staff were caring and they knew people well, they supported people in a dignified and respectful way. Staff acknowledged people's privacy. People felt that staff were understanding of their needs and provided support during periods of distress. Staff had positive working relationships with people. People living at the home told us that staff listened to their wishes and carried out care services in response to their requests. Care was based on people’s individual needs and was person-centred. People and their relatives were fully involved in the assessment of their needs and in care planning to meet those needs.

Quality assurance systems were in place that reviewed the quality of the service that was provided. The views of people, relatives, health and social care professionals were gathered as part a quality assurance process.

All of the people who we spoke with were satisfied with the quality and standard of their support and care. Assessments of people’s risks and health and social care needs were carried out and planned. People received their support and care as planned.

Arrangements were in place to ensure that people who used the service had access to safe equipment.

People who used the service liked the staff and said that the staff looked after them very well. Staff were supported to do their job, which they said was rewarding. There were arrangements in place for staff to attend training relevant to their role.

There were systems in place which allowed people to make their views and suggestions known and actions were taken in response to these. There were also systems in place to analyse information regarding any untoward events, and to take remedial action, if required, to improve the quality and safety of the service provided.

Following our last inspection visit, which we carried out on 29 August 2012, remedial action was taken by the provider to become compliant with the regulation.

People were supported by staff who now had access to improved and up-to-date information about people’s individual support and care needs. Because of this improvement, people who used the service now received an improved standard and quality of care which minimised risks to their health and promoted their dignity and well being.

We found that there were effective systems in place to ensure that people were given opportunities to make valid decisions to give their consent to be assisted with their support and care needs.

We found that people were supported by attentive and caring staff. People told us that they had no complaints to make and said that they felt their support and care needs were being met. A visitor to the home told us, "They do everything right here. I can't fault it.” Other people who we spoke with said that there was a, "Community spirit" within the home, which they appreciated. Care plans were detailed but we found that some of these had not been reviewed for more than one month. The standard of people's personal care was variable and areas required more attention to improve the quality of this.

People said they liked their rooms. The home was accessible and safe for people who used the service, staff and visitors.

Effective recruitment and selection systems were in place to ensure staff were suitable to work with vulnerable people.

There was a suggestion, compliments and complaints system in place and information about this was publicly available. People who we spoke with were satisfied with the standard and quality of their care and had no concerns about these.

We spoke to several people who use the service when we visited the home. They stated that they liked living here and one person explained: “I love living here. I can get up and go to bed when I want. I have my room which is mine, staff do not go there. When they come to me, they always knock on the door. I do feel safe here. I don’t want to socialise with others too much and there is no pressure on me to be with the others.”

One person stated that the home “is very good” and stated that, “Staff always come when we need them. There is always someone around when we need them”.

Five people told us that they felt safe and respected in the home.

One person told us that they wanted to have their bedroom door open so that they could see people walking by. Staff confirmed that this wish was respected.