We Inspected the service on the 13 November 2018.

Homeacre is a residential care home for five people, some of whom may be living with dementia. At the time of our inspection four people were using the service. The service has spacious living areas and is set over two floors with a stairlift in place should this be needed. The service is set in a residential area with easy access to the local community and has a large garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good and 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.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). 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 had sufficient amounts to eat and drink to ensure their dietary and nutritional needs were met. The service worked well with other professionals to ensure people's health needs were met. The environment was appropriately designed and adapted to meet people’s needs.

The service was caring. Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

The service was responsive. Records showed people and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and when there was a change in care needs. People were provided with the opportunity to participate in activities which interested them. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The service was well-led. The provider had a number of ways of gathering people’s views. They held regular meetings with people and their relatives and used questionnaires to gain feedback. The provider carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

The inspection took place on 30 March 2016 and was unannounced. Homeacre provides accommodation and personal care and support for up to five older people. People who live at Homeacre may have a mental health need or may be living with dementia. The service is based in a semi-detached house, within a residential area, which has been furnished in a homely style to meet people’s individual needs. At the time of our inspection there were five people who lived in the service.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

Health and social care professionals we spoke with were all positive in their comments about the support provided to people at Homeacre.

The service had appropriate systems in place to keep people safe, and staff followed these guidelines when they supported people. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely. People received safe care that met their assessed needs. There were sufficient staff to provide people with the support they needed to live as full a life as possible. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

People were supported by staff who assisted them to make day to day decisions. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s health care needs were assessed appropriately and care was planned and delivered to meet people’s needs safely and effectively. People were provided with sufficient choices of food and adequate quantities to eat and drink and their nutritional needs were met. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people’s healthcare needs were well managed. Staff interacted with people in a caring, respectful and professional manner, and responded to people’s requests promptly and had a detailed understanding of people’s individual care and support needs.

People were supported to follow their own chosen hobbies and interests and encouraged to take part in activities that interested them and were supported to maintain contacts with the local community so that they could enjoy social activities outside the service.

There were systems in place to manage concerns and complaints. There was an open door culture and the manager and staff provided people with op

We spoke with two of the five people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the service and with staff. We also spoke with two staff members, the manager and provider. We looked at five people's care records. Other records viewed included staff training records, staff rotas, health and safety checks, medication records and satisfaction questionnaires completed by the people who used the service, their relatives and staff.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw appropriate processes were in place with regard to medication and it’s administration, so that people could be confident they were protected from the unsafe use and management of medicines.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "The staff are very nice and friendly."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People we spoke with told us they were provided with a good choice of meals on a daily basis. One person told us: “The food is lovely, all home cooked." Another told us: “The food is good, I am just not very hungry today."

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People's choices were taken in to account and listened to. People who used the service were generally provided with the opportunity to participate in activities which interested them. The daily care records viewed provided little information confirming activities undertaken.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People can therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We gathered evidence of people’s experiences of the service by talking with people who lived in the home and visiting relatives. We observed how people spent their time and noted how they interacted with other people and with staff. We saw that people were comfortable with staff and others who lived in the home and that there was a relaxed atmosphere.

People told us they were happy with the standard of care and comments in the home’s quality monitoring surveys were also complimentary. One person told us: “It's lovely here, they [the staff] are lovely.”

We saw that staff were knowledgeable about the needs of people who lived in the home, treated them with respect and provided care in ways that people preferred and that met their needs.

There were recruitment processes in place that ensured staff were suitable to work with vulnerable people; staff received support and training to make sure they had the skills and knowledge to care for people safely.

We gathered evidence of people's experiences of the service by talking with people, observing how they spent their time and noted how they interacted with staff and other people who lived in the home.

We saw that Homeacre provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people who used the service in a confident and considerate manner.

During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able to. Staff clearly understood each person's behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a caring and proactive way.

The planning and delivery of care did not fully ensure the welfare and safety of people. The staff team were well trained but were not fully supported to carry out their role by way of supervision.

The provider had effective systems in place to monitor the quality and safety of service that people received.

People who use the service were given appropriate information and support regarding their care or treatment.

People told us that their privacy, dignity and independence were respected and that their views on the support and care they receive are taken into account.

They also told us that generally they were able to make choices about aspects of their

care. For example, we spoke with two people about how they are supported to

choose what to eat each day. They told us that staff offered them a choice of meals each day and they could then choose where they have these. They were also able to make a decision as to whether or not they participated in social activities.

One relative confirmed they were happy with their relative's care and support and found staff to be kind and caring.

One person said, in relation to personal care, "Oh they are very good I always need help."

People were not all able to tell us whether or not they had been involved in the development of their care plans.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that ensured people’s safety and welfare.

People made the following comments:

"It's a nice home", "The staff and manager cannot do enough for you" and "I can eat what I like here and I feel safe".

They also said they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People told us when we visited that they liked the home and that they liked living there.

People also told us that they liked their rooms and found them comfortable and were happy at the home and liked the way it was presented.

People told us that they felt well looked after by the staff at Homeacre. One person said "I feel safe here and the staff and manager are like my family"

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.