About the service:

Honey Lane is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Honey Lane Care Home is registered to accommodate 41 older people, who have needs associated with dementia. At the time of our inspection there were 37 people living in the service.

People’s experience of using this service:

Activities within the home were extremely person centred. A range of meaningful activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day, seven days a week and were developed in line with people's preferences and interests.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people's likes and dislikes, and staff spoke with people in a friendly manner. Our observations during inspection, were of positive and friendly interactions between staff and people.

The provider had responded to feedback relating to staffing levels from staff and relatives and had recently increased staffing at the service at a busy time. All staff had attended safeguarding training. They demonstrated a clear understanding of what abuse was and how to report concerns.abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Risk assessments were in place, which identified possible risks and how to manage them.

Staff told us they received the support and training they needed to help them do their jobs well. The managers were proactive in ensuring staff completed training relevant to the needs of people living at the service. The registered manager responded and took action straight away when we identified an issue with staff practice. The service provided specialist training to enable staff to care for people with particular needs.

People were supported to eat and drink. The registered manager took immediate action to ensure fluids were recorded appropriately when active monitoring was required. 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.

The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required. People and their relatives felt able to speak to the registered manager or any of the staff team at any time if they needed help and assistance.

Rating at last inspection: Good (report published 6 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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.

The inspection took place on 15 June 2016 and was unannounced. When we last inspected the service on 26 June 2014 we found the service was meeting the required standards at that time.

Honey Lane provides accommodation for up to 41 people who have needs associated with dementia. It does not provide nursing care. At the time of this inspection there were 36 people accommodated at Honey Lane.

A registered manager was in post at 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 2008 and associated Regulations about how the service is run.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority.

People and their relatives told us that they felt people were safe living at Honey Lane. Staff and management were knowledgeable about safeguarding matters. Risks to people`s mobility and general safety were identified and risk assessments had been developed to mitigate these risks.

Our observations during the inspection confirmed that staffing levels in the home were appropriate to meet people's needs. Staff members did not start to work at the home until satisfactory employment checks had been completed.

There were suitable arrangements for the safe storage and disposal of people's medicines.

People were supported to make meaningful meal choices and people were assisted to eat in a calm and unhurried manner. However, measures to monitor people who were at risk of dehydration and malnutrition were not effective.

People received care and support from a staff team who had the knowledge and skills necessary to provide safe and effective care. Staff asked people for their consent before they delivered all aspects of care.

People's health needs were well catered for. People were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual's needs and preferences and people were involved in the planning of their care where they were able.

Visitors were encouraged at any time of the day and people's privacy was promoted. We observed sensitive and kind interactions between staff and people who used the service.

Care was centred on the needs of individuals. There were arrangements for activities and stimulation in the home.

Meetings were arranged with people who used the service, and their relatives to facilitate feedback about the quality of the service provision. People were confident to raise anything that concerned them with staff or management and satisfied that they would be listened to.

People who used the service, their relatives and staff members found the home manager to be approachable and supportive.

During our inspection we spoke with eight people who used the service, eleven support and ancillary staff, four relatives, one external health professional and the manager. We considered all the evidence we had gathered under the outcomes we inspected.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. Safeguarding vulnerable adults from abuse procedures were robust and staff understood how to safeguard people they cared for. Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put into place to ensure that people's human rights are protected should their liberty be restricted in any way. Staff had been trained to understand when an application should be made and knew how to submit one.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The service was safe, clean and hygienic. Environmental audits were carried out regularly therefore not putting people at unnecessary risk.

The provider had safe and effective staffing rotas. Policies and procedures were in place to make sure that unsafe working practice was identified and people were protected.

Is the service effective?

People’s health and care needs were assessed with them. Specialist dietary, personal care and psychological needs had been identified in care plans where required. People told us that they had been involved in writing their care plans and said that they reflected their current needs.

Is the service caring?

People were treated with respect and dignity by the staff. People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. People we spoke with told us, “The staff are very good here and do as much as they can for us. They never make me feel bad for asking for help or ringing my alarm bell."

People who used the service, their relatives, friends and other professionals involved with the service completed a yearly satisfaction survey. 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 knew how to raise a concern or complain if they were unhappy.

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

People completed a range of activities in and outside of the service regularly.

Is the service well-led?

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

Staff told us they were clear about their roles and responsibilities and staff demonstrated a good understanding of the ethos of the service.

People we spoke with during our inspection gave positive feedback about the staff and the care provided. One person said, “The staff are very nice and friendly. If you don’t feel well, they will help you. They always ask me what I want to do. They are very polite to me and to others. You couldn’t ask for more from them. They are very good.” Another person said, “The staff are good and kind. They are very thoughtful. They get us involved in activities.”

One relative said, “I am very grateful to the staff. They provide good care.” Another relative said, “The staff are very good and I am very thankful.”

A healthcare professional commented, “The staff are approachable and very helpful. They are excellent in what they do. They are respectful of the people they care for.”

We observed how staff interacted with people who were suffering from dementia. We noted that the calm approach of the staff helped to de-escalate situations where the agitated and aggressive behaviour of some individuals could have upset or injured other people who used the service.

We noted that people’s nutrition and hydration needs had been met and people were neatly dressed in clean clothes. This indicated that people’s wellbeing had been promoted by taking account of their physical needs.

Many of the people using the service had complex needs which meant they were not able to tell us about their experiences. We used a number of different methods to help us to understand their experiences. We spent time directly observing care or listening to everyday interactions to help us to determine what it was like for people living there. These indicated that people were relaxed and comfortable and found their experience at the home to be positive.

We also spoke with relatives of two people who told us that people received care that met their needs and preferences. One person said, “Staff are very good and very respectful. They have accommodated our food choices and do respect our religious needs.” Another person said, “I cannot fault it. She is well cared for, and her nails and hair are always nicely done”.

The provider had systems in place to regularly check the quality of the service and follow up anything that needed to be improved. We found that people’s medicines were safely managed.

People told us that staff were knowledgeable and able to support people’s needs. One person said, “The staff talk to people nicely and calm them down if they get upset, they are never unkind. They know how to care for her, and they do.” Records showed that staff received training and support to help them to do their job effectively.

Many people using the service were unable to tell us their views on the care they received due to cognitive impairment or dementia. We saw that people were well supported and that care was delivered with sensitivity and respect.

People with whom we spoke told us they were satisfied with the care received at Honey Lane and that there were enough staff available to them to meet their needs. One person who uses the service said that they were well cared for. A relative told us “We are satisfied with the way they care for X, and the way they look after them." People also said there were enough staff available to them to meet their needs.

People felt that they or their relatives received safe care at Honey Lane. A relative said “I do feel safe about X being here, the staff speak to everybody with patience and respect. We have no concerns, I feel I could say if I did.” People with whom we spoke told us that there were meetings that relatives could attend and share their views of the service. They also told us that the manager is approachable and available if they wish to discuss anything.

People told us they found the home clean and comfortable. One person using the service said “The room is nice, and I like that I have some of my own things with me".