Howards Residential Home is a residential care home that provides accommodation and personal care for up to 20 people some living with dementia. The inspection was carried out over two days, the 31 May and the 12 June. Both were unannounced. The service had 19 people using the service on the first day of the inspection and 17 on the second day.

At our last inspection we rated the service 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.

Why the service is rated Good.

Staff knew how to keep people safe and there was a sufficient number to meet people’s needs. People’s risks were assessed and measures were put into place to protect people from harm while respecting their freedom of choice. The home was clean. Policies and procedures meant that medicines were managed safely apart from the lack of PRN protocols which has since been addressed.

Staff considered people’s individual needs. Staff were trained to deliver the care needed. Staff had sound knowledge of legislation and guidance relating to consent and decision-making requirements. The home’s design and decoration met the needs of the people living there. People were supported to maintain a balanced diet and have plenty to drink. People had access to healthcare and staff liaised with healthcare professionals.

Staff were caring and respectful of people and their needs. Staff genuinely appeared to enjoy working for the service. People were cared for in a homely environment. Staff knew people well and interacted with everyone in a friendly caring manner. There was good communication with families who were made to feel welcome and contributed to care planning where people did not have the capacity to do so for themselves.

Staff took time to find out about people as individuals. Activities considered people’s interests and hobbies and helped to reduce social isolation. Relatives and people could freely express concerns knowing that they would be listened to and action would be taken. There was great sensitivity around end of life care and people were enabled to express their wishes about how they would like to be cared for at the end of their life.

The registered manager nurtured an open culture in the service, while they provided a good level of support to staff. Good communication was facilitated by meetings and by the registered manager’s availability and approachability. The registered manager continually looked for ways to improve the service and sought the advice of other professionals when needed. The registered manager understood her managerial responsibilities and the legal requirements were met.

Further information is in the detailed findings below

The inspection took place on 13 April 2016 and was unannounced.

Howards Residential Home provides accommodation and personal care for up to 21 older people, some of whom are living with dementia. There were 18 people living at the service at the time of our inspection.

There was a registered manager in post. 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 were safe because there were enough staff on duty to meet their needs. Risks to people had been assessed and staff had taken action to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly and medicines were managed safely. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

People were supported by staff that had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. They had access to regular supervision, which provided opportunities to discuss their performance and training needs.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when decisions that affected them were made and applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People enjoyed the food provided and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed when they moved into the service and were kept under review. Staff ensured that people who required assistance to eat and drink received this support.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity. Relatives told us they were made welcome when they visited.

The provider had a written complaints procedure, which was given to people and their families when they moved in. There had been no complaints about the service since our last inspection. People told us they had not needed to complain as any concerns they had were resolved through discussion with the registered manager.

People had opportunities to take part in activities at the service and to go out to local places of interest. Relatives told us that staff encouraged their family members to socialise with other people to ensure they did not become socially isolated.

People who lived at the service and their relatives told us their views were encouraged and listened to. Residents meetings were held regularly and the provider distributed satisfaction surveys to friends and families annually.

The registered manager provided good leadership for the service. Relatives told u

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read our full report.

This is a summary of what we found-

• Is the service safe?

We found that staff carried out regular checks to ensure that care was provided in a safe, secure environment. We also saw evidence that audits had been carried out to assess performance in key areas such as infection prevention and control and the management of medicines.

People told us that there were always enough staff on duty to provide care appropriately and to keep people safe. Vacant shifts on the rota were usually filled by permanent staff and agency staff were rarely employed.

• Is the service effective?

People who used the service told us that they were happy with the quality of care they received. They said that staff knew their needs well and that they provided their care in the way they preferred.

Relatives told us that their family members were well cared for at the home and that their physical, emotional and healthcare needs were met. One relative told us, “It’s a very friendly home. My Mum’s very happy here” and another said of their family member, “They’ve looked after him very well. His health has really improved since he moved in.”

The healthcare professional we spoke with told us that staff identified changes in people’s needs effectively and made referrals to healthcare services when necessary. The healthcare professional said that the staff they met were well informed about the needs of the people they cared for and that they communicated well with other professionals.

• Is the service caring?

People told us that staff were kind and helpful and that they provided good care. One person said of the staff, “They’re all very good, very caring.” Relatives said that staff treated their family members with respect and knew their needs well. One relative said of the staff, “They’re very polite and helpful” and another told us, “They look after Mum very well.”

We observed that staff engaged and interacted with people in a positive manner and encouraged people to maintain their independence. Staff spoke to people in a friendly but respectful way and communicated effectively with people when supporting them.

• Is the service responsive?

People received a personalised service based on their individual needs. People’s preferences about their care, such as their preferred morning and night time routines, were recorded and known by staff.

Staff encouraged people to make choices and supported their decisions, for example about how they spent their time and where they ate their meals. People were consulted about the home’s menu. The cook knew people’s preferences about their food and provided alternatives to the menu if required.

People told us that they had opportunities to have their say about the service. They said that their views were listened to and gave us examples of changes that had been made as a result of their requests. One relative told us, “They’re always open to suggestions.”

• Is the service well-led?

The home had an established staff and management team, the majority of whom had been in post for a number of years. Staff were positive about their roles and told us that they received good support from their managers and colleagues.

Staff received an induction when they started work and had access to training in key areas. Staff also had opportunities to discuss their professional development and training needs and to achieve further, relevant qualifications.

During our inspection at Howards we spoke with four members of staff as well as the registered manager. We also spoke with six residents and four relatives of people who used the service. We carried out some observations throughout our visit to see how staff interacted with people.

The people who lived at the service who we spoke with told us they liked living at Howards and that staff were kind to them. One person told us “It’s smashing here.”

We saw the care that people received was appropriate and was in line with their care plan. For example, we saw that one person needed a drink available to them at all times and we saw that this was done.

We saw records that showed that the provider had followed a recruitment process and had completed relevant checks on staff before they started work.

We looked at other records held by the provider and saw that these were up to date and kept securely.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an expert by experience; people who have experience of using services and who can provide that perspective.

We spoke to three people who lived in the home who told us that they were happy living there. One person told us “I like it a lot” and that staff were “always nice”. Another person told us that if they needed help staff “come straight away”.

We asked people about mealtimes and they told us that they enjoyed the food. One person told us it was “smashing food”.

We also spoke to three relatives about the service, all of them told us that they thought the staff and care given were very good. One relative told us that “staff love their residents”. However one relative told us that they would like there to be more outside activities for people who used the service.