This inspection took place on 23 October 2018 and was unannounced.

Since the last inspection the home has been expanded from 10 beds to 18 and the domiciliary care service has been added to the registration.

Hummingbird Care is a care home and domiciliary care service.

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.

The domiciliary care agency provides personal care to people living in their own homes in the community, within a five-mile radius of the care home.

The service specialised in providing personal care to older people, some of whom were living with dementia. The home also provided day care and respite care to people. The home is not registered to provide nursing care.

At the time of the inspection there were 12 people living at the care home and 11 people were receiving a service in their own homes.

There is 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 2008 and associated Regulations about how the service is run. The registered manager was not available at the time of the inspection.

Improvements were needed to make sure the care home was well led. Quality monitoring systems had not always been robust and effective in identifying shortfalls in the record keeping and identifying possible risks to people. The provider had not informed the Commission of notifiable incidents in line with their legal responsibilities.

Some people at the care home were living with dementia and it was not always clear how they had given consent, or received care in their best interests. We have recommended that the provider makes sure all staff are aware of current legislation regarding people who lack capacity to make decisions.

People living at the care home and receiving care in their own homes felt safe with the staff who supported them. People told us staff were always kind and caring. Comments about staff included; “The carers are very punctual, respectful, caring, effective and careful” and “Staff are quite polite and friendly. I have no complaints.”

People’s healthcare needs were monitored and the staff worked with other professionals and care providers to make sure people received the care and treatment they required to meet their needs.

People received their medicines safely. Clear records were kept showing when medicines had been administered or refused which enabled the effectiveness of medicines to be monitored.

People received their care from a small number of staff who they had been able to build trusting relationships with. Staff helped people to maintain their independence where possible.

The risks of abuse to people were minimised because the provider had a safe recruitment procedure and staff knew how to report concerns.

People had opportunities to take part in activities according to their interests and abilities and continued to be valued members of their community.

People were happy with the food they received. One person said, “Lunch is always nicely cooked. The veg is good.” Another person told us, “The food is pleasant.”

People could be confident that if their needs changed the service would adapt to meet their changing needs. The service also responded to the needs of the local community.

People told us the management for the service was open and approachable and they would be comfortable to raise concerns or make a complaint.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

Further information is in the detailed findings below.

This inspection was unannounced and took place on 02 March 2016.

Hummingbird Care is registered to provide care and accommodation for up to 10 people. The home specialises in the care of older people.

The last inspection of the home was carried out in April 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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 2008 and associated Regulations about how the service is run.

People living at Hummingbird Care told us they were happy with the care and support provided. They said the manager and staff were open and approachable and cared about their personal preferences and kept them involved in decision making around their care. One person said, “I am really happy living here, home from home. I can make my own choices and I feel I am listened to.” One visiting relative said, “It is always welcoming and cheerful when I come.”

Everybody told us they felt safe living in the home, one person said, “Yes I feel very safe living here, they are all very nice.” One visiting relative said, “If I didn’t think [the person] was safe I wouldn’t leave them here.”

People were supported by sufficient numbers of staff who had clear knowledge and understanding of their personal needs, likes and dislikes. Staff took time to talk with people during the day. The registered manager also ensured that when agency staff were used to cover regular staff, a regular team from an agency knew the home and people living there. One person said, “It is like living with family. If I need help they are there as soon as I ring the bell.” Another person said, “They are all very kind, they know what is needed and get on with it.”

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people, for example they were receiving training in end of life care and dementia care. The registered manager explained the home was supported by a local college, visiting healthcare professionals and the local doctor’s surgery to ensure staff had up to date training specific to the needs of the people in the home. All the staff understood people’s needs and were able to explain to us how they would care for each person on a daily basis.

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care and/or a relevant representative. People’s needs were discussed with them daily and adjusted as necessary. All care plans included the person’s written consent to care. Staff had comprehensive information and guidance in care plans to deliver consistent care the way people preferred. The registered manager had, for example sought support from a mental health expert to ensure care and support for a person who could sometimes display challenging behaviours was consistent.

The registered manager had a clear philosophy for the home. They said, “We aim to provide a holistic approach to care. Recognising the whole person rather than just their needs. We are family orientated and aim to involve people’s families.” Staff spoken with emphasised the aim to be family orientated and people said they felt like the home was, “Home from home” and “Like being with a family.”

The provider had a robust recruitment procedure which minimised the risks of abuse to people.

People saw healthcare professionals as required such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbein

During our inspection the inspector considered our five 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, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. We saw information displayed in the office about abuse that included contact details for the local county council safeguarding team and a flow chart that detailed the process that staff should follow if they had any concerns about possible abuse.

Staff we spoke with were able to tell us there were different types of abuse, the signs they may observe that suggested possible abuse and were clear about the process to follow.

The manager told us that no applications had needed to be submitted regarding Deprivation of Liberty.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

One person told us that they had support from a financial adviser and the manager explained that people were offered the support of a solicitor who specialised in the needs of older people. This showed that appropriate external support was available to people if this was required.

We saw that care plans included the identified need, a goal and action. Details of what the person was able to do independently and the level of support that people required to meet these needs was detailed in the actions required. This showed that care plans were centred on the person as an individual.

We saw that the environment was safe and spacious; necessary equipment was provided to meet the needs of people living at Hummingbird Care.

Is the service caring?

One person told us that “the treatment of individual’s needs is exceptional; it is in a class of its own. Staff are very respectful and very helpful in my experience”.

During our visit we observed staff respectfully speaking with people and giving people choices. We saw that the atmosphere was very calm and relaxed and people were given time to make decisions and not rushed.

We looked at three care folders during our visit. We saw that these contained details of people’s preferences and likes and dislikes and references to people having choice and control in their lives.

We saw a weekly programme of group activities and individual sessions that was developed for each person. One person told us that “we have a quiz tomorrow and an arts group. We had entertainment last week; lots of things happen”.

One person told us that staff were “very good caring people. The manager has been very supportive during my move. People say they like the family feel, a lovely atmosphere. I have been able to bring my own things and had help to fill out forms”.

Is the service responsive?

We were given examples of one person who had kept a dog at home and missed this. A dog sitting arrangement had been agreed so the person looked after a dog for one and one half hours a week. Another person who was a farmer was keen to go to a livestock market and this had been arranged.

The manager told us that access to the hydrotherapy pool at Musgrove hospital had been arranged so that people could access hydrotherapy with a physiotherapist. Balance classes (that are designed to improve balance, strength and posture of older people and reduce the risk of falls) have been run at the home with the intention of continuing these in the future. Links were developed with the local community through coffee mornings and other activities. This showed that people had opportunity to access to a wide range of therapeutic and social activities.

Is the service well-led?

Staff had a good understanding of the ethos and the quality of care they were expected to provide. One member of staff we spoke with told us “It is such a lovely environment, we like to break down barriers and show people what we are doing; we are really proud of what we are doing here”.

Staff we spoke with told us there was excellent written and verbal communication between staff and between shifts with processes in place to ensure that staff had read information provided by the manager. This helped to ensure that people received a good quality service at all times.