This unannounced comprehensive inspection took place on 24 September and 3 October 2018.

Iddenshall Hall is a care home located in the village of Clotton, near Tarporley. It is an adapted property with purpose-built extensions on the ground floor level. Care and support is provided for up to 42 older people. At time of our inspection the service was supporting 32 people.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and we reviewed both areas during this inspection.

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.

The service had 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 were assessed prior to receiving support from the service to ensure that person centred care and support was provided. Care records included detailed risk assessments and support plans to help staff appropriately manage people's needs and keep them safe from harm. Care and support plans had been developed with the involvement of family and were reviewed regularly to ensure effective support was being provided at all times.

The service continued to use safe recruitment processes to ensure that staff were suitable to work with vulnerable people. Staff had completed a detailed induction program and shadow shifts with experienced staff members before lone working. Staff completed mandatory training as well as additional training specific to people's individual needs. Staff were supported in their role through regular supervision and meetings to ensure they maintained the right skills and knowledge to carry out their role.

Staff had received training in relation to safeguarding adults from abuse and understood what actions they should take when concerns are identified. Safeguarding policies were available for staff to access when needed.

Medicines were stored, managed and disposed of safely by staff who were suitably trained to administer medications to people living in the home. Staff consistently and accurately completed medicine administration records (MARs). The registered provider had policies and procedures in place for the safe management of medicines.

Consent was gained in accordance with the Mental Capacity Act 2005; the registered manager, management team and care staff understood the need to obtain consent from people prior to offering support.

Interactions between staff and people being supported were positive and staff showed a good knowledge of the people they supported. People were treated with dignity and respect and staff ensured privacy was maintained at all times. People were encouraged to be as independent as possible and provided with choice and control over their day-to-day lives ensuring that the least restrictive support was given where appropriate.

Activities within the home were extremely person centred. People were offered an extensive range of activities that were based on their likes and preferences. The service's activities co-ordinators ensured that people were involved in the choices of activities provided. The activities co-ordinators worked extremely hard to ensure that people experienced positive outcomes and to improve socialisation, physical strength and mobility, independence and confidence.

We looked at four care records and generally the care plan documentation was up to date, but we found a few minor discrepancies and the activities monthly reviews had not been brought up to date.

We spoke with seven people who used the service and their relatives, five staff and three professionals involved in the service. People who used the service said “The home is very clean”, “The staff are very good and caring” and "I am well cared for." Relatives commented “I am always offered refreshments when I visit”, “The staff are lovely and pleasant” and “I have no concerns and I am very happy with the home.” Staff commented “The staff team get on well together”, “We have regular staff meetings”and “The management team are helpful and professional.” Other professionals commented “The staff seem to know the patients and their needs well”, “The home is always clean when I visit” and “I have no concerns or complaints."

We looked at staffing levels at the service. We found that on three occasions there had been periods of time during the night when staffing levels were below normal levels. A compliance action has been made.

We saw that Iddenshall Hall had received three complaints since the last inspection and the Commission had not received any complaints about the service.

We observed interactions between the people who used the service and staff and found a relaxed and friendly atmosphere between them. We found the home was clean and odour free.

We spoke with seven people who lived at Iddenshall Hall. They told us the staff were kind and caring and that they were supported with all their care needs. Comments included "I am very happy here", "The meals are very nice", "I am looked after very well" and "I like it here." People who lived at Iddenshall Hall told us they were happy and we saw they were well supported.

We spoke with five staff members and they confirmed that they liked working at Iddenshall Hall. They said "I really like my job", "The staff team work well together", "Its very nice here" and "The residents are lovely here and I feel I have achieved something when I cheer them up." All staff spoken with confirmed that they had good support from the manager and the senior staff team.

During the visit we spoke with a visitor who commented "The staff are very friendly here. There are lots of activities for people to join in. When we were looking for a care home, we looked at about ten and this is the only one that asked about Mum as a person with a past history, rather than problems she now had. I was impressed with that."

We spoke to people who use the service and they said:

“I am very well cared for and I like it here.”

“Have been here three years. I am well at the moment. I get well looked after by the staff. My daughter helped me choose this home. It has been a good choice and I feel safe here.”

“Have been here two years. I have no concerns. I am very comfortable and happy. Staff will support me when I need it. I get the paper delivered every day.”

“All ok here. Everyone is pleasant. We have a hairdresser on site and I have my hair done twice a week. I miss my family sometimes as they live a long way away.”

“It is very good here. I am well looked after. I am happy here and it suits me. My family live locally and I see them regularly. I don’t get bored as there are activities on each day that I can join in if I want to.”

“Staff are nice and kind. I am well taken care of.”

We had a discussion with small group of residents in the lounge and they were asked, if you could what you would change? And they all agreed nothing. They were happy with the home. The staff are kind and helpful and the food is good.

We spoke with relatives of the people who use the service and they said:

“The home is wonderful. The staff are very kind and the food is good. The staff are very kind to all our family and the activities coordinator is very good.”

“The home is very good. I don’t have any complaints. The staff are very nice and helpful. The unit manager is very good. I am kept up to date with anything that is happening with my relative. The activities coordinator is very good.”

“The home is excellent. They have a good ethos and they manage my relative’s needs well. The staff are very caring and the food is good.”

“I am very happy with the care of my relative. They are well looked after. The unit manager is good and will let me know if there are any problems. The staff approach is good and their care and attention to detail is good. My relative’s room is lovely.”

We spoke with staff and they commented:

“It is very hard work but I enjoy my job. I have had a good range of training and I have enjoyed it. If I was concerned about a safeguarding issue I would speak to the person in charge.”

“The staff are a good team and work well together.”

“Have worked here for three years and l enjoy my job.”

We spoke to people who use the service and they said:

“I am very well cared for and I like it here.”

“Have been here three years. I am well at the moment. I get well looked after by the staff. My daughter helped me choose this home. It has been a good choice and I feel safe here.”

“Have been here two years. I have no concerns. I am very comfortable and happy. Staff will support me when I need it. I get the paper delivered every day.”

“All ok here. Everyone is pleasant. We have a hairdresser on site and I have my hair done twice a week. I miss my family sometimes as they live a long way away.”

“It is very good here. I am well looked after. I am happy here and it suits me. My family live locally and I see them regularly. I don’t get bored as there are activities on each day that I can join in if I want to.”

“Staff are nice and kind. I am well taken care of.”

We had a discussion with small group of residents in the lounge and they were asked, if you could what you would change? And they all agreed nothing. They were happy with the home. The staff are kind and helpful and the food is good.

We spoke with relatives of the people who use the service and they said:

“The home is wonderful. The staff are very kind and the food is good. The staff are very kind to all our family and the activities coordinator is very good.”

“The home is very good. I don’t have any complaints. The staff are very nice and helpful. The unit manager is very good. I am kept up to date with anything that is happening with my relative. The activities coordinator is very good.”

“The home is excellent. They have a good ethos and they manage my relative’s needs well. The staff are very caring and the food is good.”

“I am very happy with the care of my relative. They are well looked after. The unit manager is good and will let me know if there are any problems. The staff approach is good and their care and attention to detail is good. My relative’s room is lovely.”

We spoke with staff and they commented:

“It is very hard work but I enjoy my job. I have had a good range of training and I have enjoyed it. If I was concerned about a safeguarding issue I would speak to the person in charge.”

“The staff are a good team and work well together.”

“Have worked here for three years and l enjoy my job.”

We inspected this service on 2nd and 3rd December 2015 and the inspection was unannounced on the first day.

Iddenshall Hall has been operating as a care home since 1987. It is an adapted property with purpose-built extensions on ground-floor level. Care and support is provided for up to 42 older people.

The home is in a rural location in the village of Clotton, near Tarporley. The grounds and gardens are accessible to residents. There is also an internal courtyard area (with seating), which residents can access.

The previous inspection was undertaken in August 2013 and action was needed in relation to staffing. We followed this action up in December 2013 and found the service was able to demonstrate they were meeting the required standards without a need to visit the service.

There is a registered manager in place at this 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.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “I have no concerns or problems”, “The activities are good”, “Staff meet the needs of [name] well”, “The staff are very nice and helpful”, “The staff get on well together” and “It’s very good here, homely.”

We found the registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge. Policies and procedures related to safeguarding adults from abuse were available to the staff team. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

The provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and staff recruitment.

People where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where changes in someone’s health needs had been identified. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and treated people with respect.

We found the home was clean, hygienic and well maintained in all areas seen.

We looked at the care records of three people who lived at the home. We found there was good information which was centred on the individual person and was written in a way that recognised people’s needs. We saw that care plan reviews were completed and up to date.

We saw that the administration of medication was undertaken in a timely manner, which meant that people received their medication administered as prescribed.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people could be confident that they were protected from staff that were known to be unsuitable.

We looked at staff training and we saw that staff undertook a range of training in line with their identified roles. Staff had up to date supervision and appraisals and had the opportunity to attend relevant meetings.

We looked at staffing levels at the service. People who lived at the service said that staff were available when they needed them. A range of activities were available to encourage social contact and stimulation. We noted that an activities coordinator was employed at the service and that there were planned activities throughout the month.

We looked at how complaints were dealt with. People told us they would approach the staff on duty or the management team. The service had received three complaints since the last inspection and we saw the documentation relating to these and found the procedure used followed the information within the complaints policy and were dealt with in a timely manner.

We saw that the service had a range of quality assurance systems in place and we noted these were up to date.

People told us the food was very good. We observed the lunch time meal being served and saw that sufficient staff were available to help people as required throughout the mealtime.