This inspection took place on 20 and 21 November 2018 and was unannounced.

Immacolata House provides accommodation for up to 49 people who require nursing and personal care. The home provides most of its care to people living with dementia. At the time of the inspection there were 49 people living in the home.

Immacolata House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at 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.

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 2008 and associated Regulations about how the service is run.

Why the service is rated Good.

There were processes and practices in place to keep people safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people. All staff spoken to were able to tell us what they would look for and how they would report anything they thought put people at risk of harm or abuse.

People received effective care and support from staff who had the skills and knowledge to meet their needs. All staff attended regular updates of the organisations mandatory training.

People who were able told us, and we saw, they were cared for by kind and caring staff. Staff respected people’s privacy and dignity at all times. Relatives told us they were involved in developing and agreeing care plans. They confirmed they were kept informed of any changes and that the staff in the home communicated well with them.

People received responsive care and support which was personalised to their individual needs and wishes. There was clear guidance for staff on how to support people and how to know when a person was not happy or distressed. This was important because not all people were able to verbally communicate. People were supported to access health care services and see healthcare professionals when necessary.

People took part in a range of meaningful activities which included in-house entertainment, trips out and walks in the grounds which had a small holding where people could help care for the animals. A local preschool nursery visited each week and people were engaged in watching or taking part in the children’s activities.

People were supported by a team that was well led. Everybody spoken to said they thought the service was well led.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

Further information is in the detailed findings below.

The inspection took place on 16 June 2016 and was unannounced. The service was last inspected on 20 September 2014 and no concerns were identified.

Immacolata House provides accommodation for up to 49 people who need nursing and personal care. At the time of the inspection there were 49 people living at the home. The majority of people were living with a dementia and many had complex nursing or other support needs. Most of the people who lived in the home were unable to express themselves fully due to their dementia or other health conditions.

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. The registered manager told us their service philosophy was “For our residents to live as they want to live, safely”.

Staff supported people in a very caring and considerate way and had a very good understanding of each person’s needs and preferences. We observed there was a genuine affection between people and the staff.

People and their relatives told us the service was responsive to their needs and people had a lot of choice about how they spent their days. One person said “There’s something on every day” and a relative told us “I’ve only got to say a concern and they are on to it”. People benefitted from individual engagement with the care staff as well as a variety of organised social and recreational activities.

Most relatives thought the registered manager was open, accessible and responsive. One relative said “She runs the place very well. She’s definitely focused on the people here. The whole team are dedicated to the residents and to looking after the relatives”. Staff described the registered manager’s style as “fair but firm”. Most of the staff liked this approach as they said they knew where they stood. The provider’s quarterly staff survey results showed a high staff satisfaction score at Immacolata House.

There were enough suitably qualified staff to keep people safe and to meet their needs, although there had been quite a high turnover of staff over the last 12 months. Over recent months staff turnover and the number of agency staff hours had significantly reduced.

People were kept safe because risks were well managed and people were protected from abuse and avoidable harm through appropriate policies, procedures and staff training. People received their medicines safely from registered nurses and people were protected from the risk of infection. There were always two qualified nurses on each day shift to ensure people’s clinical needs were met.

A local GP visited the home on a weekly basis and a dentist, optician and chiropodist visited regularly. The service also worked in close partnership with other health and social care professionals to meet people’s health and wellbeing needs.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. Staff were knowledgeable about each person’s dietary needs and preferences. A new two weekly menu was about to be introduced following consultation with people and their relatives. The new menu choices looked varied and appetising.

The home’s environment had been purpose built to support people living with a dementia. It was spacious, clean and bright throughout with lots of natural light. Communal facilities were signposted with pictures to help people understand their use. There were spacious, well maintained, secure gardens and grounds for people and their visitors to enjoy.

The service had good links with the local community. Various events were organised at the home, including: open days, Alzheimer’s days, Art in the Garden supported by the local Ladies Guild, reminiscence events, fetes and other nationa

A single inspector carried out the inspection of Immacolata House. At the inspection we spoke with the registered manager, care supervisors, senior care and nursing staff. We also spoke with care assistants and domestic staff. We spoke with ten people who used the service and eight relatives of people who used the service. We observed how staff interacted with people who became distressed or confused and at meals times when many of people who used the service needed one to one support or prompting to eat their meal. We looked at people’s assessments and support plans and their daily records. We also looked at staff recruitment and training records.

We also used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. However if you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The provider had policies and procedures that explained how to identify and report safeguarding concerns. We spoke to people who used the service and they told us they felt safe at Immacolata House. People told us that they could tell the provider if a member of staff hurt them. The people who used the service told us they felt confident that they would be listened to.

Each person had a staying safe assessment on their file and this included risks of falls, behaviour that could put them at risk to themselves or others. This meant that any risks were identified and plans put in place minimise the risk of harm.

The provider showed us safeguarding concerns they had identified for people who used the service and the referrals they had made to the local authority safeguarding team. We evidenced that the referrals had been made in a timely manner and any actions needed to reduce the risk of harm and been put into place. We also looked at an application the provider had made to the local authority under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and saw it had been made appropriately and had been discussed with the person’s relative and GP.

The provider had a business continuity plan. We looked at the plan and saw the provider was doing their upmost to safeguard people in emergency situations; for example emergency evacuation of the home. There were also emergency plans and actions for care staff to follow if they identified an emergency for an individual they cared for.

Is the service effective?

People who used the service and their relatives told us their care needs were being met and they were included in assessments and reviews. We saw care plans were regularly reviewed and this included discussions with relatives, GP’s, social workers and district nurses. The care plans included information about people's health conditions, likes and dislikes and wishes and preferences about how their care was delivered.

We saw from the care records we looked at people’s care plans were regularly reviewed and amended should their needs change. We also saw that relatives of people who used the service had been informed about any new needs the provider had identified. Care staff told us people’s nursing and care needs could change frequently and they needed to be responsive to this and change their care plan accordingly. A relative of a person who used the service told us “I am always involved in the care planning and reviews of my relative.”

Is the service caring?

At our inspection we spent time observing the staff and their interactions with people who used the service and saw them talking respectfully, calmly and sensitively to the people they cared for. Care staff told us they had the time to give people individual and personalised care. We observed staff encouraging people to be involved in activities and also assisting people to eat their meals. We saw calls or requests for help from people who used the service were responded to by care staff in a timely and sensitive manner. A relative of a person who used the service told us “the staff are wonderful, they are all really caring and understanding of my relative’s needs.” A person who used the service told us “I think the care I get here is wonderful.”

Is the service responsive?

In the records we looked at we saw care plans reflected people’s individual needs and had been updated every three months and in some cases sooner if new risks or needs had been identified. This meant the provider was responding to any new needs people who used the service presented with.

We saw the provider had a complaints policy and this was clearly displayed in the communal areas of the home. We spoke with people who used the service and they told us they had been given information about complaints and how to make a complaint. The people who used the service and relatives told us they felt the provider would listen and take action if a complaint was raised.

Is the service well led?

The provider had an audit schedule and this included regular reviews of the care delivered at Immacolata House. We found audits had been carried out in line with the provider’s policy and actions to address any issues identified had been put in place.

The provider supported staff to undertake national qualifications. Staff told us the registered manager supported their professional development and took the quality of the service delivered seriously. Staff also told us the registered manager encouraged staff to identify service developments and improvements. The people who used the service and their relatives told us the home was well led by the management team.

People or their representatives had the opportunity to discuss their care needs and how their needs were to be met. People told us they had spoken with care staff and had been part of the assessment of their needs. We observed staff supporting and assisting people in a caring and sensitive way. We found that people's dignity and rights of privacy and independence were respected.

People and relatives we spoke with told us they were very happy with the care provided. Comprehensive assessments had been completed of people's health and social care needs. Care plans were individualised and reflected people's personal circumstances and needs. Care staff were observed assisting and supporting people to ensure their care needs were being met. There were good arrangements for the reviewing and updating of care plans. Care plans accurately reflected the needs of people using the service.

Staff demonstrated a good understanding and knowledge of the nature of abuse. Those we spoke with were clear about their responsibility to report any concerns about possible abuse. People told us they felt safe living in the home.

There were arrangements in place for monitoring and auditing of the service. These included infection control, management of medicines and care planning. Quality assurance questionnaires were issued to people using the service and their representatives.

The provider had addressed the area of non compliance in relation to records.

This visit was part of our routine schedule of planned inspections.

Due to concerns raised regarding medication we also asked a pharmacy inspector to visit the home.

Some people that lived at Immacolata House were able to tell us about their experiences and we also spoke with visitors and staff that worked in the home.

People spoken with said they felt very well cared for. One person told us that they felt very “safe and happy”. Another person said they were very happy living in the home and thought the staff members were very kind and caring. A visitor spoken with told us that they had seen a marked improvement in their relative. They said “they are so relaxed and happy it is nice to visit, they always look well cared for as well, and seem to have plenty to do.” One person who lived in the home said, “I feel very happy here, I have just had a very good dinner and I am waiting to go outside”.

At the time of our visit staff told us that no one was able to look after their own medicines, so they were all given by staff. Qualified nurses gave most of the medicines but some creams and ointments were applied by the care staff.

People we spoke with told us that they were happy with how their medicines were looked after and were given the right medicines at the right times.

During our inspection we spoke with three people who lived in the home and six of their relatives who had visited on the days we inspected. We read six care plans that informed staff how to deliver people’s care needs. We also spoke with five members of the care team.

People we spoke with told us staff enabled them to make their own decisions about care and treatment. One person said “they ask you what you want and they always give you a couple of choices, staff will see to it straight away if you have problem”. Relatives told us they were very happy with the home. They said communication was really good. They said “they are very good at phoning if something is not right”.

The majority of people who lived in the home had advanced dementia. This meant that some people were unable to tell us their experiences of what it was like to live in the home. We carried out observations of how people’s care was delivered. Through our observations, we found staff interactions with people were sensitive and considerate. We saw staff reducing individual’s anxieties by spending time with the person to put them at ease.

Through our observations we checked people’s care was delivered in line with their care plan. Some records did not reflect the person’s current care or treatment. This meant that there was a risk that people could receive inappropriate care.