About the service: Kexborough House provides personal care and accommodation for up to 22 older people. Accommodation is on two floors, access to the first floor is by a passenger lift. There is also a single storey purpose built extension. Kexborough House has large landscaped gardens to the rear of the property, with an accessible patio area. At the time of our inspection there were 18 people using the service.

People’s experience of using this service:

Staff supported people in a caring, responsive and friendly manner. They encouraged them to be as independent as possible, while taking into consideration their abilities and any risks associated with their care. Everyone we spoke with made positive comments about how staff delivered care and how the home was managed.

People received safe care and treatment. People’s needs had been identified, and management plans were in place which respected their freedom and choices. People were safeguarded from the risk of abuse. Accidents and incidents were monitored to identify and address any patterns or trends. People's medicines were managed in a safe way.

There were enough staff employed to meet people's needs in a calm and unrushed manner. People received consistent care from staff they knew.

The service was clean and tidy. Overall people were protected from the risk of infection, however, some areas of the home needed attention. We discussed these with the management team who gave us reassurances plans were already in place to address them.

Recruitment procedures continued to make sure staff employed were suitable to work with vulnerable people. Staff had received the training and support they needed to develop their skills and knowledge. This enabled them to meet people’s needs effectively.

Care and support was planned and delivered in a way that met people’s individual needs and preferences. Where possible, people had been involved in planning their care. People were offered choice over their daily routines and how they lived their lives.

People received a varied and healthy diet which offered choice and met their needs. Everyone we spoke with was complimentary about the meals and snacks available at the home.

People had access to social activities and events which they said they enjoyed. However, there was no activities programme to make sure stimulation was provided on a regular basis.

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. Staff made sure they had people’s consent before delivering care and support.

The service had an open and positive culture which encouraged the involvement of people using the service, their families and staff. The registered manager was visible around the home and staff had a clear understanding of their roles and responsibilities.

Checks had been completed to identify areas the service needed to improve. Where areas for improvement had been highlighted, the management team had put action plans in place to address them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: Good (report published 26 October 2016).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service through the information we receive.

This inspection took place on 15 September 2016 and was unannounced. This meant that the provider did not know when we were inspecting the service. The home was previously inspected in October 2013 when no breaches of legal requirements were found.

Kexborough House is a care home that provides personal care and accommodation for twenty-two older people. Accommodation is on two floors served with a passenger lift and there is a single storey purpose built extension. There is a large landscaped garden to the rear of the property with accessible patio areas. At the time of the inspection 18 people were using the service.

The home had a registered manager. 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 who used the service and their visiting relatives said positive things about the service, particularly the staff, the management team and the food. One person who used the service said, “The staff are great. I get on with all of them.”” People told us that they enjoyed the range of activities available in the home, and staff we spoke with and observed understood people’s needs and preferences.

There were effective systems in place to make sure people were kept safe. Staff had a good knowledge about safeguarding people from abuse and neglect, and up to date risk assessments were in place. The way staff were recruited was safe and thorough pre-employment checks were done before they started work.

We saw evidence of people’s healthcare and nutritional needs being met. Although there was room to improve the storage arrangements, people’s medicines were stored and handled safely.

People and those who mattered to them were involved in the assessment about their care, support and health needs and involved in producing their care plans, but there was not always evidence that people were involved in the monthly reviews, so that their views about care and support could continue to be incorporated into the care plans.

Throughout the inspection most staff showed people respect and took steps to maintain their privacy and dignity. People told us that staff always knocked on their bedroom door. One visitor said, “The staff offer such good care. [My family member] is looked after with dignity and respect.”

Overall, we found that staff received a good level of training and support, but not all staff had undertaken formal training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

The management team asked people to give feedback about their care and support to see if there were any improvements they needed to make and we saw several instances where their feedback had been used to improve the service. There was a system for the managers to review the quality of care being provided, and the staff team learned from incidents and accidents.

There was information available about how to make a complaint and people were confident they would be listened to. One visitor said, “The management deal with problems straight away. No messing.”

We were not able to speak with some of the people using the service because they were unable to communicate verbally with us in a meaningful way. People with dementia are not always able to tell us about their experiences. We observed staff giving care and assistance to people throughout the inspection. They were respectful and treated people in a friendly and supportive way.

We spoke with five people and they told us they were satisfied with the quality of care that they had received. Their comments included: “it’s alright here”, “the staff are pretty good”, “I always get the medication I need”, “staff are trained well and recognise when people are feeling poorly” and “they (staff) come straight away when I use my buzzer at night”.

We spoke with one relative who was satisfied with the quality of care their relative had received.

People told us that they felt "safe" and that they had no worries or concerns. They told us that if they had any concerns or worries they would speak to a relative or staff. We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse.

We found that the service had robust recruitment policies and procedures in place that the registered manager followed when employing new members of staff.

We saw that the registered manager and area manager both completed regular checks on the quality of the service people received.

People told us that they were treated with respect and that their opinions were sought. This told us people were involved in any decisions and they had choice. People made positive comments about the staff and were satisfied with the quality of care that they had received. Their comments included: “The carers are very helpful.” “The staff are pretty good.”

Relatives we spoke with were satisfied with the care their relatives had received and they told us that they had no concerns. Their comments included: “It is very clean.” “You can visit when you want and staff are very welcoming.” “There has been lots of improvements but there is always room for more.” They also told us that they were involved with their relatives care planning.

We found that care plans and risk assessments were person centred and had been reviewed at regular intervals. We saw that people were referred to healthcare professionals when necessary and these visits were recorded in people’s records.

We saw that people who used the service benefited from equipment that was comfortable and met their needs.

We found that staff were supported to provide care to people, trained and appraised.

We saw that the home had a procedure in place to deal with complaints. People told us that they felt "safe" and that if they had any concerns they would speak to a relative or staff.

We talked to people who use the service during our inspection and they told us that they were happy living in the home and with the care that they received. People told us that staff were generally good and that they were consulted about the support that was provided and that their views were listened to.

People who we were able to communicate with told us that they were happy living at the home and that they were satisfied with the care they received. People said,

"I am quite happy here." "It's a nice place." "The staff are lovely here." "I’m happier now, I’m more settled.”

We spoke with six relatives who were visiting the home and they confirmed that they were satisfied with the care provided. One told us "We have no worries or concerns when we leave the home after visiting mum, which says we must be happy with the care here.” And another confirmed that "Our mother looks so much better since she came here, we are very happy with the staff and everything about Kexborough House, the care is excellent.”

We spoke with Barnsley Metropolitan Borough Council, social services contracts department. They said they have had no recent reports of concerns or dissatisfaction with the way the home is being run.