Keefield is a ‘care home’. 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.

Keefield is a purpose-built care facility providing personal care and accommodation for 10 people. The service consists of two bungalows each accommodating five people. At the time of inspection nine people were living at the service.

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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

We met and spoke to some people during our visit and observed the interaction between them and the staff. People were not able to fully verbalise their views and used other methods of communication, for example verbally, and through physical gestures or body language, electronic tablets and symbols.

People remained safe at the service. People had one to one staffing at all times. Safe recruitment procedures were in places to help ensure staff were suitable to work with vulnerable people.

Staff had a good understanding of risks associated with people's care needs and how to support them. Medicines were stored and administered safely, and people received their medicines as prescribed. Regular audits ensured medicines were managed in line with good practice guidelines.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The management and staff team understood the principles of the Mental Capacity Act 2005 (MCA) and

Deprivation of Liberty Safeguards (DoLS).

The staff had built strong relationships with people and treated people kindness and compassion and respected their privacy and dignity. People or their representatives, were involved in decisions about the care and support people received.

There was a friendly, relaxed atmosphere and staff were kind and attentive in their approach. People were provided with food and drink that met their individual needs and preferences.

People were supported to take part in a variety of activities and trips out based on their interests. End of life care was co-ordinated and in the best interests of the person.

The registered manager sought feedback about the quality of the service provided from people and/or family members, staff and visiting health professionals. There was an on-going quality monitoring process in place to identify areas of improvement required within the service. Where improvements had been identified, actions were taken.

Keefield is a purpose-built care facility providing personal care and accommodation for 10 people. The service consists of two bungalows each accommodating five people.

There is a registered manager at Keefield. 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.

We found that care was provided by a long term staff group in an environment which was friendly and homely. Staff knew people well and positive caring relationships had been developed. People were encouraged to express their views and these were communicated to staff in a variety of ways, including; verbally, and through physical gestures or body language.

The service had a robust recruitment process in place and we found staff to have received an appropriate induction, supervision, appraisal and training which allowed them to fulfil their roles effectively. Staff had received all essential training and there were opportunities for them to study for additional areas of interest. Team meetings were held monthly and staff had regular communication with each other at handover meetings which took place twice daily.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes.

Consent to care and treatment was sought in line with the requirements of the Mental Capacity Act 2005. The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that some people had aspects of their freedoms restricted. The registered manager was seeking authorisation for people under the Deprivation of Liberty Safeguards legislation.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They also had access to healthcare professionals as and when required.

Care plans provided comprehensive information about people in a person-centred way. People’s personal histories had been recorded and their likes and dislikes were documented so that staff knew how people liked to be supported.

Complaints were dealt with in line with the provider’s policy and relatives told us that they could raise their opinions and discuss any issues with the registered manager or any other staff member who was on duty.

Most people living in the service had limited verbal communication and were not able to tell us their views about the care and support they received. However, we observed people were relaxed and comfortable with staff, and they received care and support in a way that kept them safe.

Relatives told us they were happy with the care and support their family member received and believed it was a safe environment. People had their own bedrooms which they could personalise as they wished. Staff supported people to access the local community and take part in a range of activities of their choice.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Management were visible in the service and regularly checked if people were happy and safe living at Keefield.

A single inspector carried out this visit. They considered all the evidence gathered under the outcomes inspected and used the information to answer the five questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Members of staff were knowledgeable about what might constitute abuse and knew how to escalate any concerns. They had all received appropriate training in recognising and preventing abuse. We saw that the service acted promptly in situations where they suspected that abuse may have occurred and took action to prevent these incidents from happening again.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We found that maintenance issues were responded to and resolved quickly. The provider had a development plan which they were following to ensure that the premises remained in good condition.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager told us that no one at the service had applications submitted under this system. They had recently assessed each person using the service in relation to the DoLS and sought advice about the operation of the DoLS from the local authority's DoLS co-ordinator. The provider also had a written DoLS policy which had last been reviewed in June 2013.

Is the service effective?

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. The service carried out a needs assessment with the people who were new to the service. They gathered information from people using the service, their families and their health or social care professionals to understand their care needs and how these might be informed by their personal or social history.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risk assessments had been carried out for each person depending on their abilities and need for support in different areas. Plans were put in place to minimise risks. For example, if someone was at risk of falling in the shower, then strategies for how best to support that person to prevent this from happening were recorded.

Is the service caring?

Members of staff spoke to the people using the service in a calm and polite manner. The people using the service appeared relaxed in their interactions with members of staff. Members of staff promoted people's well being by engaging them in a range of activities. The service took a person-centred approach to care and was working on 'active support' plans to encourage people to become more independent.

We spoke to relatives of people who were using the service. They were all satisfied with the care that was being provided. They emphasised the 'homely' feel of the service. One relative told us, "I have no concerns. I trust the staff completely." Another relative said, "It is a happy place. I am very happy for my son to be there."

Is the service responsive?

We examined how the service responded to complaints as well as what actions they took in response to any adverse incidents involving people who used the service. We found that the service acted to resolve complaints within 24 hours and had more formal systems in place for investigating complaints that could not be resolved in this timeframe. We saw that the service carried out investigations in relation to any incidents and put strategies in place to prevent incidents from occurring again.

Is the service well led?

The provider had effective systems to regularly assess and monitor the quality of service that people received. This included obtaining feedback from people using the service, their relatives and other relevant health and social care professionals. The registered manager also carried out audits, for example of medication used, to ensure that the service was safe and that the care being provided was suitable and effective.

During our inspection, we found that staff ensured that people and their families were involved in decisions about their care where possible and that staff gained consent before carrying out care and treatment. Where people did not have the capacity to consent, best interest decisions were made as required and staff were aware of their role in ensuring people's human rights were respected.

We found that people's needs had been assessed on admission and that person centred care plans, which included detailed risk assessments were in place to support people's individual needs. We saw that relatives and healthcare professionals were involved in people's care and that care plans were regularly reviewed to ensure people's needs were met.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs and that their nutritional intake was monitored. We saw that healthcare professionals were involved where necessary to review people's nutritional needs, and care plans were adapted accordingly to ensure people's welfare.

We found that the provider had effective systems in place to reduce the risk and spread of infection. Staff had received training in infection control and cleaning audits showed that the cleanliness in the home was maintained. Staff were supported to carry out their roles and had received a range of training, regular supervision, annual appraisal and attended regular staff meetings.

On the day of our inspection there were eight people living at Keefield.

We were unable to communicate with the people who lived at Keefield to obtain their feedback as a result of their limited verbal communication or limited cognitive ability. We spent time listening to and observing everyday life at the service to help us to understand what it was like for people living there. This indicated that people were relaxed and comfortable and found their experience at the home to be positive. We saw that staff explained what was being served for lunch and what care people were about to receive. Staff offered encouragement and support as appropriate.

We spoke with two relatives of people who used the service. They spoke very highly of the care that their relatives received. One person said, "They always speak to [my relative] and let [them] know what they are going to do next, [for example] if they are going to move [them] from a chair to a wheelchair."

They went on to say, "They let me know if there's any slight thing, a cold or if [they've] got a doctor's appointment, as I always like to go along."

Speaking of the people who used the service, one relative said, "They get TLC (tender loving care) and looked after. [My relative] goes to a day centre but if [they] couldn't, they'd take [them] out. They go shopping; they take them out for dinner. As soon as you walk in, they say, 'Do you want a cup of tea and a biscuit?' and they say, ‘[Your relative] has been doing this or that.’ They treat you like part of the family."

People who use this service were, because of their disabilities, unable to engage in two way conversation with us. Therefore people could not tell us if they are included in day to day decision making within the service, but comments from relatives and visitors indicated that they are satisfied with the way the service is run and with staff attitudes towards people who live there. They also told us that they thought people enjoyed the food and that the service is kept clean and tidy.