At our last inspection in September 2016, 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.

People felt safe living at the service. Staff knew how to recognise abuse and how to report it. Risks were assessed so that staff knew what action to take to keep people safe. Incidents and accidents were reported and actions were taken to reduce the risk of them happening again. Planned staffing levels were achieved, however, we asked the deputy manager to review the deployment of staff to ensure it was responsive to people’s needs. Safe recruitment processes were in place to ensure the suitability of staff for their roles. People’s medicines were managed safely and people told us they received their medicines regularly.

People continued to receive an effective service. Care and support was delivered in line with good practice guidance. Staff were provided with training and development opportunities to ensure they were able to provide care that was effective and met people’s needs. People were provided with a healthy and nutritious diet and were provided with the support they needed to eat and drink sufficiently. People were supported to access health services when required and staff worked well with other professionals to provide coordinated care. 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 place supported this practice.

Staff were kind, caring and respectful. They knew people well and provided reassurance and support to people when they were anxious. Staff protected people’s privacy and dignity. People were offered choices in their daily lives and staff respected their wishes. People were supported to maintain relationships with friends and families.

People continued to receive personalised care that was responsive to their needs. Care plans were reflective of people’s needs and were reviewed and updated regularly. A wide range of activities and entertainment were offered and people were encouraged to participate in activities to maintain their mobility and independence. People were able to choose whether they wanted to participate and how they spent their time.

Systems were in place to monitor the quality of the service and the care provided. A range of quality audits were completed by the registered manager and areas for improvement were identified. Views of people using the service and their relatives were sought and staff felt engaged and involved. An overall action plan was in place and updated regularly to ensure improvements to the service were taken forward.

Further information is in the detailed findings below.

We undertook the unannounced inspection on 2 and 3 August 2016. The service provides residential and nursing care for 38 people over the age of eighteen. On the day of our inspection 35 people were using the service. The service is provided across two floors.

The service had a registered manager in place at the time of our inspection. 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 and associated Regulations about how the service is run.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed. Risks to people’s safety were assessed and reviewed on a regular basis. These risks were managed in such a way as to both protect people and allow them to retain their independence.

Staffing levels in the home were sufficient and the registered manager regularly reviewed staff levels to ensure that they remained safe depending on the needs of the service. People received their medicines safely from suitably trained staff. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition and dehydration. Specialist diets were provided if required. Referrals were made to health care professionals when needed.

People who used the service, or their representatives, were encouraged to contribute to the planning of their care They were treated in a caring and respectful manner by staff who delivered support in a relaxed and considerate manner.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their care and their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with eight of the 25 people who were using the service and two relatives to ask them for their views. We also spoke with four care workers, a housekeeper, a senior care worker and the registered manager. We looked at some of the records held in the service including some on a newly introduced electronic care planning system. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were systems in place to ensure people received their medication safely. A person who used the service told us, “I am given my medication. They bring it to me when I have my breakfast and when I go to bed. I trust them to do it, I would get in a muddle remembering what to take when.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. The manager and senior staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found staff were effective at respecting and involving people who used the service. The cook went round mid-morning asking people to choose from the menu what they would like for lunch that day.

Staff were effective and met people’s health and welfare needs. A staff member told us, “It is really good here, we will cover if someone is off work. I love my job.”

We found the provider was effective at assessing and monitoring the quality of the services provided. A relative told us, “I am very fussy so I raise anything that is not right. There is nothing to raise currently.” A person who used the service told us, “There is nothing to complain about this place.”

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. A person who used the service told us, “I am looked after very well.” Another person said, “Staff keep me clean, they are very kind and helpful.”

Is the service responsive?

We found staff responded to people who used the service in a way that respected and involved them. A person who was being made comfortable by staff told us, “I rang my bell, that’s why they helped me.” A staff member told us, “We take the time to listen to what people have to say.”

There were sufficient care workers to respond to people’s health and welfare needs. People who used the service told us they had to wait sometimes for the support they needed, but understood the reasons for this. One person told us, “You have to wait a little while sometimes, you have to wait your turn.”

We found the provider responded to the views of people who used the service. A person who used the service told us, “The manager comes and asks me how I am.”

Is the service well-led

We found staff received the direction and leadership needed to respect people who used the service and involve them in their care. One example was people who used the service were involved in the recruitment of new staff.

Staff were supported to introduce a new care planning system. A staff member said, “I am learning at the moment, I am happy with the training we have had.”

The manager held an open surgery where any person who used the service or relative could come to discuss things with them We saw some relatives speaking with the manager as they were leaving the home .

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and two relatives and asked them for their views. We also spoke with four care workers and the registered manager. We looked at some of the records held in the service, including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

The building had recently been completely refurbished and had a large extension built. The staff and people who used the service said they were very pleased with the changes. A new manager had recently been appointed and told us they were putting new systems into place to run the home effectively.

We found where people were able to they gave consent to their care and support. A person told us, “I am happy with my care, I am able to decide things, and they (staff) get my permission first before they do things.”

We found the plans for people’s care did not always show the care and support people needed or when people’s needs had changed. A senior staff member said the documentation was not properly completed and told us, “I think the reviews (evaluations of people’s care plans) need to be done better.” The manager told us they knew more work was needed on the care plans.

We found people who used the service were kept safe and protected from harm. A person who used the service told us, “They are always checking on me, that helps me to feel safe.” Staff knew how to respond to any allegation of abuse.

We found the staff team were supported through training and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, “They (staff) know what they are doing, they are very professional when they help me.”

People were treated with respect and dignity. We saw a member of staff discretely asking one person to go to their room to see the visiting district nurse. A person told us, “I am treated with respect, I am one of the lucky ones, I can do things for myself.”

People told us they were given choices as part of their daily routine. This included a choice of main meal at lunch. One person said, “I enjoyed lunch, we get a choice of what we want.” Another person said, “I am happy with the staff, they always ask for my agreement to do anything.”

People told us their needs were met by a hard working staff team. One person told us they had been taken ill on several occasions sine they had moved into the home and said staff had always got them the healthcare they needed, including calling an ambulance on one occasion to take them to hospital. They also told us they felt well cared for in the home and said, “It’s clean, warm and we get plenty of drinks. It’s not posh but it is homely, you couldn’t ask for better.” Another person said, “They are a good working group of staff, they get on with it even if it’s not a nice task.”

In the afternoon we saw a group of six people painting with two staff. The completed pictures were displayed in the dining room. One person who had taken part in the activity told us afterwards, “I enjoy sketching, that was very enjoyable.” Another person said, “We get to play skittles and all sorts. Some people don’t want to join in they just watch television.”

People were protected from unsafe or unsuitable equipment because the provider ensured all equipment was in good working order. One person told us, “If the washing machine goes wrong they soon get someone out to fix it.”

A person who used the service told us, “New staff come and watch and just do small jobs for the first two or three days. Then they go on a training day so they can do a little bit more.” They added, “When they have been here for a while they do an NVQ (National Vocational Qualification) and get a badge to wear.”

One person told us they had complained about an agency cook who had been working in the home as they had the lunch ready early and didn’t want to make a cup of tea after dinner. They said the manager had “tried to sort it, but it hadn’t been easy.” They went on to say things were “fine now as we don’t have an agency cook anymore.”

Another person told us, “I have little niggles sometimes, but I just mention it and they (staff) sort it.”

People who used the service told us that they receive care in a way that was respectful of their privacy and dignity.

People who used the service told us that they were treated by staff in a kind and caring manner. We were told that care staff were respectful and open to changes in care needs.

Representatives told us that they could talk about any issue of concern, in relation to their relatives care, welfare or safety.

People who used the service told us that they felt safe living there.

People that we spoke with told us that there always seemed to be enough staff on duty and that if they ring their call bell; they never had to wait long for a staff member to respond to it.

People who used the service told us that the manager was very proactive and that they had felt a change ‘in the atmosphere’ of the home since she arrived.

People who used the service and their relatives, told us that they can speak with staff and managers at any time and that they feel included in decisions made about the care received and the way in which the service is run.