Netherclay House is a residential care home for 42 older people, some of whom are living with dementia. There are 35 bedrooms, as well as five apartments in the grounds.

At our last inspection on 13 and 17 August 2015, we rated the service as good. At this inspection we found evidence continued to support the rating of good in four key questions. From our ongoing monitoring of the service there was no evidence 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.

Since our last inspection, the registered manager had left. Another manager was appointed but they did not apply to register with the Care Quality Commission (CQC). They then chose to work in another service. This means the service has been without a registered manager for 18 months. A registered manager is a person who has registered with the CQC 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. A new manager has been in post since 23 October 2017, the management team said the aim was for the manager to apply to register with CQC in early 2018. We will be writing separately to the registered provider about this matter.

People visiting, living and working at the home gave us positive feedback about the management team. People said they could speak with staff if they had a concern and were confident actions would be taken, if required. There was a strong commitment to staff training, which included recognising and reporting abuse, and increasing the staff team’s knowledge and skills. There were sufficient numbers of suitable staff to keep people safe and meet their needs. Recruitment practices ensured people were supported by appropriate staff. Medicines were well managed.

The staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. Staff supported people to be involved in making decisions and planning their own care on a day to day basis.

People were supported to maintain a balanced diet. People were positive about the food at the service. People were supported to follow their interests and take part in social activities. The provider employed a designated activities coordinator. They ensured each person at the service had the opportunity to take part in activities and social events which were of an interest to them. People said staff treated them with dignity and respect in a caring and compassionate way.

Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were individualised. People were referred promptly to health care services when required and received on-going healthcare support.

The premises were well managed to keep people safe. There were emergency plans in place to protect people in the event of a fire. There was a quality monitoring system at the service. People’s views were sought through meetings, reviews and questionnaires to continuously improve the service.

Further information is in the detailed findings below.

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with nine people who used the service, two relatives of people in the service, four members of staff and the provider’s care director. We also reviewed five people’s care records. There were thirty eight people using the service at the time of our inspection.

Is the service safe?

People lived in an environment that was safe, clean and hygienic. Visitors were met at the front door and asked to sign a visitors book.

There were sufficient numbers of staff on duty to meet the needs of the people in the service. Staff we met told us they received training to recognise safeguarding issues and were confident to raise concerns to the manager.

People’s care records were retained in a secure area and only accessed by authorised staff. People’s medicines were being kept safely and administered correctly.

Is the service effective?

Staff had a good understanding of people’s care and welfare and knew people in the service well. Staff training was designed to meet the needs of the people living at the service.

People can be reassured their needs will be met at this service. Each person had an individual care plan which detailed their support needs. People told us they were happy with the staff support in place.

Is the service caring?

People in the service were supported by kind and respectful staff. Staff demonstrated patience when they were with people. People told us they were able to do things at their own pace and were not rushed. Our observations throughout the visit confirmed this. One person told us, “They’re all very good and never rush any of us.”

A relative told us, "Everyone here is so kind”. A survey sent to families was complimentary, with comments such as, “This is a very good place, a lovely home.”

Is the service responsive?

Care records reflected people’s individual support needs and described staff interventions. This ensured care and support was provided in accordance with people’s wishes.

People told us they met with their keyworker monthly to update their care plans where necessary.

People had regular access to activities that were important to them and were supported to maintain relationships with friends and relatives where people wished.

Is the service well-led?

Clear quality assurance processes were in place, including regular audits and monitoring of complaints and surveys.

People’s personal care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Staff had a good understanding of the aims of the service and told us they were clear about their roles and responsibilities and were regularly supervised by senior staff at all times.

At the time of our inspection there were 33 older people living in the home. During our inspection we spoke with six people who lived in the home, three visiting relatives, five care staff and three visiting professionals. We also observed the care and support provided throughout the day.

We observed people who lived in the home were free to make their own choices regarding all aspects of their day to day living. We saw staff respected and acted on the decisions people made.

Most of the people who lived in the home were relatively independent and only needed limited support with their personal care needs. One of the people who lived in the home said “On the whole the staff do a good job and try to accommodate people’s needs”.

People who lived in the home, their relatives, staff and visiting professionals all said the home was kept clean and they had no concerns about hygiene standards.

People we spoke with told us staff “Knew what they were doing”. One of the staff said “We receive loads of training. Staff are regularly asked what training and development they would like. Management always try to support our personal development”.

The provider had a complaints policy for ensuring complaints were recorded and fully investigated. People spoken with said they would have no hesitation speaking to the manager if they were not happy with any aspect of their care. One person said “If I had any problems I would just tell the manager and they would sort it out”.

During our visit we spoke with seven people and three visitors to the home. We also made our own observations throughout the visit.

People who lived in the home were positive about the service and said they were treated with respect. Each person commented that they were happy to live at Netherclay House. One person said “Everything is fine here."

People told us that staff treated them as individuals and made the changes to their daily routines when they requested it. One person said “I choose what to do, staff are very good at that.”

Several people told us that they had good relationships with the staff and said they "felt safe" at the home and were able to talk to staff if they had any worries or concerns.

People made positive comments about staff. One person told us the staff “I get on with the staff, they treat us decently." Whilst another person said “the staff are polite.”

We saw that people participated in regular community meetings which were supported by newsletters which they shared with their families and friends.

This inspection was unannounced and took place on 13 and 17 August 2015.

Netherclay House provides personal care and accommodation for up to 42 people. In addition to the main care home, accommodation and personal care is provided to people in four self-contained flats adjacent to the main house. The home specialises in the care of older people. At the time of the inspection there were 35 people at the home.

The last inspection of the home was carried out in September 2014. No concerns were identified with the care being provided to people at that inspection.

There is 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.

During both days of the inspection there was a relaxed and cheerful atmosphere; staff and people living in the home were happy and at ease when they spoke with us. We observed friendly but professional banter with staff discussing the weather and being able to sit in the garden for tea and cakes. People told us Netherclay House was always homely and relaxed. Visitors said they always felt welcomed and were always offered a cup of tea.

People were supported by sufficient staff to meet their needs. People spoken with said they felt there were enough staff working in the home. One person said, “There always seems to be plenty around when you need them, I never hear bells ringing for any length of time and if you ask for help they are there straight away.”

Records showed there were adequate staffing levels on each shift. The registered manager confirmed staffing levels could be flexible to meet the care needs of people and to support other staff with activities such as parties and trips out. We observed staff took the time to chat and socialise with people and call bells were answered promptly. Staff told us they only had to ask and the provider would increase staffing to meet increased needs. One staff member said, “We never feel rushed or pushed to get work done. There is always time to sit and have a chat”.

Some staff spoken with said they felt they would benefit from an extra staff member in the afternoon during supper and when people asked to go to bed. We relayed this information to the registered manager and quality and service development manager who said they would look into providing a staff member to cover the “twilight” shift to support staff to help people eat and go to bed.

The provider’s vision for the home was to provide a, “Secure, relaxed and homely environment in which the care, well-being and comfort of all residents are of prime importance.” Everybody spoken with said Netherclay House was homely relaxed and a safe place to live. One visitor said, “It is always so relaxed and cheerful here they are chatting and laughing every time I visit.” One healthcare professional said, “There is always a homely relaxed atmosphere in this home.”

Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns bought to the registered manager would be dealt with appropriately. There was a robust recruitment procedure in place which minimised the risks of abuse to people. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People’s health care needs were fully assessed and care and support was provided on an individual basis. One staff member told us, “Communication is good, we have regular handovers and the care plans are changed if resident’s needs change.” This meant people’s individual changing needs were considered and catered for in consultation with them or a family member if necessary. Care plans and care practices were monitored to ensure people’s preferences were being followed and improvements were made when needed.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

Everybody spoken with told us they enjoyed the food, they all said the food was good. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified and unhurried manner. Most people ate in the dining room, lunch was observed to be relaxed unrushed and a social occasion. Some people chose to eat in their room and food was delivered promptly and covered so it was still warm when it arrived.

People could join in a range of activities, such as bingo, a games afternoon, a creative workshop, an exercise workshop and visiting entertainers. For people who chose to stay in their room the activities programme include one to one sessions to prevent them becoming isolated. There were magazines and newspapers around the home for people to read. One lounge had a computer which the activities person could assist a person to use.

There were systems in place to monitor the care provided and people’s experiences. Quality audits were carried out by the quality and service development manager. Action plans were put in place to address any issues found. These included staff meetings, supervision, further training and changes to the way the service was provided. A regular survey was carried out asking people and their relatives about the service provided by the home. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.