About the service:

• The service is in a residential area of Maidenhead and close to the town centre.

• The service provides accommodation and personal care to older adults, some of whom have early stages of dementia. The care home can accommodate 23 people in one adapted building.

• This is the only location that the provider operates.

• At the time of our inspection, 19 people used the service and there were 17 staff employed.

People’s experience of using this service:

• The service continued to provide safe, compassionate and well-led care.

• People liked living at the service.

• There was a homely atmosphere and the staff enjoyed caring for people.

• The providers were actively involved the day-to-day operation of the care home, including the provision of personal care to people.

• People were protected against abuse, neglect and discrimination. Staff ensured people’s safety and acted when necessary to prevent any harm.

• Staff knew people well. They had developed good relationships with people. People clearly enjoyed the presence and attention from the staff.

• People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems at the service supported this practice.

• People had an active say in how the service was operated and managed.

• People’s care was personalised to their individual needs.

• Appropriate governance processes were in place to ensure high quality care.

• The service met the characteristics for a rating of “good” in all key questions.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated “good”. Our last report was published on 11 May 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates. We made some recommendations within our report, which we will check at our next inspection.

This inspection took place on the 24 March 2016 and was unannounced.

At our last comprehensive inspection of 29 October 2013 we found the service was meeting the requirements of the regulations in place at the time.

Normanhurst Residential Home (Normanhurst) is registered to provide care for up to twenty three older people, some of whom may live with dementia. Seventeen people were being cared for at the time of our visit.

The service did not have a registered manager currently 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. Following the resignation of the previously registered manager a recruitment process had recently been completed and an appointment made. After the inspection visit we confirmed the registration application process for the new manager was underway.

The majority of the feedback we received was very positive about the service. “Thank you for the wonderful care you have provided for our mother” and “care is first rate” were some of the comments made to us by people who lived in Normanhurst or their relatives. There was some concern expressed about inconsistent record keeping and the pressure at times on staff which were said to have led to people being; “rushed” when being assisted to get up in the morning. We have made a recommendation about this in the report.

There were safeguarding procedures in place and staff received training on safeguarding vulnerable people. This meant staff had the skills and knowledge to recognise and respond to safeguarding concerns.

Risks to people were identified and managed well at the service so that people could be as independent as possible. A range of detailed risk assessments were in place to reduce the likelihood of injury or harm to people during the provision of their care.

We found set staffing levels were adequate to meet people’s needs effectively. The staff team worked well together and were committed to ensure people were kept safe and their needs were met appropriately. The senior management team gave additional support when required due to short-notice absences of regular staff.

Staff had been subject to a robust recruitment process. This made sure people were supported by staff that were suitable to work with them.

Staff received appropriate support through induction and supervision. Although formal supervision was only approximately two to three monthly, all the staff we spoke with said they felt able to speak with the senior management team or senior staff at any time they needed to. There were also team meetings held to discuss issues and to support staff.

We looked at records of training for all staff. We found there was an on-going training programme to ensure staff gained and maintained the skills they required to ensure safe ways of working.

Care plans were in place to document people's needs and their preferences for how they wished to be supported. These were subject to review to take account of changes in people's needs over time. We found some inconsistency in the level of detail and completeness of care records. We have made a recommendation about this in the report.

Medicines were administered in line with safe practice. Staff who assisted people with their medicines received appropriate training to enable them to do so safely.

The service was managed effectively. In the absence of a registered manager the senior management team regularly checked quality of care at the service through audits and by giving people the opportunity to comment on the service they received and/or observed.

We spoke with people who told us they felt the carer's were "caring and respectful" and were always available when needed. They told us that they were given choice about the care they received and about daily life within the home. People told us the carer's always "knock on doors" before entering their rooms and were good at promoting people's independence. People told us they mostly liked the food choices and felt that they had choice if they did not like anything on the menu and the cook provided alternatives if this was the case.

People told us they felt safe living at the home and the carer's were good at looking after them. People told us their medicines were always given at the right times and they felt their health needs were managed effectively. We spoke with a GP who told us the home were good at managing health needs and they were good at managing medicines.

We spoke with three carer's who told us "everything is about them" and that they always asked permission before performing any care tasks. They told us they liked to give each person time to talk about their life as they felt it made people feel valued and made it easier to promote individual needs.

People we spoke with told us they were offered a number of choices in their care. These included choices in the time of getting up and going to bed, choice of menu and choice in furnishing their bedroom.

People we spoke with were positive about the staff. They told us the staff were kind and looked after them well.

We saw the provider had a comments book placed in the communal lounge. This was available for people who used the service and their advocates to complete with feedback. The manager told us they checked the book regularly and any comments were followed up by them. One person had recorded in the book, "It's always a pleasure to visit. The staff are very welcoming and always very helpful and friendly".