About the service:

Noss Mayo Residential Home provides accommodation, care and support for up to 14 older people who have physical disabilities, some of whom may experience memory loss and have needs associated with conditions such as dementia.

There were 12 people living at the service at the time of the inspection.

People’s experience of using this service:

•People were protected against abuse and discrimination and their rights were upheld.

•Staff received training and were supported to ensure they had the skills, knowledge and confidence they needed to perform their roles effectively.

•People did not always receive services which were responsive to their needs as they had not always been supported to have access to person centred activities which met their needs, in particular for those who lived with dementia.

•People were enabled to have choice and control of their lives and staff supported people in the least restrictive way possible; the registered providers policies and process supported this practice.

•Staff treated people with kindness and their dignity and privacy was respected.

•People and their relatives were involved in reviewing their care and making any necessary changes.

•A process was in place which ensured complaints could be raised. Concerns were acted upon and lessons were learned through positive communication.

•The service was consistently managed by an established registered manager and the registered provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

Rating at last inspection:

Good (report published June 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained rated good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This was an unannounced inspection carried out on 9 June 2016.

Noss Mayo Residential Home can provide accommodation and personal care for 14 older people and people who live with dementia. There were 14 people living in the service at the time of our inspection all of whom were older people.

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.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse including financial mistreatment. People had been helped to avoid the risk of accidents and medicines were managed safely. There were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received training and guidance and they knew how to support people in the right way. People had been assisted to eat and drink enough and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (MCA) and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. No one living in the service was being deprived of their liberty and so the registered manager had not needed to seek any DoLS authorisations.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given all of the assistance they needed. This included people who lived with dementia and who could become distressed. People were supported to pursue their hobbies and interests and there was a system for resolving complaints.

Quality checks had been completed to ensure that people received the facilities and services they needed. Good team work was promoted and staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We visited the home to check if the provider had made any of the required improvements to the issues we highlighted during our last inspection of the service completed on 20 May 2014.

The summary is based on a review of the action plan sent to us in response to our last inspection, our observations during our visit, our discussions with people who used the service, a visiting relative and the staff who supported them.

We also looked at people’s care records, management records and other documentation. A single inspector carried out this inspection.

During our inspection we focused on a key question we always ask; is the service responsive?

Below is a summary of what we found. If you want to see the evidence supporting the summary please read the full report.

Is the service responsive?

We found the provider had taken action to install appropriate curtain screens in three rooms that people shared at the home. This ensured people’s dignity could be better respected when they received personal care or wanted privacy in their room. One person who shared a room said, “I like the curtains. They (the curtains) are easy to use and we can still see each other when we choose to.” A relative told us. “The privacy curtains look good. I think this is an improvement.”

We also found the manager had involved people in the development of their individual care plans and any decisions regarding the arrangements in place for their care. For example, people and their representatives had been involved in care plan reviews.

One person said, “I feel like I am home here. I am involved in things as much as I want to be.” A relative commented. “We as a family feel involved and would shout up if we felt there were any areas we had not been consulted about.” The relative also told us, “I know they (staff) have been updating care records and the manager has involved me as the main family contact in the process recently.”

Below is a summary of what we found when we inspected Noss Mayo Residential Care Home on 20 May 2014.

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people’s care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

When we visited there were 13 people living at the home. We spoke with three people and also observed how staff provided care and support to people who lived in the home. This was because some people either chose not to speak with us or had problems with their memory and could not tell us directly about their experiences of the care they received.

A single inspector carried out this inspection. During the visit we also spoke with a visiting relative, the manager, home owner and five staff members.

The focus of the inspection was 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 and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service caring?

Throughout our inspection we observed staff were respectful and sensitive in their approach to meeting people’s needs. People told us things like, "The care here at the home is good” and “I enjoy living here. The staff are always about and they listen when we call for help.”

Is the service responsive?

The manager and home owner confirmed any concerns raised with them had been addressed straight away and we found responses had been open and timely. People could therefore be assured that informal concerns were addressed and systems were in place to make sure more formal complaints would be investigated in the right way.

When we spoke to people about their involvement with their care plan one person commented, “I know the staff keep a check on things but I haven’t been to any meetings to talk about my care. I’m not really bothered because they sort it out.”

Records showed people were involved in an assessment either before they moved into the home or as soon as they moved in. Care plans were created with people based on the assessment information. This included people's individual choices about how they wanted to be cared for when they moved into the home.

However, information did not show how people had been involved in the ongoing development of their care plan or any changes made to them. For example people had not been involved in their care plan reviews.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the involvement of people in identifying and agreeing any changes in the delivery of their care.

Is the service safe?

People told us that they felt safe living at the home. We saw safeguarding procedures were in place and that staff understood how to safeguard the people they supported.

The manager had policies and procedures in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant people were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore did not put people at unnecessary risk.

Is the service effective?

We found people's nutrition was assessed and dietary needs were monitored to ensure people were not at risk of malnutrition.

We saw people were supported to have a choice of food and drinks and staff encouraged people to make decisions about their meals for themselves. Where people needed access to a special diet they received food appropriate to their needs.

We also found mobility and equipment needs had been identified in care plans where required.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a consistent service at all times.

The service worked well with other agencies and services to ensure people received their care in a joined up way. The manager had a quality assurance system and records seen by us showed that any shortfalls identified were addressed in the right way.

When we visited the service in November 2013 we asked the provider to make improvements in staffing levels. This visit was to look at those improvements.

On the day of our visit 13 people were living at the home. The majority of people had a memory loss.

We spoke with two people who lived in the home and two members of care staff. The manager was not available to speak with on our visit.

The provider had sent us an action plan telling us what they were going to do make the improvements required. We found improvements to the staffing levels in the service had been made during the daytime.

The people we spoke with told us there were sufficient staff on duty to meet all of their needs. One person told us, “The girls have got more time for us now.”

When we visited, 13 people were living in the home. We looked at the care of three people in detail, spoke with five people who lived there as well as staff, the manager and two relatives of people in the home. Some people were unable to speak with us and we used our observations to understand about the care they received. We also looked at records and observed how staff supported the people living in the home.

We saw people being asked for permission/consent by staff before they undertook any care needs or treatment and staff respected the response they received.

However, we found no evidence that people had given their consent for photographs to be taken or care staff to give them their medicines.

People appeared well cared for and relaxed. The people we spoke with told us they were happy living in the home. One person told us, ”I like it here.” A relative we spoke with said, “They’re so kind to xxx.”

People received care and support although this was not always reflected in their care records.

Medicines were stored, administered and disposed of safely.

Because only two care staff were on duty during the day, we found that one person in the lounge was being relied on to use the call bell for staff’s attention if it was required. People’s psychosocial needs were not always met.

There were systems in place to monitor the quality of service given to people. People we spoke with told us they could raise any issues with the manager and felt confident they would be dealt with quickly.

The provider had sent us an action plan telling us what they were going to do to make sure they were compliant with the two standards we had set compliance actions against when we visited in October 2012.

We did not speak with people who used the service. This was because we were looking at the premises, checking records and speaking with staff.

The provider had made improvements to the way it managed infection control relating to the routine cleaning of commode pots. There was a risk assessment in place regarding the cleaning of them.

Care records had improved since we visited in October 2012. We saw staff supervision sessions and staff meetings had been recorded.

We visited the home as part of our scheduled inspections for the year. In addition, we looked at whether the service was now compliant following the actions we asked them to take during our last inspection.

During our visit we looked at records. These included care plans and minutes of meetings. We spoke with care staff, people who use the service and people who visit the service. We also sat and watched care staff delivering care to people in the home.

People told us they liked living in the home and staff were kind and friendly. One person told us, “I love it here.”

People told us they felt safe in the home. A relative told us, “I’ve never heard anyone raise their voices to the residents.” Care staff knew how to protect the people in the home and who to contact if they had concerns.

We found the home was not taking sufficient care to protect people from the risk of infection but the provider had improved the heating in the lounge so that people were warmer.

We saw evidence that care staff received training and support to do their jobs and people told us they felt the staff knew what they were doing.

People felt they were asked about their opinions in the running of the home by the manager and felt confident taking any concerns directly to her.

Records, although kept securely, were not always accurate or updated as quickly as they should have been.

On the day we visited one of the owners, the registered manager and two members of care staff were present. There were fourteen residents living in the home.

People told us they liked living in the home and staff were kind and friendly and knew what they were doing. However, one person said they didn’t like being called “darling” by care staff and we told the manager about this.

The manager told us the home could always get the help of health professionals whenever they needed it and we found evidence in the care plans that district nurses and doctors visited people when it was necessary. People told us they were not always involved in their plan of care.

Everyone felt safe living in the home and when we asked them what they would do if they did not, they told us they would tell the manager who they felt would do something about it. Care staff knew the different forms of adult abuse and what to do if they suspected it.

We heard one of the people say that they felt cold and when we asked if they frequently felt cold that told us they did in the cold weather.

We saw staff caring for people in a dignified manner and people were very complementary of the care they received from staff. One person told us “We all get treated very well.”