We inspected OSJCT Bohanam House on the 9 and 11 October 2018. Bohanam House provides accommodation and personal care to 40 older people. At the time of our visit 39 people were using the service. This was an unannounced inspection.

We last inspected the home on 30, 31 March and 1 April 2016 and rated the service as ‘Good’. We found the service were meeting all of the relevant legal requirements.

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 on-going 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.

There was a registered manager in post. The registered manager was leaving the post to take up a promotion within the providers organisation. A registered manager from another home of the provider was moving to the service. 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.

People enjoyed living at OSJCT Bohanam House. People and their relatives told us they were safe at the service and enjoyed active and social lives. People had access to activities which were tailored to their individual needs and preferences. People felt cared for and happy.

People were supported with their ongoing healthcare needs. Care staff supported people to access the healthcare support they required. People told us they enjoyed the food they received within the home, and had access to all the food and fluids they needed. Where people needed support to meet their nutritional needs, this support was provided.

The service worked with healthcare professionals to assist people at various stages of their life. Nursing staff had a clear focus on improving the service, including skin integrity care and the management of people’s prescribed medicines.

People were supported by staff who were supported and trained to meet people’s individual needs. Staff were supported to develop and access additional training to further improve their skills. Staff spoke positively about the support they received and felt their development was promoted.

People and their relatives spoke positively about the management of the service and felt the service was well led. The registered manager ensured people, their relatives and external healthcare professionals’ views were listened to and acted upon. The registered manager and provider had systems to assess, monitor and improve the quality of service people received at Bohanam House. The provider was implementing additional systems to drive improvements across their homes.

This unannounced inspection took place on 30, 31 March and 1 April 2016.

Bohanam House provides nursing, residential, and respite care for up to 40 people. At the time of our inspection 34 people were living there. There was a registered manager. 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. There were no legal breaches of legal requirements at the last inspection in September 2014.

People received care from staff who generally had the skills, knowledge and understanding needed to carry out their roles. Training for some staff required updating and this had been planned. A new process was completed during the inspection to provide a complete record of all staff training.

People were kept safe by staff trained to recognise signs of potential abuse and they knew what to do to safeguard people. People and relatives told us the home was safe and the service provided was safe. The recruitment procedures followed ensured people were cared for by staff that had appropriate checks completed before they started work and their practice was monitored.

People were supported to make their own choices and decisions where possible. Where people lacked the capacity to make decisions the registered manager had followed procedures for a mental capacity assessment and completed a best interest decision record.

People had access to health and social care professionals and their changing needs were monitored. People's dietary needs and preferences were recorded and they were referred to a dietitian and speech and language therapist if staff had concerns about their nutritional wellbeing. There was a choice of food and people’s preferences and cultural differences were respected. The food looked nutritious and people told us they loved the food.

People were treated with kindness and compassion. We observed all staff including housekeeping, catering and care staff spending time with people engaged in conversations or taking part in activities. People told us, “I like it here”, “Exceptional carers” and “I like it here, I love the dog”. People were encouraged to stroke the registered manager’s dog and they considered the dog to be the homes pet. People’s bedrooms were personalised and decorated to their taste and they had been involved in choosing decorations for the communal areas.

Care plans were personalised and each record contained information about the person’s needs their likes, dislikes and people important to them. The service was supportive and caring to relatives and friends of people nearing the end of their life. The Dignity Champion member of staff monitored practice and supported new staff, leading by example, to ensure that all training given on end of life care and dignity was practised.

There was a range of activities people could be involved in and regular outings into the community which included the local church, coffee mornings, local markets and walks in the local park. Staff encouraged people to maintain relationships that mattered to them.

The service had quality assurance procedures which included seeking feedback from people and their relatives. Action was taken when improvements were identified. Staff meetings were held and staff were able to influence any changes. Systems were regularly audited to improve the service.

The inspection helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service caring?

We saw people being supported by polite and attentive staff. We saw staff sitting with people whilst assisting them with their meals. We observed people using the service smiling and holding two way conversations with staff. One person told us "staff are very good here" whilst a relative told us “the carers seem to care”.

We saw that care workers were patient and gave encouragement when supporting people. We heard one staff saying to a person using the service "are you ok? Are you sure? Do you want to get up now and try your chair?" A person told us “staff are very good here, I've got no complaints."

Relatives told us they were encouraged to get involved in the home's activities. One relative told us "they tell me what is going on." We observed staff knocking on people's bedroom doors before entering and then keeping the door closed whilst providing personal care.

Is the service responsive?

The care files confirmed people's preferences, interests and individual needs had been recorded and the support provided met people's wishes. A relative told us "as soon as an issue arose we were contacted immediately" whilst a person told us “I nearly always get what I ask for.”

To help staff get to know people as individuals there was ‘All about me’ information in people’s bedrooms. One notice said a person liked wearing green and on the day of inspection the person was wearing a range of green clothing.

Relatives were involved in contributing towards people's annual care review and their views were taken into consideration. In one review, the relative made a significant contribution and signed the review in several places. One relative said "I get asked about what she needs."

We saw that the service worked well with other healthcare professionals. There were several letters in people’s care records from health professionals suggesting changes to a person’s care or treatment and staff had made the changes. One family member told us that staff would always speak with the GP if they had any concerns about their relative's health.

People could make choices. We regularly heard staff asking people to make a choice. We heard staff asking a person "let me know when you want to get up." A person told us “I am always choosing what to eat.”

Is the service safe?

We found the home safe at the point of entry. To enter the home we had to ring, wait for the door to be opened, we signed in and signed out. People were cared for in an environment that was safe, clean and hygienic. We found the environment in good decorative order and staff had the equipment needed for moving and lifting people safely.

We saw from the completed records that equipment at the home had been well maintained, serviced regularly and therefore safe for people to use. People told us that staff looked after them well one person said “one nurse keeps on to me for my own safety.”

Staff we spoke with were able to tell us what action they would take if they saw abuse taking place and where to find the correct contact information and procedures. One staff told us "I treat people here as I want myself or my mother to be treated."

The staff carried out a range of health and safety checks to ensure people were kept safe. Records showed that fire drills were carried out and that people had their personal evacuation plans.

People ate food which had been safely supplied and prepared. The catering facilities had been assessed by an environmental health officer in 2014 and were given the top star rating.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which apply to care homes. The Deprivation of Liberty Safeguards are in place to protect people's human rights. The records showed that some people’s mental capacity has been assessed and best interest meetings held.

Is the service effective?

Relatives told us that they were happy with the care they saw and felt people's needs had been met. One relative told us "the manager told us exactly what was happening and kept us informed” whilst another told us “I can not believe how the laundry comes back so quickly.”

Staff told us that communication was good in the home, issues relating to individuals were discussed at handovers. From viewing the care records we saw that sudden changes to a person’s health were added to the care plans. Staff also told us that their views were heard and taken into consideration.

Is the service well-led?

The manager was registered with the Care Quality Commission as the registered manager for the service. One relative told us "I am confident she knows what she is doing" whilst another relative said "the manager is responsive and works well."

The training chart we viewed and the staff confirmed that they had received regular training to meet the needs of the people living at the home. The staff regularly updated their training and recently appointed staff told us they had done their common induction standards training in care. Staff told us there were prompts in place to remind them when training updates were due and we were shown how this system worked.

The home had a range of quality control processes in place. The records needed for the safe and smooth running of the home were in good order and up to date.

People's relatives were included in how the home was run by being asked annually for their feedback on the service. Relative's views had been listened to and we saw changes had been made where required. One person using the service told us “all the staff listen and are willing to help.” Staff told us their views were heard and changes could be made to how the service was run.

We found the home was well equipped. The staff were observed using electrical hoists and the bathrooms offered a range of facilities to meet people’s needs.

We found the care files for people who used the service to be accurate, up to date and reflected their individual needs. Assessments had been completed monthly where necessary to ensure staff were providing the necessary care. We observed that people were offered a choice at mealtimes with the chef taking a special interest in making sure the food was what people wanted to eat. Some staff made it a social occasion for the person, explaining what the food was, talking to them and allowing them time between mouthfuls. However other staff were observed just to sit in silence with no explanation and not always allowing the person enough time to eat their food between mouthfuls.

We looked at the training records for staff. These showed us that the majority of staff had received training in adult safeguarding. This meant that staff were aware of how to recognise abuse and what to do. We saw the minutes for a number of meetings that took place including a nurse meeting, one for people who used the service and their relatives and a health and safety meeting. These minutes demonstrated that issues were discussed in detail. Where actions needed to be taken we saw evidence that this had been completed. We spoke to three people who used the service. They told us “I have nothing to complain about, but it’s not home. The staff are all very friendly and look after me very well”. “I like living here”.

We did not speak to people who used the service. This was a follow up inspection to check compliance with a warning notice.

We did not speak to people who used the service. This was a follow up inspection to check compliance following a previous inspection. We checked recruitment records and spoke to an operations manager from the registered provider.

We spoke to three people who were using the service as well as three visitors.

One person told us that the service was "very good" and stated that they had “nothing to complain about".

People told us that staff did ask for their permission before giving personal care but this did not happen on all occasions.

We heard positive views about the staff with one person describing them as a "helpful lot" although there were mixed views about the response to call bells.

People told us they felt safe and knew where to go with any complaints.

We spoke to people who use the service.

One person told us, “I like it here, they are pretty good to you". Another person said "I am very happy here".

We heard positive comments about the staff such as “very helpful” and “very good”.

One person described the meals as “excellent".

People told us that they received enough help to meet their needs and that their privacy was respected.