We carried out an unannounced inspection on 12 April 2018.

OSJCT Fosse House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

OSJCT Fosse House provides accommodation for up to 42 older people with care needs including physical frailty and dementia. It is situated on the outskirts of Lincoln and provides accommodation over two floors. On the day of our inspection there were 39 people staying at the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good overall. At this inspection our rating for the responsive domain changed to requires improvement as care records did not always reflect people’s current care needs and some social activities could be improved. However, this did not affect the overall rating of good. 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 place. 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.

Systems and processes were in place to keep people safe. Staff understood their responsibilities for safeguarding the people they cared for and assessed risks to their health and safety. Measures were in place to reduce these risks and people were supported to stay safe, whilst not unnecessarily restricting their freedom. However, documentation in this area was not always fully reflective of the steps being taken by staff. Recruitment processes ensured appropriate staff were recruited to work in the home. Accidents and incidents were recorded, investigated and learning identified. Safety checks of the premises and equipment were completed and processes were in place to prevent and control infection. People’s medicines continued to be managed safely.

Staff received appropriate training for their role and they were supported to further develop their knowledge and skills. People’s needs were assessed and care was delivered in line with national guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, documentation of mental capacity assessments and decision making in people’s best interests was not always fully completed. People were supported to access their GP and other healthcare professionals when it was necessary.

Staff were knowledgeable about the people they cared for and treated them with kindness. They respected people’s privacy and dignity. People were involved in planning and reviewing their care.

Care was generally responsive to people’s individual needs, but care plans were not always fully updated in response to changes in people’s requirements. Information about people’s personal preferences in relation to their care and their life history was available. Some activities were available for people in the form of entertainment, external visits and one to one and group activities at the home. However, people we spoke with and their relatives told us they would like more activities to be provided. The service had not fully embedded the accessible information standard which ensures that provisions are made for people to have information about their care in ways which are meaningful to them.

Staff felt supported by the leadership and management team and had the opportunity to raise issues and concerns. Relatives told us that when they identified a concern, it was listened to and addressed. The provider and the regis

The inspection took place on 18 September 2015 and was unannounced.

OSJCT Fosse House is registered to provide accommodation and personal care for up 42 people. There were 41 older people living at the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment, but no one at the time of our inspection had a current DoLS authorisation.

People felt safe and staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People praised the staff and staff told us that they were passionate about their roles

People were kept safe because staff undertook appropriate risk assessments and care plans were developed to support people’s needs. The registered manager ensured that there were sufficient numbers of staff to keep people safe and care for their needs.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities.

People had their healthcare needs identified and were able to access healthcare professionals such as their GP or district nurse. Staff knew how to access specialist professional help and emergency care when needed.

People met regularly with the head cook and had input into the menu plans. People were given a choice of nutritious and seasonal home cooked meals that were made from fresh ingredients. There were plenty of hot and cold drinks and snacks available throughout the day.

People were supported to make decisions about their care and treatment and staff supported people with disabilities to maintain their independence. People were treated with dignity and respect by kind, caring and compassionate staff and we saw that people were treated as equals.

People were treated as individuals and were enabled to follow their hobbies and pastimes. There were a wide range of activities provided both inside and outside the service. The service had formed strong links with the local community and people were involved with children and young people at all stages of their education. People told us that they looked forward to their visits.

There were systems in place to support people and their relatives to make comments about the service or raise concerns about the care they received. People and their relatives were encouraged to attend regular meetings with staff to discuss ways to improve the service. People and their families told us that the registered manager and staff were approachable.

The registered provider had robust systems in place to monitor the quality of the service. Staff received feedback on the outcomes of audits, lessons were learnt and improvements to the service were made. The service had received national accreditation for dementia care and internal accreditation for infection control and medicines.

During our inspection we spoke with five people who used the service and one visiting relative. We also spoke with the manager and seven members of staff. We looked at three people’s care records, three staff employment files and a number of records and documents relating to the running of the service.

People told us they liked living at Fosse house and felt safe and well supported. One person said “I’ve been happy since moving here.” Another said “Nothing is too much for the staff.”

One person’s relative who was visiting said “I’m chuffed to bits with the care.” They told us, “They could sleep at night” because they knew their relative was safe and happy.

We saw people were involved in deciding how their care would be provided. We noted written plans of care were signed as agreed by people and staff regularly discussed and reviewed their wishes, feelings and care needs with them.

People told us they received support when required with medical appointments. We saw people received prompt and effective support from doctors and other health professionals at the care home and in community surgeries.

People we spoke with said they enjoyed the food provided and a wide range of social and leisure activities including trips shopping and visits to places of local interest.

We saw medication was managed safely and effectively by staff with appropriate training. Discussions with staff and our review of records showed workers were recruited, trained and managed in a way that ensured people were cared for safely and effectively.

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We looked at three care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met.

The people we spoke with told us they all took part in a variety of activities details of which were displayed in one of the communal areas. One person said, “There’s something going on each day and we’re encouraged to take part.”

We looked at the menus and saw they offered a wide range of hot and cold meals. One person who lived at the home commented, “The food is very good I never go hungry, they keep a real good eye on us.” We saw each care plan contained a monthly assessment of each person's nutritional needs.

We looked around the home and observed a good overall standard of cleanliness. We saw people’s rooms were clean and communal areas were clean and tidy. One relative told us, “The home is kept spotless.”

People looked relaxed in the company of the staff. One person told us, “They look after us really well, nothing to complain about at all. Another person commented, “The staff are lovely, they go out of their way for you.”

One person who lived at the home told us, “They look after me really well here, I can’t think of anything I would change.”

We found that people were cared for in a clean, well presented home. One person commented, “My room’s ever so nice and clean.” People’s care was based on their individual needs. The staff provided care in a pleasant and professional manner.

We saw staff had time to interact with people. The home had two activity coordinators who organised a wide range of activities.

The home had a resident’s committee which acted as an advocate for people who wanted to express concerns. One committee member told us, “They always try to put things right.”

We saw the cook provided a choice of hot and cold foods at each mealtime and snacks throughout the day. There was also a cooked breakfast available each day.