Palmersdene is a two storey residential home which provides personal care for up to 40 people. There were 39 people living there at the time of our inspection, some of whom were living with dementia. All bedrooms had en-suite facilities.

At the last inspection on 4 and 5 February 2015, the service was rated good. At this inspection we found the service remained good.

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.

Staff received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

There was a welcoming and homely atmosphere at the service. People were at ease with staff and people and relatives said staff were caring. Staff treated people with kindness and compassion.

Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.

Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said there was an open culture. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

Further information is in the detailed findings below.

Some people were not able to tell us directly what they thought about the service. We decided to undertake a Short Observational Framework for Inspection (SOFI) exercise. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

During our visit, all interactions we observed between the staff and the people living at the home were open, respectful and courteous. We saw that people's needs were met in a calm and unhurried way. There were enough qualified, skilled and experienced staff to meet people’s needs. Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

People and their relatives we spoke with were generally positive about the care they received from Palmersdene.

Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.

We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.

Comments from people who live at Palmersdene included "The staff are always there if you need them.", "I do like it here. I keep myself to myself.", "The food is canny and so are the staff."

We spoke to three visitors of people who live at Palmersdene who felt that their relatives received good care and were looked after well. One told us "My x is happy here and she has put on weight since coming to live here" Another relative told us "I am happy with the staff here. They let me know about anything and I do not have any worries about this place."

We visited the home unannounced on 18 January 2012 from 9.30am to 7.15pm as part of our routine programme of inspections.

We spoke with a number of people who live here, as well as visitors, staff and the registered manager. There were 35 people living in the home at the time of our visit but one person was in hospital.

Not all people using the service could comment about their care due to their disabilities, but some could.

We spoke with one person who was having a mid morning bacon sandwich, which they had requested. They commented very loudly that “it’s good here” but also said, “it’s really disappointing. I want to go to bed at half past eight but they make me wait an hour”. They said they had “complained loads of times but no-one listens”. They commented that the food “was beautiful”. They were also loudly critical of a care worker within that person’s hearing. With their permission, their comments were discussed with the registered manager who felt sure that no person would have to wait an hour for assistance to go to bed.

We also asked other people how long they had to wait for assistance when they wanted to get up or go to bed. One person said they needed help from the care workers to get dressed but they did not have to wait longer than 15 minutes and felt this was acceptable. They said, “I like it here, the carers are good”. They told us that they were able to live the lifestyle they wanted, and although aware that social activities took place, preferred to spend time in their own room. They told us they were treated well and had no concerns, but if they did, they would take these up with the manager.

Another person was very cheerful and told us they had lived here for ten years and liked it. They enjoyed “keeping (themselves) occupied” with various hobbies.

We spoke to three visitors of people who live here who felt that their relatives received good care and were looked after well. Two told us they were always consulted and kept fully involved in their relative’s care. They all felt the home provided good care, good nutrition and a good range of social activities. They all said that they would readily raise any concerns with the manager if they had any.

This inspection took place on 4 and 5 February 2015 and was an unannounced inspection. The last inspection took place on 4 December 2013. At that time the service was meeting the regulations we inspected.

Palmersdene provides care for older people for up to 40 people. Nursing care is not provided.

At the time of this inspection there were 39 people living in the service. The home had 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.

The home is split over two floors, with the upstairs area being mostly for people living with a more advanced dementia or higher support needs.

The service was warm, (and whilst some modernisation of electrics, doors and windows had just begun), was clean and well maintained. There were eight care staff on duty and ten other staff. The service had an ethos of personalised support. This was demonstrated through the use of one page profiles outside some bedroom doors. The bedrooms were also called “flats” by staff, as the service ethos was this was their own flat, with its own front door.

Staff were always visible throughout the building, including upstairs where people living with more advanced dementia and needed extra support. We saw activities taking place throughout the day. Staff supported people to take part in these activities. When staff engaged with people these were all positive. For example, we observed one person started to cry at the table during lunch. A senior carer went to her and soothed her. Another person living in the service commented that staff appeared at times to be very busy, “They are a bit short staffed then they get stressed.” But over the two days staff were not seen to be rushed in any of their interactions with people.

The service had recently made changes to the breakfast routine in the downstairs dining area following consultation with the people using the service. For example, having set breakfast times to make it feel less chaotic and more relaxed. The registered manager advised us the routine around mealtimes upstairs was under review. This was following staff and one person living in the service attending specialist dementia training. The registered manager aimed to integrate the learning from this specialist training over time.

Staff and people we spoke with all said they felt safe. They told us they could report concerns about safeguarding, complaints or other issues. One person said, “Oh yes I feel very safe.” A relative said, “She was in sheltered housing before, she looks a lot better since being in here.” There was documentary evidence that complaints and comments were responded to. One relative had commented negatively that, “The only reason I knew about her hospital appointments was because my wife told me.” Another relative commented, “They always telephone me and keep me up to date with her care and appointments.” Evidence was seen of communication between the service and families, and their involvement where possible.

The home, gardens and bedrooms were all maintained to a high standard. The sluice room on the first floor needed tiles replacing and had continence pads stored where they could be at risk of contamination by waste. The service manager took immediate action to replace the tiles and order new sluice equipment. The service’s windows and internal doors were about to be replaced. Presently all windows had window locks and were in good order.

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS). There were a nineteen people in the home who were subject to the Deprivation of Liberty Safeguards (DoLS) process. Referrals had been made appropriately by the service and this was documented in people’s care plans. There was evidence of best interests decisions being made for people who lacked capacity under the Mental Capacity Act 2005; however we discussed with the manager that records needed to reflect the principles of the MCA.

Staff we spoke with all said they enjoyed their work. They demonstrated a positive ethos and understanding of the needs of individuals in line with their care plans. When safeguarding and whistleblowing were discussed, staff stated they would raise issues with the registered manager, and felt that she was approachable. One staff member stated, “If I saw ill treatment from (either) a resident or staff I would report it immediately.” We saw evidence in staff files of checking of references and Disclosure and Barring Service (DBS). Action was being taken with staff whose performance was not as the provider expected. Records showed regular staff meetings were held and that actions identified were then completed.

It was observed that medication was managed flexibly to ensure that those with time specific medications were prioritised.

The deputy manager had recently won a national care award. The service had its own award scheme. People living in the service, staff and visitors had the opportunity to nominate staff for an award.