Patron House is a residential care home without nursing and provides care and support for up to 12 older people. On the day of our inspection there were 8 people resident in the home.

At the last inspection, the service was rated Good there were however two breaches of regulations in relation to medicines and recruitment. At this inspection we found the service had met all relevant fundamental standards and remained rated as Good.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Risks to people were assessed and where required a risk management plan was in place to support people manage an identified risk and keep the person safe.

Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely. Staff completed training to ensure they were suitably skilled to perform their role. Staff were supported through a supervision programme

People were supported to maintain good health and had access to external health care professionals when required.

Staff were caring towards people and there was a good relationship between people and staff. Staff demonstrated and in-depth understanding of the needs and preferences of the people they cared for.

Support provided to people met their needs. Care plans provided information about what was important to people and how to support them. People were involved in activities of their choice.

There were systems in place to assess, monitor and improve the quality and safety of the service . Staff described the registered manager as supportive and approachable. Comments from surveys and compliments received by the service confirmed that people were happy with the service and the support received.

Further information is in the detailed findings below

We undertook an unannounced inspection of Patron House on 17 November 2015. When the service was last inspected in September 2013 no breaches of the legal requirements were identified.

Patron House provides accommodation for people who require personal care up to a maximum of 12 people. At the time of the inspection there were nine people living at the home.

A registered manager was in post at the time of the inspection. 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 service had not ensured that staff were adequately trained and assessed as competent in the administering of medicines. This placed people at risk. We also found that the appropriate pre-employment checks on staff had not always been completed.

There were sufficient staff on duty and people felt safe at the service. Staff spoke positively about the training they received and how this assisted them in being skilled and knowledgeable in their role.

The registered manager had ensured the Deprivation of Liberty Safeguards (DoLS) had been applied for when appropriate. The conditions of the authorisations had been facilitated. DoLS is a legal framework to lawfully deprive a person of their liberty when they lack the capacity to make certain decisions in regards to their care and treatment. When a person lacked capacity to make a particular decision a process was followed in line with the Mental Capacity Act 2005 (MCA). However, it was not always clear who was involved in making the best interest decision or what the outcome of the process was.

People were provided with activities within the home which we saw people enjoying during the inspection. Activities were also offered in the community. This enabled people to pursue their interests and hobbies.

People told us that staff were kind and caring. We observed positive relationships between staff and people at the home, for example when engaged in conversation or involved in an activity.

The service was responsive to people’s needs. Care records were personalised and gave detailed information about the person’s history and preferences. Family and friends were welcomed to the home and could visit at any time. People were able to give feedback about the home at meetings and in surveys.

Staff said that Patron House was a positive place to work. Staff had regular meetings and were encouraged to give their views and opinions to improve the service. The registered manager and the provider had systems in place to monitor and review the quality of the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  You can see what action we told the provider to take at the back of this report.

At the time of our inspection 10 people were living in Patron house. During our inspection we spoke with people living in the home, visiting relatives, staff, the registered manager, the provider. We also examined the care records for people living in the home.

Not all people were able to verbally tell us about the care they received.. This was because some people were living with a form of dementia. Therefore, we observed how staff interacted and supported people in communal areas and crossed referenced this with their individual care plans. This enabled us to make a judgement on how their individual needs were being met.

Overall the people we spoke with who could verbally communicate were happy with the care they received. Comments included; “it’s ok here it’s in walking distance to where I used to live”; “Yes it’s nice here. I would like to be at home but I can’t”; and “Staff are nice. I get enough support and if I wasn’t happy I would see the manager”.

Comments from relatives and friends included; “overall it’s really good here and the food is good. They took X out for lunch recently and that was nice, just wished it could happen more often”. “I don’t worry about X anymore now she is here, staff are lovely”. “Some little things annoy me like the laundry system, as often clothes get damaged”. We discussed this concern with the provider and registered manager. They agreed to follow this up.

We found the provider had systems in place to effectively monitor the service provided.

We visited the service in October 2012 and found the service was not meeting the 'Essential Standards of Quality and Safety' in outcomes 4, 8,10,13,16 and 21. During this inspection we observed some good improvements had been made in all outcomes and the provider was compliant in these areas.

During our inspection we spoke with three people living in the home, two staff, and one relative. We also spoke with the manager and the registered provider. We examined the care records of four people living in the home and observed if these were an accurate reflection of people’s needs.

Overall people we spoke with who used the service were happy with the care they received. Comments received included; "I am happy here really, the staff are nice", “food is home cooked its ok”. Another person told us, "they do try hard, the staff are lovely”.

One member of staff told us things had improved since our last visit, and that the new manager was working very hard to improve things.

We spoke with one relative who was visiting the home who told us, “the new manager appears nice. There’s been a big turnaround since your last inspection. Fresh fruit around the home is a big improvement”.

At the time of our visit there were 11 people living at Patron House. Not everyone was able to discuss their experience with us verbally. However, we made observations of their care, looked at their care records, spoke with members of staff, relatives of people that used the service, and observed staff interactions with people.

We spoke with five relatives and comments included; "The staff are very welcoming, they work so hard"," the television is always on in the lounge, even if people were asleep.” "The staff are nice but just too busy, they do everything". Another relative told us they felt the home was a “bit dirty”, but also stated the care staff do clean their relative’s room each day.

Some people told us they felt safe and happy in the home. One person said “they are lovely here to me". Another person using the service told us “It’s boring here staring into space, people don't ask me anything". However this person's relative was present, and reminded the person of the activities they had been involved in recently, and confirmed photographs had been taken.

Staff comments included “I love working with the resident's here", “we do all the cooking, cleaning, laundry, activities and attend to people's personal care needs. That’s what we do here, yes it’s busy but it’s ok".

A member of staff told us “I have tried to discuss the lack of staffing, but it hasn't changed. Staffing is the same, however people's need have increased greatly over the years".