Penny Pot is a ‘care home’. People in care homes received accommodation and nursing or personal cars as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Penny Pot accommodates up to 38 people in one adapted building. At the time of our inspection there were 37 people living in the home.

At the last inspection, the service was rated good. At this inspection, we found the service remained good.

A new manager in post was in the process of being registered by the commission. In the interim, the provider on a day-to-day basis supported them.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge to keep people safe.

Medicines were generally managed safely, but we did observe some unsafe practice on the day of inspection. Environmental risk assessments were in place but actions taken needed to be highlighted on audit forms to ensure clear oversight.

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. Management and staff understood their responsibility in this area. Staff were committed to ensuring all decisions were made in people’s best interest.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The inspection took place on 16 June 2015 and was unannounced. Penny Pot provides accommodation and personal care and support for up to 38 older people, some who may have a mental health need. At the time of our inspection there were 34 people who lived in the service.

The home had a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

The service had appropriate systems in place to keep people safe, and staff followed these guidelines when they supported people. There were sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time. The provider also had a robust recruitment process in place to protect people from the risk of avoidable harm.

People’s health needs were managed by staff with input from relevant health care professionals. Staff supported people to have sufficient food and drink that met their individual needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support. Care plans reflected people’s care and support requirements accurately and people’s healthcare needs were well managed. Staff interacted with people in a caring, respectful and professional manner, and responded well to people’s care and support needs.

People were encouraged to take part in interests and hobbies that they enjoyed. They were supported to keep in contact with family and develop new friendships so that they could enjoy social activities outside the service. The manager and staff provided people with opportunities to express their views and there were systems in place to manage concerns and complaints.

There was an open culture and the management team demonstrated good leadership skills. Staff were enthusiastic about their roles and they were able to express their views. The management team had systems in place to check and audit the quality of the service. The views of people and their relatives were sought and feedback was used to make improvements and develop the service.

We spoke with five people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time. We noted how they interacted with other people who lived in the service and with staff. We also spoke with staff members and people's relatives. We looked at four people's care records. Other records viewed included staff rotas, training and supervision records, health and safety checks, safeguarding notifications and records which related to the quality assurance of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw the service had processes in place which ensured that staff had the skills and knowledge to support people safely.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "This is a good place to be, I like it."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently, and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People could therefore be assured that complaints were investigated and action was taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

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

The service had a quality assurance system in place and records showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We used a number of different methods to help us understand the experiences of people who used the service. Some of the people who used the service had complex needs which meant they were not able to tell us about their experiences. Where people were unable to provide a response or tell us about their experiences, for example as a result of their limited verbal communication or poor cognitive ability. We noted their non- verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Penny Pot to be positive.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and preferences.

We found that there were enough trained, skilled and experienced staff to meet people's needs and staff received the training they needed to provide care and support safely. Staff were able to demonstrate that they understood the specific needs of the people who used the service.

Penny Pot was effectively run by a competent manager; there were robust systems and processes in place to ensure people received a good service that took into account their needs and preferences.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noted how they interacted with other people living in the home and with staff.

We saw that Penny Pot provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner.

During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.

People with whom we spoke told us that their privacy, dignity and independence are

respected and that their views on the support and care they receive are taken into

account.

They also told us that generally they were able to make choices about aspects of their

care. For example, we spoke with three people about how they are supported to

choose what to eat each day. They told us that staff offer them a choice of meals each

day and they can choose where they have these. They are also able to make a

decision as to whether or not they participate in social activities.

One relative with whom we spoke confirmed they were happy with their relative's care

and support and found staff to be kind and caring.

One person said, in relation to personal care, "Oh they are very good I always need help."

People spoken with were not able to tell us whether they had been involved in the development of their care plans or not.

People with whom we spoke made the following comments:

"It's a nice home", "The staff and manager cannot do enough for you" and "I can eat what I like here and I feel safe".

Those people with whom we spoke said they could choose whether or not to join in

activities and could spend time alone in their room pursuing their own interests if they

preferred.

People using the service told us that staff helped them with their medication when they needed it.

People told us when we visited that they liked the home and that they liked living there.

People told us that they liked their rooms and found them comfortable. People with whom we spoke during the inspection were happy at the home and liked the way it was

presented.

People told us that they feel well looked after by the staff at Penny Pot. One person with whom we spoke said "I feel safe here and the staff and manager are like my family"

People told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to.