About the service:

Pool Cottage is a residential care home for up to 17 people which provides accommodation and personal care to older people. At the time of our inspection there were 13 people living there. The home is situated in the village of Melbourne, in the grounds of Melbourne Hall. It is accessible to people who use wheelchairs because there is a stair-lift to the first-floor accommodation.

People’s experience of using this service:

The service met the characteristics of good overall with requires improvement in well-led.

The provider and registered manager did not always have clear responsibilities and defined accountabilities. This meant there were sometimes difficulties managing priorities, responding to concerns and supporting staff. After our inspection, the registered manager and provider provided us with a joint action plan which added clarity to their roles. It gave us an assurance that they had addressed these concerns.

People continued to receive safe care. There were systems in place to safeguard people from abuse and staff showed understanding of their responsibilities. Staff assessed risks to people and monitored these to keep people protected from harm. People received their medicines as prescribed. There were enough staff to support people and the provider recruited and trained staff as required. Good infection prevention and control practices were in place to protect people.

The care given continued to be effective. People enjoyed the meals available and could exercise choice. They 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 had access to healthcare services and received coordinated support, to ensure their preferences and needs were met. The provider continued to improve the environment to meet people’s needs.

Staff were kind and caring when interacting with people. We received many positive comments from people and their relatives. Staff made relatives feel welcome. Staff respected every person’s privacy and dignity. Staff supported people to be involved in their care.

The staff and provider continued to be responsive. People had personalised and holistic care plans that staff regularly reviewed. Care plans incorporated information about positive risk-taking and empowering people to be independent. Staff encouraged people to access activities and arranged for external people to facilitate them. Staff identified people’s information and communication needs by assessing them. People knew how to make a complaint and felt confident they would be listened to. Staff had written comprehensive end of life care plans which detailed people’s preferences about their care. The provider showed compassion and kindness when dealing with bereavement.

All staff shared the positive culture and vision to support the people’s health and wellbeing. There were strong links to the community in the service and multiple people told us how the service was a real part of the village. Improvements to the building were ongoing. The registered manager was transparent, open and collaborative with external agencies.

More information is in the full report below.

Rating at last inspection:

Rated as good, report published 5 July 2016.

Why we inspected:

This was a scheduled inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We inspected Pool Cottage on May 19 2016 and it was unannounced. Pool Cottage provides accommodation and personal care for up to 17 older people. There were 14 people living at the service when we visited. The service was last inspected on 22 and 23 December 2014. At our last inspection we found that the provider did not consistently manage risks to people’s health and welfare. At this inspection we saw that improvements had been made. The provider had introduced systems to assess risk, actions were put in place to reduce it and that their effectiveness was monitored and regularly reviewed.

At our last inspection the provider did not meet all of the requirements to ensure that people consented to their care. At this inspection we saw that people did consent and if they did not have the capacity to do this for themselves a best interest decision was made on their behalf. We saw that appropriate applications were made to restrict people’s liberty when it was identified that this was in their best interest to keep them safe.

At our last inspection people did not always have care plans that described their current needs. At this inspection we saw that people were involved in planning and regularly reviewing their care and staff knew what their preferences were. People’s records were up to date and accurately reflected their care.

At our last inspection there was not a registered manage in post and systems to effectively manage the home were not in place. At this inspection we saw that the service had appointed 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. We saw that the registered manager had developed and implemented quality improvement systems. The staff team were well supported and plans were in place to continue to develop their skills. There was an inclusive culture which welcomed feedback in order to support the development of the service.

People told us that they felt safe and staff we spoke with were confident that they could identify signs of abuse and would know where to report any concerns. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. There were enough staff to meet people’s needs promptly. Staff developed caring, respectful and patient relationships with the people they supported. Staff knew people well and provided care that met their preferences while respecting their privacy and dignity at all times.

People received the medicines they were prescribed safely and there were systems in place to reduce the risks associated with them. They were supported to maintain good health and had regular access to healthcare professionals. Mealtimes were not rushed and people said that the food was good. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk.

People were encouraged to pursue interests and regular activities were planned for them. Visitors were welcomed at any time and there was a focus on making community links. People told us that they knew the manager and felt confident that any concerns they raised would be resolved promptly.

We carried out this inspection following some information of concern we received. We met nine people who used the service, two relatives and two staff. Some of the people we saw in the home had memory problems or difficulty with communicating their needs. We spoke directly with six people living in the home, they were happy with the care they received and with the staff who cared for them. One person told us. “They look after me very well, it couldn’t be better.” Another person said. “The staff are kind they help me when I need help”.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Support plans lacked detail but staff knew the people who used the service well and were able to provide personalised care. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire. Staff had received training to ensure that people were protected from the risk of abuse and there are systems in place to deal with complaints received. People received their medications at the right time. The provider had effective arrangements for the safe management of medicines. Staff we spoke with understood how to identify and report signs of abuse. Procedures were in place for managers and staff to learn from events such as accidents and incidents as well as complaints. Staff told us they received training to enable them to carry out their role and we saw training records to confirm that staff received regular updates to their training.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control.

Is the service effective?

People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. We saw that people were treated with respect and their dignity maintained by staff and were they happy with the care and support they received.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw people were supported by visiting doctors, specialists and district nurses on a regular basis. People were treated with respect and dignity by staff. We saw limited examples of how staff treated people with dignity and respect as staff were mostly involved in providing personal care in people’s bedrooms.

Is the service responsive?

People had their needs assessed before moving to the service. We also saw that they were reviewed regularly and where people’s needs had changed they were reviewed more frequently. If a person became unwell a GP was called to see them.

Is the service well-led?

Quality assurance systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Staff spoken with understood the standard of care expected of them by the provider. The provider for Pool Cottage had changed and the new provider had been in place since December 2013. The provider assured us that they are still working towards improving the environment within the home and so some areas raised in the audits have yet to be addressed.

Pool Cottage provides care for up to 17 people who need support with their personal care.

This was an unannounced inspection, carried out over two days on 22 and 23 December 2014. The service must have a registered manager but currently this post is vacant. 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.

We last inspected this service in August 2014. At that inspection we found the service was meeting all the essential standards that we assessed.

People said they felt safe and that the staff were able to support them in the way they wanted to be. Not all staff provided care according to people’s care plans and not all staff administered medication safely. People were not always assessed by appropriate professionals for their moving and handling needs. Staff were not having supervision or regular staff meetings and this was as a consequence of the service having no registered manager.

People who used the service and their families were not always involved in the creation and review of their care plans.

Staff were aware of how to maintain people’s independence and maintain control over their lives.

Staff treated people with kindness and respect. Staff made time to talk to people in the home and welcome visitors to the home. People lived in a home where staff were kind and made time for them.

People were given a choice of meals, snacks and drinks. Where people needed specialist diets, such as for diabetes, this was supported. However where people had needs around fluid intake this was not always monitored to ensure they maintained a healthy level.

Visitors could visit the home anytime they wanted and could see their relatives in private if they so wished. Visitors were made to feel welcome by the staff.

The home did not have a robust system in place when recruiting new staff. Staff understood their responsibilities to keep people safe from harm and abuse. They knew who they needed to speak to if they suspected abuse. They would contact the appropriate authorities if the provider did not take their concerns seriously.