This inspection took place on the 1st and 5th September 2016 and was unannounced on the first day.

At our most recent inspection in May 2014 we found the service was meeting the requirements of the regulations in place at the time.

Pratt House is registered to provide care for up to twenty nine older people. Twenty one people were being cared for at the time of our visit.

The service 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.

We received mostly positive feedback on the quality of the service from people who lived in Pratt House and their relatives. Health care professionals we contacted were also positive about the standard of care they observed and the communication and co-ordination that existed between Pratt House and themselves.

There were safeguarding procedures in place and staff received training on safeguarding vulnerable people. This meant staff had the skills and knowledge to recognise and respond to any safeguarding concerns. The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessment needed to be completed and best interest decisions made in line with the MCA. Staff had a good understanding about giving people choice on a day to day basis.

Risks to people were identified and managed well at the service so that people could be as independent as possible. A range of detailed risk assessments were in place to reduce the likelihood of injury or harm to people during the provision of their care.

We found staffing levels were adequate to meet people’s needs effectively. The staff team worked well together and were committed to ensure people were kept safe and their needs were met appropriately.

Staff had been subject to a robust recruitment process. This made sure people were supported by staff that were suitable to work with them.

Staff received appropriate support through induction and supervision. All the staff we spoke with said they felt able to speak with the registered manager or senior staff at any time they needed to. There were team meetings held to discuss issues and to support staff. Overall the staff we spoke with were positive about the newly appointed registered manager. People commented favourably on the ‘open door’ policy of the registered manager, who had a high profile throughout the service and who was readily available to staff, people who lived in Pratt House and their relatives.

We looked at summary records of training for all staff. We found there was an on-going training programme to ensure staff gained and maintained the skills they required to ensure safe ways of working.

Care plans were in place to document people's needs and their preferences for how they wished to be supported. These were subject to review to take account of changes in people's needs over time. We found the format for care plans was sufficiently comprehensive to ensure people were protected by accurate and up to date records of their care.

Medicines were administered in line with safe practice. Staff who assisted people with their medicines received appropriate training to enable them to do so safely. Problems with the storage temperature of medicines were addressed satisfactorily during the inspection.

The service was managed effectively. The registered manager was also responsible for the local Abbeyfield care at home service operated from a different address. In their absence, there was effective management and communication in place. The quality of care was regularly checked through audits and by giving people the opportunity to co

People's needs were assessed and the care and support was planned and delivered in line with their individual care plan. These were detailed, regularly reviewed and updated. Risk assessments had had been written to identify and reduce the likelihood of injury or harm with guidelines in place for staff to follow. However, there was some inconsistency in relation to managing risks in relation to infection control.

People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

Activities were provided for those who wished to take part. They included one to one activities and group sessions. They were tailored to people's likes and dislikes to ensure their social care needs were met appropriately.

The provider had not ensured there were enough qualified, skilled and experienced staff to meet people’s needs during the night which had the potential to place people's health and welfare at risk.

People told us they were happy with the care and support they received. They said they were involved in the care planning and review process and their views taken into consideration. Comments included ''They look after me well...they do their very best I can't grumble at them at all.'' ''The staff are terrific, very good, I can't fault them.''

There was a complaints procedure in place to ensure people could raise any concerns they had. People told us they knew who to speak to if they had concerns.

People told us they and/or their families had the opportunity to visit the home, meet the staff and residents and view the facilities before they moved in. They told us their needs had been assessed before a placement at the home had begun. This ensured their needs could be met appropriately.

Care plans addressed people's individual needs, were detailed, reviewed and updated regularly. People had access to healthcare professionals and specialist support to ensure they kept healthy and well.

We found people were treated with dignity and respect. We observed people in the dining room during lunch time. We saw staff offered people choice of food and people were not rushed and enabled to eat their lunch at their own pace.

Daily activities were provided to ensure people's social care needs were met.

The home was comfortable, clean and warm. Each person had their own bedroom which they had personalised to their own taste.

People told us they had no concerns about the care and support they received. They found the staff to be caring and polite. One person said "I have never had to complain, I can't imagine there would be a need they are all so nice. I feel the staff are knowledgeable and I can not find any fault in them." Another said "It is a friendly atmosphere here, I have never had to make a complaint. The girls are cheerful and will always do things for me...they always welcome my visitors...all in all I am as happy as can be expected."

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). We saw documentation in one person's file which showed correct procedures were followed. A referral to the Local Authority (as "Supervisory Body") had been made and approved. This showed the provider had identified the person could potentially be deprived of their liberty and understood when an application should be made and how to submit one.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. We viewed the staff training matrix which showed all staff were provided with safeguarding training. This ensured staff had the knowledge and skills to respond to any allegations of abuse appropriately. Appropriate measures were in place to ensure that people’s money was managed safely.

Is the service effective?

People told us someone from the home had visited them to assess their health, care and social needs prior to them moving into the home. This enabled the home to access any necessary equipment prior to them moving in and to write an initial care plan with details of their preferences and wishes.

People received co-ordinated care. We saw evidence in people's care plans which demonstrated people had been visited by their GP and other health care professionals and appropriate advice sought when required

We found the care and support provided was reflective of their needs detailed in their care plans and were regularly updated where any changes in health were evident . Any accidents or incidents were recorded appropriately. They detailed the actions taken and risk assessments had been updated to document any further measures put into place to prevent a recurrence.

It was evident through discussions with people living in the home, our observations and speaking with staff that they had a good understanding of people's needs and knew them well.

Is the service responsive?

People knew how to make a complaint or raise any concerns if they were unhappy. We saw the complaints procedure displayed in the home which detailed who to direct any concern to and the timescales in which complaints would be responded to. The procedure was available in large print and braille to meet with people's individual needs.

People we spoke with told us they felt there were enough staff both during the day and night and they met their needs well. A survey sent to people using the service in September and October 2013 showed that 96% felt staff were available when needed.

Regular meetings were provided for people who used the service. Where any concerns were raised actions were put into place to resolve them and improve the outcomes for those who received a service.

Is the service caring?

The atmosphere within the home was calm and relaxed. We saw positive interactions between the staff and people using the service. We observed a meal time and saw discreet assistance from staff was available as needed. People were not seen to be rushed and were able to eat their meal in their own time in a relaxed manner.

Throughout our visit staff were attentive to people’s needs, assisted people where help was required and interacted with people positively.