Quebec Hall Limited is registered to provide accommodation for up to 22 people who require personal care. The service does not provide nursing care. The service provides support for older people, some of whom are living with dementia. Accommodation is provided on three floors and a split level, all accessible by a seated stair lift. A full lift covers all three floors. At the time of the inspection a new, larger lift was being installed. There are areas around the service where people can walk and there is a garden where people can sit outside. At the time of our inspection there were 21 people living in the home.

This unannounced inspection took place on 27 October 2016.

At the last inspection on 24 August 2015 breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements. The provider sent us an action plan telling us how they would make the required improvements. During this inspection we found that the provider had made the necessary improvements and all legal requirements were now being met.

The service 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 2008 and associated Regulations about how the scheme is run.

Although people were supported by staff with their prescribed medicines people could be at risk because some records were not up to date.

An induction process was in place to support new staff. Further training was provided to ensure all staff had the necessary expertise and skills to meet the needs of people living in the service.

People were involved in their care assessments and reviews, which meant staff knew how to provide the care and support they needed. People were supported to be as safe as possible because assessments of risks had been completed, although the details of how the risks could be managed had not always been recorded.

The risk of harm for people was reduced because staff knew how to recognise and report any incidents of harm. There was a sufficient number of staff to meet the care and support needs of people living in the service. Satisfactory pre-employment checks were completed before staff worked in the service.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and could describe how people were supported to make decisions. Although no-one in the service was currently deprived of their liberty, applications had been made to the relevant authorities in the past to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People were able to make choices about their food and drink throughout the day. Staff checked that people had sufficient amounts to eat and drink. Staff treated people with care and respect and made sure people’s privacy and dignity was respected all the time.

People and staff were able to provide feedback and information so that the management could monitor and improve the quality of the service. The registered manager had an open door policy which meant that people and staff could make any comments/improvements about the care and support provided.

Quebec Hall Limited is registered to provide accommodation for up to 22 people who require personal care. The service does not provide nursing care. The service provides support for older people, some of whom are living with dementia. Accommodation is provided on three floors and a split level, all accessible by a seated stair lift. A full lift covers all three floors. At the time of the inspection a new, larger lift was being installed. There are areas around the service where people can walk and there is a garden where people can sit outside. At the time of our inspection there were 21 people living in the home.

This unannounced inspection took place on 27 October 2016.

At the last inspection on 24 August 2015 breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements. The provider sent us an action plan telling us how they would make the required improvements. During this inspection we found that the provider had made the necessary improvements and all legal requirements were now being met.

The service 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 2008 and associated Regulations about how the scheme is run.

Although people were supported by staff with their prescribed medicines people could be at risk because some records were not up to date.

An induction process was in place to support new staff. Further training was provided to ensure all staff had the necessary expertise and skills to meet the needs of people living in the service.

People were involved in their care assessments and reviews, which meant staff knew how to provide the care and support they needed. People were supported to be as safe as possible because assessments of risks had been completed, although the details of how the risks could be managed had not always been recorded.

The risk of harm for people was reduced because staff knew how to recognise and report any incidents of harm. There was a sufficient number of staff to meet the care and support needs of people living in the service. Satisfactory pre-employment checks were completed before staff worked in the service.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and could describe how people were supported to make decisions. Although no-one in the service was currently deprived of their liberty, applications had been made to the relevant authorities in the past to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People were able to make choices about their food and drink throughout the day. Staff checked that people had sufficient amounts to eat and drink. Staff treated people with care and respect and made sure people’s privacy and dignity was respected all the time.

People and staff were able to provide feedback and information so that the management could monitor and improve the quality of the service. The registered manager had an open door policy which meant that people and staff could make any comments/improvements about the care and support provided.

Our inspection team was made up of one inspector who answered our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People are treated with respect and dignity by the staff. People told us they felt safe, we saw that staff had received updated safeguarding of vulnerable adults and that the provider had safeguarding procedures in place.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

We looked at the recruitment of new staff. This showed that some required recruitment checks relating to obtaining references were not in place. This put people at risk of being supported by staff without the appropriate background checks having been carried out.

We have asked the provider to tell us what they are going to do to meet the legal requirements when recruiting staff.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very good”. A visiting GP said “The staff were very caring and knowledgeable about people’s needs”.

People using the service, their relatives, friends involved with the service completed a 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’s needs were assessed before they moved into the service and they were offered the opportunity to visit the service on as many occasions as they wished prior to making any decisions about the suitability of the service.

Peoples views on the quality of the service provided were regularly sought by the provider. This information was used to identifies areas of improvement and identify what was working well.

Records confirmed that information relating to people’s preferences and interests were sought and that people regularly had access to a range of activities of their choice in and outside of the service.

People knew how to make a complaint if they were unhappy. People we spoke with told us that they were aware of how to make a complaint and to whom. The service has not received any complaints since the last inspection.

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. A GP told us that they receive appropriate referrals for people who use the service and that the staff were very cooperative.

The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. The service is currently reviewing how it conducts customer surveys to ensure that customer feedback is received more frequently.

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

We spoke with four people using the service and they told us that they received care and support in line with their wishes. One person commented “Sometimes I choose to take part in events but sometimes I’m too tired so I stay in my room…I am never forced to do anything.” Another person said “I am supported to maintain my independence; staff only provide assistance where it is needed.”

We observed lunch time during our inspection and found that staff offered encouragement and assisted people as necessary. People were provided with lunch of their liking and staff were aware of people’s preferences in relation to portion sizes. One person we observed liked to take a long time over their meals and we saw that this was appropriately referenced in their care plan. Staff were patient with this person and allowed them to eat at their own pace.

There were appropriate arrangements in place to safely manage people's medications.

We spoke with three members of staff who confirmed that they felt appropriately trained and supported to carry out their role. Our review of records confirmed that appropriate training courses were provided to staff and that they benefitted from a regular system of supervision and appraisal.

We spoke with people who told us what it was like to live at this home. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and an “expert by experience” (people who have experience of using services and who can provide that perspective).

We spoke with a total of seven people who were using this service. People spoken with reported that they felt respected and involved by staff. For example, one person told us that “I’m treated with both dignity and respect” and another person told us “ I come and go as I please, today, I’ve been to the village”

We also spoke to four visitors of people who were using this service. They confirmed that they were consulted with about the care that their relatives were receiving and felt able to talk to senior staff if they had any concerns. One visitor spoke highly of the individual attention shown by staff towards their relative and another visitor stated that the home had an open door policy and were always happy to support them and their relative. Another visitor spoken with reported that "the staff are absolutely brilliant, they always make me feel welcome and they are very attentive to my friend”.

People using the service reported that they enjoyed the meals provided and that the food was good. They also confirmed that people were offered help as needed and that their individual choices were respected by staff. For example one person told us “mealtimes are enjoyable”.

People spoken with reported that they felt safe in the service and that the staff were kind and attentive. For example one person told us, “I feel very safe here, staff are very kind to me”, then, having assured us there was no abuse, they told us that they had “no concerns about ill treatment, staff always have time for me”. Another person told us, “I have no concerns but if I had I would speak to staff and I am confident they will help me”.

People stated that their call bells were answered promptly and that if they needed any assistance staff were helpful.

Visitors spoken with reported that there were always plenty of staff around and that they were supportive towards the people using this service.

Six out of seven people knew that their records were kept in the office and all knew they were regularly updated. The one person who wasn’t sure said “I don’t know where my records are kept, but the staff will know”.

We spoke with people in various parts of the home during this visit who told us they are cared for and that staff are always available to assist if needed. Two visitors to Quebec Hall told us they always find the home clean, welcoming and staff work hard to provide the appropriate care to people.

People with whom we spoke confirmed they would speak to staff if they had a complaint.