Roundham Court provides accommodation and personal care for up to 35 older people who may be living with a dementia or physical disability. At the time of the inspection there were 34 people living at the home. The home offers both long stay and short stay respite care. Roundham Court does not provide nursing care. Where needed this is provided by the community nursing team.

This inspection took place on the 16 & 17 November 2016; the first day of the inspection was unannounced. One adult social care inspector carried out this inspection. Roundham Court was previously inspected in April 2014, when it was found to be compliant with the regulations relevant at that time.

The home 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.

People said they felt safe and well cared for at Roundham Court, their comments included "I do feel safe,” "I’m very happy here” and “I would recommend it to anyone.” Relatives told us they did not have any concerns about people's safety.

People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. There was a comprehensive staff-training programme in place. These included safeguarding, first aid, pressure area care, infection control, and moving handling. Some staff had received additional training in the Mental Capacity Act and Deprivation of Liberty Safeguards.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People told us they were involved in their care and support, attended regular reviews, and had access to their records. We saw staff sought people’s consent and made every effort to help people make choices and decisions.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedure for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The home had a keypad system in operation to keep safe those people who would be at risk should they leave the home unaccompanied. Those people who were safe to leave without staff support were given the keypad number to the front door, ensuring that their legal rights were protected and they were not deprived of their liberty.

People told us they were happy living at Roundham Court, staff treated them with respect and maintained their dignity. Throughout our inspection, there was a relaxed and friendly atmosphere within the home. Staff spoke affectionately about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed, and designed to help ensure people received personalised care. Care plans were reviewed regularly and updated as people's needs and wishes changed. Risks to people's health and safety had been assessed and regularly reviewed. Each person had a number of detailed risk assessments, which covered a range of issues in relation to their needs, which included personal emergency evacuation plan (PEEP).

People received their prescribed medicines when they needed them and in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held

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. The summary is based on our observations during the inspection. We spoke with three people using the service, five people who were visiting relatives or friends who lived at Roundham Court, two visiting health professionals and two members of staff. We looked in depth at four care plans and people’s daily records and we looked at the home’s equipment maintenance records.

Is the service safe?

We saw from the files that the home ensured that all the equipment was regularly maintained and was up to date. We noted that people’s personal electrical items were also regularly checked. Many people brought items of furniture from their homes and staff told us that these all had to be approved before they could be installed.

We observed the lunch time medication being dispensed. The staff member who was doing this task told us that they had been on a training course, held by the local pharmacy, on how to safely handle medication. In addition to the course they had watched a video and had shadowed experienced staff for a week before being entrusted with the task on their own. We saw that the member of staff was competent and confident in their role. They were able to answer all our queries regarding medication. One person expressed their confidence in the staff member, explaining that they were “firm and persuasive” in explaining the need for taking all their medication.

During our inspection one person suffered a fall. We observed staff reassuring the person while they ensured that they had not been seriously injured. They assessed that it was safe and appropriate to move the person. The staff then used a combination of a hoist and a wheelchair to assist the person to get up from the floor. We saw that the staff knew how to use this equipment effectively and safely.

We discussed the staff rotas with the manager. She explained that there was an additional care worker on duty in the mornings when the home was busiest. She also told us that as she managed two homes there was a full time head of care who worked at Roundham Court. The manager told us that she had a good staff team and rarely needed to employ agency staff. She said that there were rarely any staff shortages, and that if they occurred she could normally find cover from within the team or from one of the other homes. This meant that staff all knew the people living at the home and also knew the routines and standards that the home expected.

Is the service effective?

People told us that they liked living at Roundham Court. One person told us that their friend had chosen the home for their partner and had then chosen to move in themselves. Another relative said that their loved one was “much better” since moving into the home. We observed the staff working with people and it was clear that they knew everyone very well. People were addressed by their names and staff knew what they wanted and the sorts of things that they would need. We spoke with the relative of one person who was planning to move to another home. We asked why they were moving, and we were told that Roundham Court could no longer meet their relative’s needs. However the person we spoke with was keen to tell us how helpful Roundham Court had been in facilitating the move.

Is the service caring?

We observed the way staff supported and cared for the people living in the home. We also saw how staff interacted with visitors to the home. One relative told us that the staff “could not have been kinder or more helpful.” Another told us “The staff here are brilliant.” One of the health professionals that we spoke with said “The staff are approachable and willing to help. I get alerted quickly if there is a problem.” One person living in the home told us that they had never heard the staff arguing between themselves. They went on to say “I have no complaints whatsoever about the staff, they are first class.” One person living at the home told us that most of the staff were good, though one new member of staff was not. They added that this person was improving.

We saw that the staff had enough time to provide unhurried support and care for people. They used their time with people to engage in conversation.

Is the service responsive?

In our last report we had noted that the people living at Roundham Court had asked for themed nights. We asked about this and were told that they had been tried, but had not been successful. The manager thought this was mainly due to people not liking the different food flavours.

We saw that the home held meetings for residents and their families to discuss issues to do with the home. We saw the minutes of these meetings. The provider might find it useful to note that the manager was unable to show us what actions resulted from this. She did, however, tell us that she always followed things up after the meetings.

We heard from a visitor that the home had responded "magnificently" following the death of a relative of someone living at the home – providing a family buffet following the funeral.

We heard from the visiting health professionals that the home responded quickly to any health related changes that people presented. We were told that staff sought appropriate health advice and support.

Is the service well-led?

The manager had been in post for two years and she was also responsible for another care home. The manager told us that it was her practice to work occasional night shifts and some week-ends so that she maintained a practical understanding of all the shifts at the home. One of the people living at the home told us that “things were improving with the new manager.”

We asked for, and were shown, the latest quality assurance questionnaires that people living in the home had completed. These were complimentary. We also saw questionnaires that staff had filled out. The provider might find it useful to note that we did not see an action plan that addressed the issues that were highlighted by the staff questionnaire responses. We heard that there had been some staff turnover while others had worked at the home for several years.

The home was part of a group of care homes in the Southwest. The group provided support to the home through a group location manager. This person also provided human resources advice and support to the manager. The group also employed a quality assurance manager and we saw that they inspected the home on a regular basis, providing a report to the manager on what they were doing well and on areas where improvements might be made. We were shown these reports. The home also benefited from the support of a group accountant and a health and safety consultant.

On the day of our inspection 28 people were living at the home and receiving care from the service. One person was receiving respite care. We, the Care Quality Commission (CQC), spoke with four people, one relative, the manager, three care workers and an external trainer. We also spent time observing care and people having lunch. We looked at four care plans.

One person said “I’m very happy here.” Another person said “It’s very good here. The food is very good.” An external trainer described Roundham Court as “a really good home”. They were positive about staff’s communication skills and said “Staff communicate at people’s level, clearly and take their time.”

All the people and relatives we spoke with were positive about their experience of care at the home. One person told us their experience was “wonderful” and added “I can’t fault them. It takes a lot of beating.” One relative told us that their family member was always “clean and well cared for”. They added that the staff were “very caring and cheerful” and made them feel welcome.

There were effective recruitment and selection processes in place. Suitable arrangements were in place to support staff to provide care to people safely and to an appropriate standard.

There were systems in place to monitor the quality of the service and manage risk. One person told us “One of my friends has moved in because of what I told them. Another person I know has booked a room.”

We carried out an unannounced inspection on 31 July 2012. On the day of our visit there were 29 people living at Roundham Court. We spoke with 11 people living at the home, one relative, six staff members, which included the registered manager and the locality manager, a staff member from head office, a care worker/entertainer and the cook and we looked at four peoples care files.

Comments included: “It’s lovely here”; “the staff are really nice and helpful”; “we are involved in planning our care.”

People told us what it was like to live at the home and 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 Care Quality Commission (CQC) inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

Some of the people who used the service at Roundham Court had a dementia and therefore were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

People who live in the home told us they were happy at the home. Comments included ‘it’s perfect, gracious living and very good staff’; ‘they look after you very well, we’re very lucky’ and ‘there’s not a single thing to complain about’.

One person told us they sometimes get distressed by another person’s behaviours within the home.