The inspection of Saxonwood took place on 3 and 4 November 2016 and was unannounced.

Saxonwood provides accommodation for up to thirty-six older people, some of whom are living with mental and physical health needs and who may need support with their personal care. The home was on three floors with four bedrooms on the lower ground floor, 17 bedrooms on the ground floor and 15 bedrooms on the first floor. The ground floor also included a kitchen, the dining room, a communal lounge with access to the garden and an office.

There was a registered manager at the home. 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 service is run.

Throughout our inspection, people spoke positively about the home. Comments included, “All the staff are really pleasant” and, “I am very happy here.” Although staff and managers knew people well and had a good understanding of their individual needs and choices there was a lack of a consistent quality assurance system which could prevent effective analysis of information relating to incidents and accidents. We made a recommendation about a quality assurance system being applied consistently.

People told us they felt safe living at Saxonwood. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had recently increased staffing levels based on the dependency of people’s needs.

Medicines were managed safely. The provider had put in place clear guidance for staff to follow on PRN medication.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “The cook is very good and we get a choice.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. One person said, “The staff are very caring.” A staff member told us, “We have good relationships with the residents. They trust us.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received regular supervisions with their manager to discuss additional training needs and development and annual appraisals.

Robust recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. Staff received an induction followed by a week of shadowing experienced staff.

People’s health and wellbeing was monitored and staff regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “Saxonwood is a caring rest home and I have no worries about them. If staff have any concerns they are straight on the phone to me.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in the person’s best interests.

People’s individual risk assessments and care plans were person-centred and reviewed monthly or when their needs changed. Clear information about the service

Our inspection team was made up of one inspector. We 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 describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Saxonwood had good systems in place to manage their medicines safely. We saw that the home had made appropriate provision to ensure that people received the right medication at the right time. Through the process of individual risk assessment people were able to manage their own medicines if they chose to. This meant that the home was able to balance safety and choice effectively.

We saw that staffing levels were based on people's assessed needs and were responsive when these changed. Therefore people's safety was protected because they received support when they needed it. We observed that care staff prioritised answering people's call bells which meant that people were less at risk of falling because they received the help they needed in a timely way.

Saxonwood had a range of specialist equipment to enable people to mobilise safely and comfortably. We saw that those people who required equipment to aid their care had been appropriately assessed. Care plans provided clear guidance to staff regarding the use of equipment.

We found evidence that the home had taken steps to ensure that it was compliant with the Mental Capacity Act and Deprivation of Liberty Safeguards. Through staff training and ongoing care plan reviews we found that the home had taken appropriate action to ensure that people received support that protected their legal rights and balanced safety with choice.

Is the service effective?

We saw that people had good relationships with the staff who supported them and observed positive relationships between them. People described staff as "Very kind" and "Fun" and "Always there".

We found that people received good quality meals at Saxonwood. People told us that they had "Lots of choice" about their meals and that they could always request something different to the menu if they wanted to. People could choose where to take their meals, although most people said that they like the sociability of eating in the dining room. Regular weight monitoring and nutritional screening assessments enabled the home to ensure people were well hydrated and nourished.

Is the service caring?

Throughout the inspection we observed a real atmosphere of kindness. We saw that staff were very considerate and respectful towards people and in turn they showed the same kindness to each other. People told us that that they had made "Really good friends" since moving to Saxonwood. They said that they would "Recommend living here to anyone." Staff told us that they would be happy to have their own relatives looked after at Saxonwood because people "Receive high quality care." We saw evidence that people's families frequently thanked the manager and staff for the care they provided. People continuously used the words "Kind" and "Caring" to describe the support provided at Saxonwood.

Is the service responsive?

People’s needs were continually assessed. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people’s wishes. Staff had a good understanding of people’s needs and demonstrated that they recognised and responded when these changed.

Is the service well-led?

People and staff could not offer enough praise for the registered manager. She was repeatedly described as "An excellent manager", "Truly fantastic" and "Always goes way beyond what is expected of her." The registered manager had fostered a culture of openness and responsibility at Saxonwood, one in which people wanted to live and work.

The provider had good systems in place to monitor and improve the services provided. The whole management team demonstrated a sound commitment to listening to the people who lived there.

We observed care being provided by staff in attentive and caring ways. We spoke with seven people who used the service. They all told us that they liked living at Saxonwood. One person said, "the staff are very caring, nothing is too much to ask."

People who lived at the home told us they were involved in their care and felt they could positively influence the running of the home. One resident told us "there is a real community feel about the place."

Staff had received a wide range of mandatory training, appropriate arrangements were in place to support and develop staff. One staff member told us, "it's a really nice place to work, I enjoy working here."

The home was seen to be clean and tidy and the food nutritious and popular. One resident told us that "the food is excellent, you can pretty much order whatever you want."

People we spoke with told us that they liked living at the home very much. One person told us that the staff were “always polite”. Another told us the food was good and there was “always plenty of choice”. Others told us they enjoyed the views from their rooms and the trips out on the minibus.

People we spoke with said they were happy with their life at Saxonwood. They felt that their needs were generally well understood and attended to by staff, and that they were involved in decisions about their care. Some people in the home thought that there was a lot of use of agency and bank staff and this provided a lack of continuity for those people who have some degree of confusion. In general people said they found staff helpful and kind, and thought that they were aware of their day to day routines. However, they said that new staff were not always aware and they needed to retell their routines and preferences over again which was a source of irritation. People said that staff were too busy to spend any time with them as they used to do.