About the service: Snydale is a care home which was providing personal care for up to 50people aged over 65, who may be living with dementia. There were 43 people using the service at the time of the inspection. There were a further two people in hospital.

People’s experience of using this service:

¿ Improvements to the management of medicines and quality audits have been made since our last inspection in December 2017.

¿The service met the characteristics of Good in all areas; more information is in the full report.

¿ Staff were kind and caring and there were sufficient numbers to keep people safe and to meet their care needs.

¿ People were supported by staff who were motivated, enjoyed their job and felt well supported through supervision and training.

¿ Care plans were up to date and detailed exactly what care and support people wanted and needed.

¿ Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

¿ People felt safe at the home and appropriate referrals were being made to the safeguarding team when necessary.

¿ Medicines were being administered safely and people’s health and dietary needs were met.

¿ Activities and outings were arranged to keep people occupied.

¿ The home was well maintained, clean and tidy.

¿ There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

¿ The registered manager provided staff with leadership and was very approachable. Audits and checks continued to be used to drive improvements to the service people received.

¿ People’s feedback was used to make changes to the service, for example, to the menus and activities.

Rating at last inspection: Requires Improvement (report published 31 January 2018). The overall rating has improved following this inspection.

Why we inspected: This was a planned 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

Our inspection took place on 8 December 2017 and was unannounced. At our last inspection in May 2017 we rated the service as ‘requires improvement’ overall and identified two breaches of regulations relating to safe care and treatment and person-centred care. At this inspection we found the provider was making improvements, however remained in breach of the regulation relating to safe care and treatment. We also identified a breach of regulations relating to good governance.

Snydale Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home can accommodate 52 people. At the time of our inspection there were 39 people using the service. There was no registered manager in post, however the person managing the home had applied to become registered. 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.

At this inspection we found most areas of medicines management had improved, however some medicines were not being managed and recorded properly, and we saw medicine storage was not always secure. Some areas of risk assessment required improvement.

People told us they felt safe, we found they lived in a home which was well maintained, and we saw any accidents and incidents were managed appropriately. Staff understood how to identify and report any potential abuse. We observed the same staff engage in poor moving and handling on three occasions, and brought this to the attention of the Director of Care.

Staff were recruited safely and deployed in sufficient numbers. Staff told us they received regular training and effective support.

Not all documentation relating to capacity and consent was fully or appropriately completed. People were able to choose how and where they spent their time, and lifestyle choices were respected.

People said enjoyed the food served, and told us they had choice. The chef had good knowledge of people’s nutritional needs.

We saw staff and people who used the service knew each other well, and we saw examples of caring practice during our inspection. Equality and diversity principles were well embedded in the culture of the home.

The provider was in the process of making improvements to people’s care plans which evidenced people who used the service participated in the process. We found some care plans which had not been re-written contained some incorrect information, and we made a recommendation about planning to rewrite the remainder of care plans. We observed a detailed handover between night and day staff.

There were systems in place to ensure complaints were managed appropriately, and people told us they were confident their concerns were dealt with well.

We saw some improvement in areas of audit, however we found further improvement was required. Audits carried out by the home manager did not always evidence action was taken when needed.

Staff and people who used the service felt it was well-led, and we saw the home manager and operations director were a visible presence in the home. People and staff had a stake in the running of the service. There was evidence of a lessons learnt culture.

We identified two breaches of regulations during the inspection. You can see what action we have told the provider to take at the back of the full version of this report.

This inspection took place on 16 and 18 May 2017. Day one was unannounced and day two was announced. At the last inspection in January 2016 we found the provider was in breach of five regulations and the service was rated as requires improvement. The regulations related to safeguarding people from abuse and improper treatment, staffing arrangements, dignity and respect, consent to care and governance. At this inspection we found the provider had taken action relating to the previous breaches but were in breach of two different regulations which related to person centred care and safe care and treatment.

Snydale Care Home provides accommodation and personal care for up to 52 older people. At the time of the inspection the service did not have a registered manager. A manager had been appointed and told us they would be submitting an application to be registered. 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.

At this inspection we found medicines were not being managed safely. People did not always receive their medicines as prescribed. Staffing arrangements had improved; people told us and we observed there were enough staff to meet people’s needs. People lived in a safe environment and most areas of the home were well decorated. A problem was identified with the temperature of one shower; swift action was taken to rectify this. Risks to people were assessed, however they were not always appropriately managed; this meant people were not always safe because action was not taken to reduce risk.

Staff told us they felt well supported and had received training to help them understand how to do their job although some struggled to recall what they had learnt. People were encouraged to make their own decisions. Systems were in place to ensure people were protected when they were deprived of their liberty. People enjoyed the food and received choice and varied meals. They told us their health needs were met but it was difficult to find out when people received support from healthcare professionals because appointments were not consistently recorded. We have made a recommendation about oral healthcare

People told us they were well cared for and staff were kind. Visiting relatives told us they were always made welcome and the service was caring. On both days of the inspection we saw people were treated with kindness and respect. There was a pleasant and relaxed atmosphere. People looked well cared for and were comfortable in their environment. They could choose where to spend their time. Communal areas provided adequate space for people to watch television, spend time with a group or in a quieter area.

We received mixed feedback when people told us about their experience of moving into the service. One person told us it was a positive experience; two people told us they did not receive an introduction so did not know what to expect. The quality of care recording and care planning varied. Some information was personalised; other information was out of date and there was a lack of guidance. People enjoyed the range of activities provided in the service and the local community. People were comfortable raising concerns and complaints.

People who used the service, their relatives and staff told us the service was well led. The management team encouraged everyone to share their views through meetings and surveys. The provider had systems in place to monitor different areas of the service; however, auditing processes had not picked up issues identified at the inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to safe care and treatment and person centred care. You can see t

The inspection took place on 7 January 2016 and was unannounced. The home was last inspected on 29 October 2013 and was found to be compliant in all the areas We looked at.

Snydale Care Home provides residential and nursing care to older adults some of whom live with dementia. The home has two floors with a passenger lift from the ground to the first floor. The home does not have units specifically for people living with dementia.

The home did not have 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.’ The registered manager left in November 2015 and was in the process of applying to de-register as the registered manager. There was a new manager in post and they were in the process of registering with the CQC.

People were protected against the risk of abuse because staff had received training in recognising the signs of abuse and knew how to raise their concerns. Staff were aware of the whistleblowing policy.

Not all people who used the service felt there were enough staff to meet their needs in a timely manner. Staff felt there were not enough staff to support people at the busier times of the day. Visitors to the service felt there were not enough staff. The manager told us they were fully staffed and there were enough staff to meet people’s needs. However they thought the way staff were allocated during the shift needed to change to be able to meet people’s needs.

People were protected against the risk associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the safe storage and disposal of medicines. However, we found the recording of medicine administration was not consistent. We found not all medicines administered by staff had been signed for.

Recruitment practices were robust and staff confirmed they had received a period of induction. However not all staff we spoke with felt they had received the training during their induction for them to be confident in working alone. We saw staff received supervision.

Infection control procedures were followed. Staff told us they had a plentiful supply of aprons and gloves.

The new manager had a good understanding of the legal requirements of the Mental Capacity Act 2005 (MCA). However, staff we spoke with did not have a thorough understanding of how the MCA impacted upon their work and the need to protect the rights of people who may lack capacity.

We saw a well- balanced diet was available for people and people’s nutritional needs were assessed. The manager ensured referrals had been made to the appropriate health professionals when they needed support with their healthcare.

The manager had systems in place to monitor the quality of the service. Monthly checks and audits had taken place and covered all aspects of service provision. However the examples of deficits which we found in compliance with the regulations had not been picked up through these quality assurance processes

We found five breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full report.

At the time of our inspection there were 45 people living at Snydale Care Home.

During our inspection we spoke with three people who used the service, one visiting relative and two district nurses. We also spoke with three staff including the manager. One service user we spoke with told us "I am a round peg and I have found a round hole. I love living here". A family member told us "they are very supportive of my wife. Staff make sure that if she is unwell I am immediately informed, it is such a comfort to know she is in safe hands".

We observed staff talking to people in a respectful manner. Staff called people by their preferred name. We saw that people appeared relaxed and happy sitting in the communal area. We found that the home trained staff correctly before they undertook any responsibility for administering medication.

Staff we spoke with told us that they felt supported by the home manager and other team members. They said that there were always adequate numbers of staff available on each shift. They also told us that cover would be sought for any staff absences from within the home's establishment. Records we reviewed showed that staff had access to training relevant to their roles.

Staff we spoke with had a good knowledge of safeguarding and knew how to report abuse.

People were provided with a choice of suitable and nutritious food and drink. People's dietary requirements, such as likes and dislikes, were detailed in their care plan.

People say they enjoy living in the home. One person said that they had enjoyed Christmas and in particular the Pantomime. Another person said the meals are very good. Two visiting relatives said they are really please with their relatives’ progress as they have regained their appetite and are putting on weight. They went on to say that they are very happy with the care provided and in particular the good quality of the meals.

People told us they like living in the home and that they feel safe. One prospective service user told us that they are enjoying their visit as everyone seems very kind and the home appears to be very clean.

Two visiting relatives told us that they are very happy with the care and support provided

People told us that they are happy with the way they are treated. One person says the staff are very good and they treated with dignity at all times.

People told us that they liked the people looking after them. Two visiting relatives told us that the carers are very good and listen to what they say. In a recent satisfaction survey one relative writes, ‘This home is the best place my Mum could be, we couldn’t have chosen better’.

People told us they like the people caring for them. In a recent satisfaction survey one relative writes, ‘Everyone is very friendly and eager to answer any questions’. Another writes, ’From my observations all residents are treated with kindness, care and dignity. Could not wish for better carers or nursing staff’.

People say they enjoy living in the home. One person said ‘ Moving into the home was the best thing they had ever done’. Another said the ‘staff are very good and nothing is to much trouble’. Another says the food is very good and they can choose what they want to eat’. Another person said they ‘have been poorly, but the Nurses are very good and look after them’. They said they have been seen by the doctor who has given them some tablets to make them better.

People say they like living in the home. One person said ‘If they have any concerns they can tell someone and its sorted’ Another says the staff listen to what they have to say and things get changed’ One person said they ‘feel very safe and well cared for’. People we could not communicate with appeared to be happy, very relaxed and comfortable.

One person said their ‘bedroom is very good’ and they ‘have everything they need’. People said the home is ‘always clean’ and ‘nice for when their visitors come to see them’. Another says the home is ‘second to none’ and ‘always kept clean and tidy’. One person said ‘moving into the home is the best thing they have ever done’. People who we could not communicate with appeared to be comfortable relaxing in a homely, well maintained and safe environment.

People say they like the people caring for them. One person said the carers are ‘brilliant’ and ‘very caring’. Another says ‘there is always someone there when you need them’.

People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them.

People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them.

People said they like living in the home, they like those caring for them and they feel safe People we could not communicate with appeared to be relaxed and comfortable with those supporting them and positive relationships were observed being fostered between those using the service and those caring for them.