Spiers House is a ‘nursing 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. Spiers House is registered for a maximum of 35 people with a range of needs including dementia. The service is a large residential house, with people accessing the ground floor in the London Borough of Kingston. At the time of the inspection there were 34 people living at the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to be protected against abuse as staff were aware of how to identify, respond to and escalate suspected abuse. Staff confirmed they were confident to whistleblow should the provider not take appropriate action.

People continued to be protected from available harm as the provider had systems and processes in place that identified risks and gave staff clear guidance on how to support people when faced with those risks.

People’s medicines continued to be administered in-line with good practice and as the prescribing Pharmacist intended.

The provider continued to ensure there were adequate numbers of suitably vetted staff to keep people safe. Records confirmed, staffing levels were at safe levels to meet people’s needs.

The service had clear guidance for staff in mitigating the risk of cross contamination. Staff confirmed they had access to adequate amounts of protective equipment to manage infection control.

People continued to be supported by staff that had undergone a comprehensive induction process to ensure their competency was assessed. Staff received on-going training to effectively enhance their skills and experiences. Staff also reflected on their working practices, through regular supervisions and annual appraisals.

The service was aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA). People's consent to care and treatment was sought prior to being delivered. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People continued to be supported to access a wide range of food and drink that met their dietary needs and requirements. People with specific specialist requirements were catered for. People were supported to access a wide range of healthcare services to monitor and maintain their health and well-being.

People were supported by staff members that treated them with respect and were aware of the importance of maintaining their privacy and dignity. Staff had sufficient knowledge of the importance of encouraging people to remain as independent as possible.

People’s care plans were person centred and contained adequate information to guide staff in delivering care and support that met their needs in line with people’s wishes. Care plans were reviewed regularly to reflect people’s changing needs.

People were supported to access a wide range of activities both in the service and in the local community.

People were aware of the provider’s complaints policy and how to raise their concerns. Complaints were managed in such a way to reach a positive resolution in a timely manner.

People spoke positively about the registered manager and management team as a whole. The registered manager was a visible presence within the service and people confirmed they felt she was approachable.

The registered manager continued to undertake regular audits of the service to drive improvements. Issues

This unannounced inspection took place on 5 July 2016. At the last inspection on 8 and 9 December 2014 the service was meeting the regulations we checked and the service was rated ‘Good’ in all key questions and overall

Speirs House provides accommodation, personal care and nursing for up to 35 older people. There were 33 people living at the home on the day we visited.

The home had a registered manager at the time of the inspection. 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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the registered manager or deputy at any time.

Staff were familiar with risks people faced and knew how to manage these, but the new systems the provider used to store details of the risks and management plans were not operating very well on the day of the inspection. As a result all the necessary information about the management of risks was not easily retrievable. The registered manager took action to remedy these IT concerns after our inspection and sent confirmation of this.

We saw that regular checks of maintenance and service records were conducted to make sure these were up to date.

There were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms. People were supported at the end of their lives and had their wishes respected.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary. From our discussions with the registered manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s l

At our inspection in July 2013 we found issues with records, medication and hygiene. The provider wrote to us and told us they would make the required improvements by the end of October 2013. We saw that improvements had been made to involving people in decisions; records indicated individual's needs; changes to the cleaning schedule meant people were protected from the risk of infection; medications were stored securely and records were up to date and staff received the support and training they needed. We spoke with sixteen people who use the service, four relatives or visitors, eight members of staff and the manager during this unannounced inspection.

People told us that they liked the service and said "staff are caring", "I am well looked after", "my needs are well catered for", "staff care and look after us", "there's a good atmosphere here" and "plenty of activities". We received mixed comments about the food, some people thought it "very good", others that it was "good" and one said it was "awful". One person said "the food is just like home made".

Staff told us that there had been improvements in the last few months. They said that they had the training and support they needed to carry out their role. Staff were aware of who to report to and how to raise issues or concerns.

We saw that the furniture and furnishings were clean. The atmosphere was calm and relaxed and staff interacted with people in a kindly manner and were responsive to their needs.

We spoke with two people who use the service, one visitor, two visiting health professionals, four members of staff and the Operations Manager during this unannounced visit.

People said "staff come when I call", "I have all I need in my room", "staff listen and give me the help I need" and "staff are lovely". Visitors had been informed of the safeguarding concerns and actions the provider had taken to improve things at the home.

Staff told us that they had completed training in safeguarding and where aware of their responsibility to report concerns and issues to the manager and or the local authority. One member of staff said "there's been changes, which are good". All staff said there were enough staff to meet the needs of the people who live at the home. Staff had attended staff meetings and been informed of the safeguarding concerns and actions being taken to improve the services provided.

We saw that the providers action plan for improving the services was displayed on a noticeboard near the entrance of the home. Another copy of the action plan was displayed in the staff office and staff we spoke with knew it was there and what was being done to make sure the required improvements were made.

Staff showed detailed knowledge of people's needs and how they should be met.

Two people told us that they had chosen to come to the home and were happy with this decision, saying "I am happy here", "it's a nice place" and "I have all I need in my room".

Comments about the food were positive including "the food is very good", "I enjoyed lunch", "the food is good", "we are given a choice of food" and "we have enough to eat".

People told us "the staff are very very lovely", "staff listen and help", "staff are kind" and "there are enough staff". Relatives said "the staff are lovely, always smiling", "I am made to feel welcome", "they keep me informed and up to date", "it's very good here" and "staff provide the care and support needed".

There were mixed comments about activities with some people saying they had enough to do while other people said they stayed in their rooms. People did say that they missed being able to go to the local shops, bank and post office since the driver had been off work.

People told us they were happy living at the home, they made positive comments about staff, the care they received and the food. They said they have all they need in their rooms and that they were able able to bring some of their important possessions with them. People were preparing for a quiz on the afternoon of our visit and said they have enough to do.

General comments included ‘the care is very good’, ‘I’ve always been well treated’, ‘they are very kind’, ‘In the main – very good’, ‘marvellous’, ‘I’m very content here’ and ‘I could not find fault’.

Feedback about the staff included included ‘so caring’, ‘very polite’, ‘the staff are very good’, ‘they jump up and do it for you – especially the girls’ and ‘I get on well with them. All of the people we spoke to said that they were treated with dignity and respect.

Comments about the activities provided were particularly positive and included 'the

activities organiser is excellent – she keeps us moving around', 'she organises things

for us everyday', 'plenty of activities' and 'terrific'.

‘On the whole very good ‘, ‘you couldn’t beat it – always nice and hot’, ‘I enjoy the food’, ‘the food is excellent’, ‘It’s not first class but it’s alright’ and ‘adequate – it’s always been the case’ were comments about the food provided at Speirs house.

This unannounced inspection took place on 8 and 9 December 2014. Speirs House provides accommodation and nursing care for up to 35 older people who are living with dementia or have a physical disability. There were 34 people living at the home when we visited. The home was based in a large house and all bedrooms and communal rooms were on one level. Within the home, each person has their own room with en-suite toilet and some with bath or shower rooms.

At the last inspection on 23 January 2014 we found the service was meeting the regulations we looked at.

The home had a registered manager at the time of the inspection. 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.

Relatives told us people were safe at Speirs House. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff understood how to minimise and manage these risks to keep people safe. We observed that staff were available during the day in all areas of the home, but at times people told us they had to wait before staff responded to their call bell.

The home, and equipment used were regularly checked and maintained to ensure they were safe. Medicines were stored and administered safely.

People were cared for by staff who received appropriate training and support to meet their needs. Staff felt supported by the manager. There were currently sufficient staff to support people’s needs. We observed staff who supported people had a good understanding of their needs. They supported people in a way which was kind, caring, and respectful.

Staff encouraged and supported people to keep healthy and well through regular monitoring of their general health. People were encouraged to eat a well-balanced, healthy and nutritious diet. Where there were any issues or concerns about a person’s health or wellbeing staff ensured they received prompt and appropriate care and attention from healthcare professionals.

Where people were unable to make complex decisions about their care and support, staff ensured appropriate procedures were followed to ensure decisions were made in their best interests.

The provider had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Senior staff had been trained to understand when an application should be made and in how to submit one. This helped to ensure that people were safeguarded as required by the legislation.

We saw there was a programme of activities to meet people’s social and recreational needs... We observed an exercise class attended by 12 people, who enjoyed this activity.

Relatives told us they were comfortable raising any concerns they had with staff and knew how to make a complaint if needed. They said concerns raised in the past had been listened to and dealt with responsively.