The inspection took place on 9 December 2015 and was unannounced.

Spratslade House is a care home for up to 30 people. The home provides personal care for older people and people with dementia. At the time of the inspection there were 29 people living in the home.

A registered manager was in post. 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.

Our previous inspection in 12 June 2014 found that the service was meeting all the requirements of the Health and Social care Act 2008.

Not everyone received person centred care and support. People with dementia were not always supported with their individual needs.

Some records relating to the care and welfare of people were not always accurate and/or up to date.

People’s risks were assessed in a way that kept them safe from the risk of harm. There was sufficient staff provided with enough skills and expertise to keep people safe. 

Where possible people’s rights to be as independent as possible was respected.

People who used the service received their medicines safely. Systems were in place that ensured people were protected from risks associated with medicines management.

Staff were trained to carry out their role and the provider had plans in place for updates and refresher training. The provider had safe recruitment procedures that ensured people were supported by suitable staff.

The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. Staff understood people’s ability to make decisions.

People’s health needs were monitored and referrals to health care professionals had been made in a timely way by the provider. There were adequate amounts of food and drinks provided for people.

People told us that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld.

The provider had a complaints procedure available for people who used the service. People and families thought that the registered manager was approachable and that complaints were appropriately managed.

The provider had a quality monitoring system in place to help ensure continuing improvements were maintained and improved.

The inspection took place on 27 October and was unannounced. Spratslade House Care Home is a residential home for up to 30 people who have support needs. There were 27 people living there at the time of the inspection.

There was a registered manager in post. 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.

Medicines had not always been stored in line with guidance and some medicine was being given to a person that did not have the correct prescription label on. Some people that needed ‘as and when required’ (PRN) medicine had protocols in place for staff to follow, but they were not consistently available. Therefore, people were at risk of not always getting their medicine as prescribed.

Staff were aware of what constituted abuse and what to do if they suspected someone was being abused. Appropriate safeguarding referrals had been made to the local safeguarding authority.

People felt safe living in the home. The risks people may face had been assessed and plans put in place to reduce the likelihood of them occurring, such as falls and the use of equipment. We observed staff undertaking safe moving and handling practices when supporting people.

The likelihood of emergency events occurring in the home had been reduced with appropriate fire checks being in place and personal evacuation plans were in place for people. Other safety checks had been completed such as on the gas supply and whether call bells worked so people could summon assistance.

There was enough staff to meet people’s needs in a timely manner and people did not have to wait for support. Staff were deployed effectively and had the flexibility to move to different parts of the home to attend to people who had varying levels of support needs.

Staff were recruited safely with references sought, identity checks being carried out and checks had been made with the Disclosure and Barring Service (criminal records check) to make sure people were suitable to work with vulnerable adults.

Staff were suitably trained and were supported to refresh their training. Staff also felt supported by the registered manager and had regular supervisions to discuss progress and options for improvement in how they support people. Staff also told us they were checked to ensure they had understood their training and were delivering care correctly to people.

People were protected as staff acted in accordance with the Mental Capacity Act 2005, with appropriate assessments in place and referrals made to the local Deprivation of Liberty Safeguards team. Staff offered choice and checked consent prior to supporting people.

People enjoyed the food and were offered a choice in what they had to eat.

People had access to health professionals and regular visits were undertaken by GPs, District Nurses, dentists and opticians.

The service was very caring, as staff took their time with people, choices were regularly offered and staff explained things to people. People told us they liked the staff and were happy living at the home. People were encouraged to retain their independence and to do as much as they could for themselves.

People were supported to discuss their end of life preferences and this was respected and documented within their care plans.

The service was responsive and catered for the ranges of peoples differing needs, such as providing suitable implements to eat with and updating care plans and risk assessments following a change in a person’s needs.

There were activities and events that people could participate in, with plans to further extend the availability of hobbies and interest for people to partake in. People told us they could access the community and they liked the parties that took

The inspection of Spratslade House was carried out on 12 June 2014. We spent time with the deputy manager, members of staff, people who lived at Spratslade House and a family representative. We reviewed care plans and documentation given to us by the provider.

We considered our inspection findings in respect of the following issues:

Is the service safe?

From our observations and from the information we saw set out in care plans, policies, procedures and audits the provider's safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and safeguarding the people they supported. The staff demonstrated that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions and maintain their independence. The care plans detailed each person’s capacity to consent. When people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests. The service had the support of an advocacy service when required.

Staff showed people respect and maintained people's dignity at all times.

The deputy manager told us there were no current deprivations of liberty safeguards in place for the people who lived at Spratslade House. They said that in the light of new guidance they were reviewing the requirements.

The building and living environment in the home was maintained to a high standard. All the risk assessments and safety checks were in place and up to date. This meant that the building was safe and met the needs of the people who used the service.

The staff rotas showed that the management had taken people's care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The night time staffing levels and on call system showed that the staffing provision was safe out of main hours.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's care needs had been assessed and detailed care plans were in place. There was evidence that the people and/or their representatives were involved in the assessments of their needs and care plan reviews.

We saw that people’s health care needs were continually assessed and included in care plans. Specialist health and social care professionals regularly gave support to the service.

All care, activity and risk assessment plans were reviewed regularly. We saw that the people who lived at the home were supported to maintain their mobility and independence. We saw evidence in care plans and from talking with people who used the service that the care provided was being constantly adapted to meet people’s needs.

Is the service caring?

The people we spoke to who lived at the home told us they were very comfortable there. They said the care and support they received was very good. One person said, "The staff are really nice, I like it here." Another person said, "Everyone looks after me and I have no complaints at all." A family representative we spoke with said, “The care is excellent and the staff are brilliant, they cannot do enough to help”.

The staff we spoke with told us they were committed to provide high standards of care for the people who used the service. They demonstrated they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We found that care plans were person centred and contained detailed information about people's choice and preferences. We saw that people’s health and support plans were regularly up dated to reflect people’s changing needs.

There was regular support from external social care and health professionals when needed. This meant that people’s health and welfare was regularly reviewed and monitored.

The families and people who lived at Spratslade House said that if they had any concerns, they could talk with the manager or the staff as they would always listen and addressed anything they raised.

The staff said they had regular training which equipped them with the knowledge to meet the support needs of the people who used the service.

Is the service well-led?

Spratslade House has had a stable staff team for many years and there was a clear management structure. The deputy manager and the staff we spoke with were knowledgeable about all the people who lived at the home.

The people we spoke with who lived at the home and the staff said that the manager, deputy and senior staff were always around to give advice and support. There were systems in place to provide feedback to staff about changes and developments.

All the staff we spoke with said they understood their responsibilities around safeguarding people’s welfare. They said that if they witnessed poor practice they would report their concerns.

At our last inspection on 25 April 2013, we identified that improvements needed to be made to the way that people’s medicines were managed. Following our inspection, the provider sent us an action plan detailing how they would make the required improvements. We carried out this inspection to check that the required improvements had been made.

During this inspection we saw that improvements had been made. Effective systems were in place to ensure that medicines were administered and recorded accurately and safely. This meant that people were protected from the risks associated with medicines.

We spoke with seven people who used the service, four members of staff and the registered manager. People told us they were happy with the care at Spratslade House. One person said, “They are all really good to me here”. Another person said, “I like it here. The staff are nice to me and the food is great”.

At our last inspection, we found that improvements needed to be made in how staff supported people to make decisions and how medicines were stored, administered and recorded.

During this inspection, we saw that improvements had been made to the way that the staff supported people to make decisions. People had an assessment of their ability to make decisions for themselves. Appropriate plans were in place for people who required support to make decisions, to ensure that the right support was given to meet people's needs.

People received care that met their individual needs, and they were supported by staff to maintain their skills and independence.

We saw that people were protected from the risk of infection, because staff were trained in the correct systems to reduce and manage the risk of infection. Communal areas within the home were found to be clean and tidy.

We saw that improvements had been made to the way that medicines were stored, but effective systems were not yet in place to ensure that people received their medicines as prescribed.

We saw that there was an effective system in place to investigate and respond to complaints.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people who used this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with seven people that used this service and three people visiting this service. People using the service told us they were happy with the care provided. One person said, “I wouldn’t be anywhere else”. Visitors were also happy with the care provided and the care environment. One visitor reported that the home was, “cosy and homely”.

During our inspection we observed staff treat people with care and respect. We saw that people were offered choices and that staff had a good understanding of people’s individual needs.

We found that people’s views were taken into consideration when planning their care; however the records were not always in place when people were unable to make decisions for themselves. This meant that we could not be sure that decisions were being made in peoples best interests.

We found that safe systems for the storage and administration of medication were not in place. This meant that we saw medicines stored and administered incorrectly which could place people at risk.

We found that there were systems in place to monitor the quality of the service and to make changes. This meant that the service was constantly improving.