The inspection was unannounced. Stanshawes Care Home provides residential and nursing care for up to 45 older people. At the time of our inspection there were 39 people in residence. The service is registered for up to 48 people but shared rooms were being used by just one person. The building was two storey with a passenger lift and stairways to the top floor. None of the bedrooms had en-suite facilities.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were safe. The registered manager and staff team were all knowledgeable about safeguarding issues and protected people from harm. Where concerns had been raised previously, the registered manager worked with the local authority safeguarding team and made changes where these were needed. The staff team knew how to raise and report concerns if they witnessed, suspected or were told about any bad practice or abuse. All staff had received training in safeguarding adults. Medicines were administered to people safely.

Any risks to people’s health and welfare were assessed. The care plans included instructions on how to reduce or eliminate the chances of injury. All the appropriate checks to maintain the premises and facilities had been completed regularly. Where people needed to be assisted to move, their moving and handling needs were assessed and a moving and handling plan was written.

Staffing numbers on each shift were calculated to ensure each person’s care and support needs could be met. Staff were provided with regular training and were supported by their colleagues and the registered manager to do their jobs.

The registered manager and the staff team were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were asked to give consent to care, support and treatment. Where people lacked the capacity to do this, staff worked within best interest decision making procedures.

People were satisfied with the quality of the food and drink provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People were looked after by staff who knew of the importance of having good relationships. Staff spoke well about the people they were looking after. Feedback from relatives was consistently positive and the staff team were described as caring and friendly. People’s privacy and dignity was maintained. People were involved in making decisions about their care and support. Families were included where this had been agreed upon.

People received the care and support they needed and were encouraged to express their views and opinions about how they wanted to be looked after. When people’s care and support needs changed their care plans were adjusted. People and their relatives were listened to if they were unhappy or had comments to make. Actions were taken where appropriate in order to improve the service.

The registered manager provided good leadership and management for the staff team and there was an open culture in the home. Feedback from people who lived in the home, relatives, the staff team and health and social care professionals, was seen as important and used to make positive changes. There was a real commitment to keeping people at the heart of everything they did. There was a programme of quality checks in place to ensure the standard of service provision and care remained good. Where improvements were identified, actions were taken and checks made to ensure the improvements had been implemented.

Our inspection team was made up of two inspectors. They helped answer 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 is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw that people who used the service were treated in a polite manner by the staff who were attentive in manner when they assisted people with their needs.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, and investigations. This helps continually improve the standards of care and service that people received.

The environment was safe and equipment had been serviced and checked regularly therefore reducing the risk to people who used the service. However there were a number of rooms with an unpleasant smell in them. This showed that these rooms were not hygienically clean. This also meant infection control risks had not been properly addressed in these rooms.

Risk assessments were completed that identified risks that people may face as well as the preventative actions required. There were also risk assessments that identified environmental hazards that may impact on people’s health and safety in the home. We saw that staff assisted people with their needs in the ways that had been identified in their risk assessments and care records. For example staff were observed following safe procedures when they assisted people with their mobility needs.

Is the service effective?

At our last inspection on 14 January 2014 we had found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. As part of the action plan to address the non-compliance at the last inspection, the provider had put in place a checking system. A record was now kept that showed when people had received personal care. The records also included the reasons why people may not have been offered or accepted assistance with their personal care needs.

We saw that menu choices were planned, based on people’s likes and dislikes. The people who we spoke with expressed a variety of views about the meals served at the home. A number of people spoke positivity about the food that was provided. One person told us they had ‘midnight snacks’ brought to their room when they requested them ’. Another person told us the food was “boring” and everything was served with mashed potato.

On the day or our inspection there was a lack of consideration about the variety and texture of the lunch meals. Specifically one meal option was cheesy mash potato with tomatoes on top served with mash. This lack of variety in the meal we observed could impact on how much food people ate.

Staff told us they received regular supervision of their work and overall performance. This was to assist them to undertake their roles effectively. Staff also told us they undertook regular training to further assist them in their roles, and to help them understand the needs of the people they supported.

Is the service caring?

People who used the service and relatives had generally positive views of the staff who assisted them with their needs. Examples of comments made included, “the carers are ok” and “I’ve put on a bit of weight this week I’m very pleased”, “absolutely first class we are really pleased” and “they treat me nice, with a joke”.

Wes saw that people were assisted with their needs by staff who were caring and attentive in manner towards them. For example, we heard staff ask people how they were feeling when they were assisting them with their care and support needs. We also heard staff ask people what time they wanted assistance and what meal choices they wanted for lunch.

Is the service responsive?

At our last inspection on 14 January 2014 we had found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. The provider’s action plan to address the non-compliance at the last inspection included a review of the social and therapeutic activities in the home. The times of certain activities had been adjusted to ensure more stimulating activities took place in the morning when people were more alert. Also more activities had been arranged for people who may experience memory loss due to dementia type illnesses.

We saw that people had their call bells in reach if they needed to ring them for staff assistance. We heard people ring their call bells and staff responded to them without undue delay. When referring to call bell waiting times one person told us “we sometimes have to wait a few minutes but it’s usually very good ”.

People knew how to make a complaint if they were unhappy. One person told us they had made two complaints to the manager that also related to other providers involved in their care. However the person concerned told us they had not been satisfied with the outcomes. We looked at how these complaints had been dealt with and saw that the manager had written detailed letters to the other organisations to properly address the complaints. However they had not written back to the person who had made the initial complaints. This meant the person concerned was not fully assured that their complaints had been investigated.

Is the service well-led?

Due to the registered manager being on maternity leave, the deputy manager of the home had taken on the manager’s role. They had worked at the home for over 18 years and demonstrated that they had in in depth knowledge of the needs of people who used the service.

There was a quality checking system in place to monitor the care and service in the home. However infection control audits failed to identify that there were a number of rooms in the home that had a malodours smell in them. This meant that neither the infection risks, nor the actions needed to minimise them had been identified.

We carried out this inspection because we had contact from an anonymous source who said that night staff had been told that they should get everyone up from bed before day staff arrived for duty at eight o’ clock. A relative also contacted us because they had concerns about staffing levels.

We visited the home just before seven in the morning. There were some people sat in the chairs in their room. We spoke with them about the time they had got up from bed and all were happy. Some said they were used to getting up early whilst others said they preferred to get up when they were awake.

The night and day staffing levels were adequate for the numbers accommodated in the home. There were registered nurses and care staff on duty at all times. These staff were supported by catering, cleaning and maintenance staff. The registered manager and activity coordinator were also on duty during the day.

We looked at the arrangements for the administration of medicines because the last time we reviewed this there were concerns about the recording of medicines given. We found there were errors in the recording of medicines and we have asked the provider to take action in relation to this.

One person said it was their first time at the home, for a short break. They described their experience as “very good” and when asked what made it good they replied “the people”. A person who had lived at the home for longer said “everyone treats me well staff are all very friendly". Another person said it’s “absolutely lovely”.People told us they enjoyed visits from their family members who were made to feel welcome when they visited.

A member of staff said they thought Stanshawes was a “nice home” and that the people who lived there “brightened their day”. They told us they got on well with other staff and that there was good team working.

Another member of staff commented on how things were now in place that were not there previously. There was a more disciplined approach from the manager who was described as approachable and dealt with issues as they arose. They said they felt they had good relationships with people and their families.

The home had arrangements in place to obtain consent from people before delivering care or treatment. People were asked to sign to indicate their agreement. People's needs were assessed and care plans recorded the support they needed from staff. A variety of activities were provided and trips were arranged. The home was reviewing the menu that although was well balanced did seem repetitive to people. Safe processes ensured that staff were suitable to work with vulnerable older people and the quality of service was checked.

When we visited the home in June 2012 we found that people's care, treatment and support met their needs and protected their rights. However there was still work to be done to ensure that records to enable monitoring of people's care and welfare were complete. The home was in the process of introducing new care documentation. We saw that the new system would more accurately reflect people's preferences and care needs. During this visit we saw that the record keeping system had been used properly and there was good recording.

When we visited the home in June 2012 we found that people were cared for by staff who felt supported to deliver care and treatment safely and to an appropriate standard. However formal supervision meetings had not taken place at the required frequency. Since then all staff had a one to one meeting in September 2012 and a further meeting was planned for December 2012.

Several of the people we spoke with told us that the home had been recommended to them. One person said “it’s very nice here and I’m very happy”. They said that staff called them by their preferred name, they liked the food and enjoyed the activities. Another person told us they thought the home was comfortable and that the staff were ready to give assistance as they could. They said the staff paid attention to little things like ensuring they had a cushion for their chair. A person described the food as “beautiful with choice and extra available”.

Relatives told us they were made to feel welcome. One relative who had been visiting for some time, said they had a good relationship with the management and staff. They said that if they raised any concerns, such as their relative not being well presented, there was always an appropriate response. Another relative told us that they were happy that the home always responded well to health concerns.

Staff spoke with enthusiasm about their work and the rewards it brought them. Some staff told us they had not had supervision for some time but they feel supported. A senior member of staff referred to how well staff worked together.

People who use the service told us they had a choice, "I’ve been let do what I want". We were told there is choice about food. We were also told that people are asked if they want a bath or a shower.

We spoke to relatives of people who use the service. One told us, "they respect his wishes". Another relative said they were very happy with the care and that if anything’s wrong they always ring up.

People we spoke with told us, ‘They do care, staff are all very helpful and friendly’.

People told us they would like the food to be better and that they used to go on more outings but had not been on an outing for some time.

We saw relatives and visitors freely coming and going in the home and spending time with residents in their rooms.

We spoke to residents in the home who told us they felt safe.

People we spoke with told us "The night staff are good – I only need to press it (the call bell) and they’re here". People told us the night staff checked on them hourly, "I feel their presence when I wake up at night, I feel reassured".

We monitored the call bells during our visit and found that the longest response was less than four minutes. Most were answered within two minutes.

Staff told us that no-one living at the home at the time of our visit looked after their own medicines. We spoke to three people who told us that they were happy with how staff looked after and gave their medicines. Comments included “they couldn’t look after them better” and “I always get them at the right time”.

This inspection was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. The programme looked at how providers worked together to provide care and at people’s experiences of moving between care homes and hospital. In addition the inspection was carried out to follow up concerns about the administration of medicines that led to a compliance action being set following an earlier inspection.

At the time of this inspection there were 41 people living at Stanshawes. The deputy manager told us that 11 people had a diagnosis of dementia but that their admission to the home was determined by their need for nursing care rather than because they were living with dementia. The home had not signed up to the Department of Health’s ‘Dementia Challenge’.

One of the people we spoke with said “I can’t find anything to complain about here”. A visitor said “I have nothing but praise for the place” and “the staff have a real heart”. Another relative told us they thought the staff were “stretched”.

We left comments cards at the home for people to complete. When we collected the ‘post box’ we left at the home there were five completed cards. Some people had written on the cards that their relative did not have dementia. Comments included “The carers work extremely hard here at Stanshawes. I have found them pleasant and caring towards my mother at all times. Sometimes they appear to be stretched due to being short staffed”. Another person wrote “I feel my mother is reasonably well cared for. She doesn’t have dementia but cognitive impairment and can’t really think for herself. She is sometimes dressed inappropriately and there are often small niggles but overall, in my opinion she is safe and warm. Staff are caring but not always thoughtful”.

We observed the mealtime experience for people who used the upstairs dining room. Staff were attentive to people’s needs, engaging with them and assisting them in a kindly way. People were offered choices and meals were served while hot.