We inspected Syne Hills Care Home Limited on 2 and 7 June 2016. This was an unannounced inspection. The service provides care and support for up to 35 people. When we undertook our inspection there were 32 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect them. At the time of our inspection there one person subject to such an authorisation.

The staffing levels need to be monitored on a regular basis through a 24 hour period to ensure each person’s needs are being met. Systems need to be reviewed to ensure staffing levels are adequate to meet people's needs.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe. However, attention to detail regarding possible infection control risks and thorough auditing checks need to be maintained to ensure the environment is safe and equipment is safe to use.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives. Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information.

People had a choice of meals, snacks and drinks. Meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements. New systems for auditing were in place and need time to be embedded and sustained to be thoroughly effective.

A single inspector carried out this inspection. At the time of the inspection there were 30 people using the service and we talked with four of these. Most of the people using the service had some degree of memory loss and were unable to talk to us about their care and support. We observed the care being provided and the way in which people interacted with staff. We talked with four staff and the manager and looked at the care records of five people using the service. We examined training records and the documentation relating to quality audits.

This helped us to answer the questions below.

Is the service safe?

Safeguarding policies were in place and staff understood their role in safeguarding the people they supported. We saw that action had been taken in response to a safeguarding issue which had been identified.

Individual risk assessments had been completed and equipment was in place to prevent the development of pressure ulcers and enable safe moving and handling for people who required it.

Is the service effective?

People’s care and support needs had been assessed and care plans had been put into place which clearly identified the level of support required. These had been reviewed and updated regularly to ensure they reflected people’s current needs.

Staff were provided with training and development to ensure the provision of effective care. Most staff had completed, or were in the process of undertaking, nationally recognised qualifications in care.

The service worked in collaboration with other professionals and agencies to ensure people’s needs were identified and addressed.

Is the service caring?

We observed staff showing care and compassion for the people they were caring for. They were knowledgeable about people’s needs and preferences and tailored the support they provided to take account of these.

We saw people being encouraged to undertake activities they enjoyed and they were provided with support to do this individually and in groups.

Is the service responsive?

Opportunities were available for people to provide feedback on the service and there was evidence of changes put into place in response to this feedback.

People knew how to make a complaint if they were unhappy. We looked at the complaints log and the response to the most recent complaint. We found that responses were timely and saw feedback from a complainant expressing satisfaction with the response received.

Is the service well led?

Staff felt well supported by the manager and other senior staff. They said they were encouraged to make suggestions for improvement and their views were listened to.

The service carried out quality assurance audits to monitor and assess the quality of the service provided.

A relative told us, "I visit every day and am very happy with the support the home provides. They keep me informed if there are any problems and include me in discussions and decisions". A person who used the service said, "I've been here a long time. I get to do what I want to. I can go to church on a Sunday and go out if I want to. We have day trips in the warmer weather".

We observed that care and support was assessed and delivered in line with each person's individual needs. People were protected from the risk of harm because staff had the information they needed to provide appropriate support.

People who used the service were provided with a range of meal choices to meet their specific nutritional requirements. People at risk of weight loss or who were particularly vulnerable, had their dietary and fluid intake monitored. Where specific dietary requirements were needed, the catering team knew people's needs and provided suitable meals.

Medication was managed, stored and administered safely. The provider had robust systems in place to ensure people received prescribed medication in the correct dose and at the right time.

Recruitment procedures ensured that prospective staff were vetted and checked to ensure they were suitable to work with vulnerable people. New staff received appropriate induction, which meant they could deliver care safely.

Complaints procedures were in place. People and relatives told us they had no complaints to make.

Due to the complex needs of the people using the service we used a number of different

methods to help us understand their experiences. We looked at records, spoke with care staff and a visiting healthcare professional. We also watched care staff delivering care to people in the home. This helped us to understand the needs of people who could not talk with us.

People we spoke with told us they liked living at Syne Hills. One person told us they could not be any better looked after. We saw evidence that care staff had received training and support to do their jobs and during our visit we saw some good care practices.

Management have started a quality assurance system to ensure people receive good quality care. The manager informed us he is going to develop this further.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences. We looked at records. These included care plans and minutes of meetings. We also spoke with care staff and a relative.

We also sat and watched care staff delivering care to people in the home. This helped us to understand the needs of people who could not talk with us.

We found that people who could speak with us were respected and involved in their care.

People we spoke with told us that Syne Hills was a nice place to live. They told us that the staff team provided the support and care they needed although care staff did not have time to sit and talk with them. One person said, “I’ve got everything I need and I can come and go as I wish.” People were complimentary of the food they had and said they always had a choice at mealtimes.

Over half the people in the home had a memory loss and we saw the environment of the home did not reflect the researched best practice for people with these needs.

People told us they felt safe in the home and if they didn’t they felt the manager would do something about it. Care staff knew how to protect the people in the home and who to contact if they had concerns.

We saw evidence that care staff were receiving training and support to do their jobs although during our visit we saw that some care practices needed improving.

People felt they were asked about their opinions in the running of the home by the manager and felt confident taking any concerns directly to staff members or the manager if needed. However, the home did not have robust quality assurance systems in place to ensure they monitored the quality of service that people received.