The inspection took place on 1 December 2016 and was unannounced.

The home is located in Spalding in Lincolnshire and provides residential care for up to 28 older people and people living with a dementia. The accommodation is all one level and there are several communal areas where people can choose to spend their time.

There was a registered manager for the home. 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 Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and 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. This is usually to protect themselves. The registered manager had fully understood their responsibilities under the MCA and DOLS and had taken appropriate action to protect people’s rights. In addition the environment and care provided allowed people to maximise their decision making abilities.

People received high quality care from a staff team which were supported to develop their skills through ongoing training, supervisions and observations by the registered manager. Flexible staffing levels set to meet people’s needs ensured that staff had the time to deliver person centred care and monitor changes in people’s needs. Any changes in needs were discussed with the appropriate healthcare professionals and corresponding changes in care were reflected in people’s care plans. This personalised care supported people to stay healthy and maximise their independence and ability to make decisions.

People were supported to lead fulfilling lives and to continue with hobbies they enjoyed before moving into the home. Activities were provided in the home on a communal and an individual basis and people were also supported to access the local community.

The registered manager and staff provided high quality compassionate care to people at the end of their lives. Extra staff ensured that people received one to one support through their final days. Good collaborative working with external healthcare organisations ensured that people were able to be kept comfortable and pain free at the end of their lives.

Risks to people were fully identified. Care was planned to minimise the risk to people and equipment was available when needed. Good adherence to the care plans and the correct use of equipment had led to a decrease in the amount of pressure ulcers developed in the home.

Caring staff ensured that people took their medicine as prescribed and raised concerns around medicines with appropriate healthcare professionals. People’s food was presented to them personalised to their individual preferences. People received gentle support and encouragement at mealtimes to maximise their nutritional intake. This supported people to maintain their independence and decreased the risks associate with poor mobility and fragile skin.

The registered manager had effective audits in place to monitor the quality of care that people received and they were able to address identified issues in an appropriate and timely way. They continually updated themselves on guidelines developed by the government and NHS to ensure that the care provided supported people to lead healthy fulfilled lives.

On the day we visited there were 20 people living at the Bungalow Retirement Home. We spoke with three people living at the home, staff and a visiting health professional.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI). SOFI helps us to understand people’s perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

Is the service safe?

Systems were in place to make sure that the manager and staff learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedure in place in relation to the Mental Capacity Act MCA (2005) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

We saw there was an improvement in the cleanliness of the home and infection control processes were being followed. New carpets, furniture and an ongoing programme of decoration made the home look smart and eliminated infection control risks.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. Risks to people’s health were identified and action taken to reduce the risks to people and to help them maintain their independence. We saw where people were at risk of developing pressure sores they had special mattresses and cushions in place to relieve pressure.

We saw staff ensured they asked people if they were happy to receive care. Where people could not verbalise consent we saw staff responded to non-verbal signs to see if people were happy to receive care.

Is the service caring?

A volunteer at the home told us, “They (staff) all care and I feel it’s small enough for everyone to get the care they need.”

We saw there was a warm and caring relationship between staff and people who lived at the home. The activities person ensured people who were able to had access to the local community.

Is the service responsive?

We saw the manager and staff worked collaboratively with other health and care professionals to ensure people received safe care. We spoke with a visiting community nurse who told us the manager responded to their concerns and took action if they identified a person’s needs were not being met.

Is the service well-led?

The service had a quality assurance system in place, records seen by us showed that identified shortfalls were promptly addressed. As a result the quality of service was continually improving.

The service had worked in partnership with key organisations including the local authority to ensure people received safe care.

There were 26 people who lived at home on the day we inspected. We spoke with five people who lived at the service, visiting health and social care professionals, members of staff and the manager.

People told us they had seen their care plans and consented to care described in them. One person told us “It is around here somewhere, I suppose I have signed it.” Another person said, “I can see my care plan if I needed to but I don’t want to.” People told us they enjoyed the meals provided. One person told us, “The food is alright, you get plenty of choice.” Another person said, “The meals are very good here.”

Care was planned and delivered in a way which ensured people were safe. However, We saw where care plans recorded where people did not have the capacity to make decisions; no assessment had been carried out to ensure this was the case.

The premises were not always maintained to a high standard. For example cleaning in the home did not always reduce the risk of infection and infection control audits did not identify all the issues. We also saw vanity units were olds and did not support people’s well-being.

Staff received training appropriate to their roles. However, supervision of staff had not happened on a regular basis. Appraisals for staff had been due in January 2014 and had not been completed at the time of our visit.

People were asked for their opinion about the service they received. However risks were not always identified and poor care practice were not investigated.

When we visite the service on 9 October 2012 we identified staff had not received appropraite training. We saw care plans did not always contain appropriate risk assessments to ensure staff were able to provide safe care.

We saw staff’s training needs were discussed at supervision. Regular update training needs had been identified and training booked to meet the needs.

We saw records reflected people’s current care needs. Records were audited to ensure they were correctly completed and accurate.

We visited The Bungalow Retirement Home on 9 October 2012. The visit was to check progress against compliance actions we issued following our visit on 17 May 2012.

People told us they liked living at the home. One person said, “I like my little room and I can do as I like.” Another person told us, “I’ve just had a nice bath; they always help me if I want it.”

There was a new activities coordinator in post. People told us they had spent time with the activities coordinator both individually and in groups. One person said, “The activities coordinator has been reading to me this morning.”

We saw care plans had been reviewed and people told us they had been involved in discussions about their care. Care plans had improved from our last visit; however we still identified areas where care which had been given had not been fully recorded.

Records showed there had been some training for staff in dementia care, dignity and respect and challenging behaviour. However we saw not all members of staff had completed this. The manager told us they would ensure all staff completed training in these subjects.

On the day we visited there were 24 people living at The Bungalow Retirement Home. We spoke with seven people who lived at the home, four relatives, three members of staff and the manager. The manager was new to the home and had only been there a week.

When we visited the home there was a safeguarding action plan in place. This was developed because the local county council safeguarding adults team had visited and identified issues with the care provided to people. The action plan identified areas for improvement and covered staffing levels, care and care planning, nutrition, medicines and staff training.

We spent time in communal areas observing how staff interacted with people living in the home. We saw staff were supportive and encouraging when helping people with a variety of daily tasks. Meal times were calm and relaxed. People were offered a choice of food and supported to eat independently. However where people lacked capacity to express their needs staff were not always confident in providing care.

People told us staff were not always quick to respond to their needs. One person said, “They come if its convenient, some days its not quick.” Another person told us, “They look after me pretty well, some better than others.”

Staffing numbers had been increased. However it was too soon to tell if this had improved people’s experience of living at the home.

We saw staff training and the induction process needed improvement. Where staff had identified a need for training this had not been provided.

We visited the service on 17 November 2011. We spoke with 3 people who told us that they were very happy living at The Bungalow. One person told us “The girls are lovely. Always there to help and get things for me.”

All the people we spoke with told us that the food was very good. One person said “there is always a choice and it is really very good.” Another person told us “I have put weight on since I came here.”

We observed that people seemed very relaxed and content and this was confirmed by those we spoke with.

A relative told us “We have been visiting several times a week for more than a year and the person we visit has always been well cared for. They appear to be content and comfortable. They always look clean and well presented. It doesn’t matter what time we come, the staff are always helpful and seem happy.”