This inspection took place on 23 and 29 March 2017 and was unannounced.

The Cyder Barn is registered to provide accommodation and personal care for up to 40 people. At the time of our inspection there were 23 people using the service.

There is 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.

There were good arrangements for the management and administering of prescribed medicines. However, the use of topical creams and ensuring they were used regularly to protect people's skin needed to be improved. People spoke of having their medicines regularly and people, where safe to do so, were able to manage their medicines which helped to maintain their independence.

At our last inspection we had identified the need to improve how people were involved in their care planning. At this inspection there had been some improvement. However, whilst some people told us they were aware of their care plans and had been involved in talking with staff about their care needs and care plans others were not. One person said, "I feel I do not really know about my care plan." Another person said, "No, I don't really know about my care plan." This was therefore an area for continued improvement.

People told us they felt safe living in the home. They spoke of how they had confidence in the staff being "well trained". One person said they felt safe because "Staff know what they are doing and are around to help me when I need it." Another person told us it was because they were "Well cared for."

Staff demonstrated their knowledge of abuse and responsibilities to report any concerns about possible abuse. Staff were confident the registered manager would act to protect people if told of any such concerns. The registered manager had acted to protect people and responded professionally to any concerns or incidents, which had placed people’s health and welfare at risk.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. Where people lacked capacity their rights were upheld and their health and welfare protected.

Arrangements for making decisions on people's behalf where they lacked capacity (known as best interests decision) had improved since our last inspection. This was of importance where equipment was needed to protect people from potential harm such as risk of falls and monitoring people's movement to ensure they were safe.

People could be confident that the arrangements for the recruitment of staff followed guidance and the necessary checks about the suitability of perspective employees were undertaken. Staff received training so they had the necessary skills and knowledge to meet people's needs.

People spoke very positively about the meals provided in the home. One person said, "The food is lovely I always enjoy my meal and there is always a lovely choice." A relative commented "You can see there is food and drink available at all times if need be. My relative is very pleased with the food." There was a relaxed and social atmosphere when people had their lunchtime meal. Staff were available to support people where this was needed.

People told us they found staff caring and respectful of people's privacy and dignity. One person said, "The staff are kind and responsive." Another person told us "Our rooms are ours so they act like they are our guests." People were able to make choices about their daily routines and their choices were respected. One person spent most of their time in their room. They told us "I chose to be in my room and that is not a problem. Staff know that is what I like."

People

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service caring?

We found from our observations and talking with people the service was caring. People told us staff were "friendly and there when you need them", and "we get treated very well and I get the care I need". One person told us "I can choose what I want to do, staff respect me and it is my choice". We observed staff supported and assisted people in a respectful, dignified and professional manner. We saw staff responded to an individual's distress in a sensitive, calming and re-assuring manner.

Is the service responsive?

The service was responsive to people's choices and wishes and responded to the needs of people using the service. People told us they were able to make choices about their daily lives. One individual who was able to leave the home independently told us "I can pretty much go out when I want". Other people told us they could choose when they got up and went to bed. For some people their choice was to remain in their rooms and they told us this was respected. Some people told us there could be more activities. We noted how there were limited opportunities for people to be involved in an activities or spend time with staff. This was identified by the manager as an area for improvement so the service could be more responsive to people's social needs.

We read a number of care plans and they contained comprehensive information and guidance about meeting people's care needs. Assessments were regularly reviewed to ensure they accurately reflected people's needs. We saw people had been referred to specialist support such as a community nurse and podiatrist so their specific needs could be met.

There were assessments in place which identified areas of risk for individuals such as environment, falls and moving and handling. They provided instructions to staff as to how to respond to risks and provide care in an effective and safe manner.

Staff told us they attended daily handovers and there were daily records completed which staff referred to so they were informed of people's needs and any changes. Staff told us they would report any concerns about people's care needs to a senior or the care co-ordinator.

Is the service safe?

We found the service to be safe because they had a range of policies and procedures in place to protect people's health and welfare. People we spoke with told us they felt safe in the home. They told us if they had any concerns or worries they would tell a member of staff. One person told us "if I was not treated how I wanted to be treated I would tell one of the staff and I know they would do something about it". Another person we spoke with told us they had never seen anything that had worried them. The staff we spoke with had a good understanding of their responsibilities about reporting any concerns about possible abuse. One member of staff had reported a concern to the deputy and this was being investigated.

We noted that the service's policy on the "safeguarding of service users" from abuse failed to accurately reflect good practice. It failed to state the manager's responsibility to report any concern initially, before any other action, to the local authority safeguarding team. Staff had received the necessary safeguarding of vulnerable adults training. They were aware of their rights under whistleblowing to report any concerns to an outside body such as social services.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service identified, assessed and managed risks to people's health, safety and welfare. Care plans included individual risk assessments and provided guidance to staff about how to respond and minimise risks. There were arrangements in place to safeguard people in the event of an emergency or evacuation of the home.

We noted there had been improvements in the staffing arrangements of the home. Dependency assessments had been completed to help in making an informed judgement about the level of staff needed to meet people's needs. Additional staff had been recruited so there was greater consistency and continuity of staff. We saw there were some inconsistencies in relation to weekend staffing of the home. This potentially could impact on the ability of the service to meet people's needs safely and effectively. However people told us staff were available when they needed them and responded promptly to requests for assistance and support.

Is the service effective?

We found the service to be effective because people's care and support achieved good outcomes. We also found people's rights and choices were respected. We saw where people had been identified as requiring specialist support and this had been provided. This showed the service was able to act professionally and in the person's best interest to ensure specialist or complex care needs were being met.

The completion of daily records which set out how people's needs had been met enabled the service to review people's needs and ensure care planning was accurate and up to date.

Is the service well led?

This service had a manager who was registered with CQC and supported by a newly recruited deputy manager. We saw there were inconsistencies about how the service was being led and in the arrangements for the monitoring the quality of the service. Staff told us that whilst they respected the manager they were not confident communication was as effective as it should be. This applied specifically where staff may have raised issues with the manager. They were not always informed about what had happened about the concern or issue they had raised. Some staff told us they felt the manager was not always acting "as a leader". We noted improvements were needed in providing regular individual supervision to staff.

Whilst there were systems in place to monitor the quality of the service they were not always robust. The manager did not undertake any quality audits so they could be directly informed about the quality of the service. There was a lack of auditing in relation to care plans to make sure they consistently reflected people's care needs accurately. The medicines audit was not comprehensive and failed to fully audit arrangements for the management of medicines. This meant any improvements or shortfalls could not be identified. There were limited opportunities for people to express their views about the service they received.

We carried out this inspection as part of our planned schedule of inspections. However we had also received concerns about staffing levels being insufficient to meet the needs of the people who lived in the home.

We spoke with five people who lived in the home, seven staff members, one visitor and two visiting health professionals. Everybody spoken with told us the standard of care in the home was good. However with the exception of the two health professionals everybody told us the staffing levels were low in the afternoons and some nights.

One person spoken with told us, “I can’t complain they look after us well, but they are rushed off their feet some days. I really don’t know how they manage it.” Another person told us, “I am really happy living here; I’ve seen some changes and the staff are really good they do a grand but difficult job.” One visitor spoken with told us, “They look after X really well. My only observation is when the activity person goes there is nothing for them to do and not enough staff around to occupy them.”

Records kept in staff personnel files showed us all appropriate pre-employment checks were carried out. This meant people were protected by an effective recruitment process.

We found that staff received training and support which enabled them to meet the needs of people who lived in the home.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

This visit was carried out following concerns raised about staff training and staffing levels on nights. We also looked at outcomes relating to; respecting and involving people who used services, care and welfare, and assessing and monitoring the quality of service provision.

We spoke with six people who lived at the home. They told us that they enjoyed living at the home and that there was "Always lots of laughter and fun". People told us they had lived locally, knew about the home, and had made a choice to move in. We asked about the activities at the home, and were told that there were various activities to join in with including visits to local towns.

People told us “If you want anything, staff are very responsive" and "Bells are answered within five minutes". We were told about the manager who was described as being "Very approachable". The people who lived at the home confirmed that they were happy at the home and felt safe there.

During our visit we observed staff interactions with people. The interactions were friendly and respectful. People took part in activities or chose to stay in their room. They all said they could do what they wanted throughout the day.

At lunch time we observed staff offered people a choice and provided alternatives if they were not happy with the options available. One person told us “Chef is excellent, the food is very good”.

This visit was carried out following concerns raised about recruitment practices and staffing levels on nights. We also looked at respecting and involving people who used services, care and welfare, safeguarding people who used services and assessing and monitoring the quality of service provision.

We spoke with eight people who lived in the home. They all told us they were very happy with the way their care was provided. We received some very good comments about the support and the care carried out by staff.

One person told us, “I am very fortunate really, I do not need the care that others do, but I watch what goes on every day. I don’t know how the staff stay so happy and cheerful. They are really very good at what they do and the way they do it.”

We spoke with a group of people, they told us “We are waiting for a game of scrabble“. Each person told us how happy they were, they said, “I am really happy they are so cheerful”. Another person said “I can’t fault it, it is excellently run. The food and accommodation is marvellous”. One final comment was; “very kind, very good and most of all very patient and that counts.”

During our visit we observed staff interactions with people. The home was ‘full of laughter’. Every interaction was happy, friendly and respectful. People took part in activities or chose to stay in their room and watched the snooker tournament. They all said they could do what they wanted throughout the day.

At lunch time we observed staff offered people a choice and provided alternatives if they were not happy with the options available. One person told us “we all say the food is excellent here, there’s always something to eat”.

During our visit we spoke to five people privately and to a group of three people sitting in the lounge area. We also observed the way staff and residents interacted and the way care needs were met.

All the people we spoke to said they were happy living at The Cyder Barn. One person said ‘I don’t live here yet, I come in a couple of days a week. I would recommend it to anyone.’ Another person said, ‘well it’s generally ok, it’s not really what I expected but the girls are hard working and do look after us well.’ A third person said, ‘I really love it here, I can have a laugh and a joke with the girls, you have to don’t you no good just sitting back and giving in.’

We spoke about how the home ensures people have plenty to do. ‘One person said, ‘I join in the flexercise group everyday. I was an athlete so need to keep fit.’ Another person said they found there was plenty to do if you wanted to join in. We observed people taking part in a quiz, the activity was well organised and the questions were appropriate to the age of the people taking part, not childish and belittling. One person said, I always like the quizzes, then we go onto a crossword, it keeps the brain working you know.’

We asked people what they thought of lunch, they all said it had been an excellent meal with one person adding ‘as usual.’ We saw that the meal time was a social relaxed occasion, which people seemed to enjoy.

This unannounced inspection took place on 08 and 09 December 2015.

The last inspection of the Cyder Barn Care Home was carried out in May 2014. We found areas for improvement related to formal individual supervision of staff and quality assurance. We looked at these areas as part of this inspection.

The care home is registered to provide accommodation and personal care to up to 40 people. It specialises in the care of older people.

There is a no registered manager in post. However a manager is in place and is currently in their probationary period. 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.

Policies and procedures were in place regarding the taking of decisions on behalf of people who lacked capacity. However these were not being followed to ensure such decisions were in people’s best interests and people’s rights upheld.

People told us they felt involved in their care but were not given the opportunity to take part in any formal review of their care arrangements.

People told us “Staff always seem to know what they doing”. Staff undertook the necessary training and had the skills to meet people’s health and social care needs. Staff were positive about the opportunity for training and were able to undertake professional qualification whilst working in the home.

The provision of formal individual supervision had improved since our last inspection. Staff commented on the opportunities to have support and formal supervision to help them undertake their role and responsibilities.

People spoke very positively about the quality of meals. One person told us “I always enjoy the meals here and there is always a choice.” Assessments had been completed about nutritional needs and care plans identified how to meet those needs and preferences.

People told us they felt safe living in the home. One person told us “I always feel safe here because I can trust the staff.” A relatives told us when they left the home they did not worry about their relative because “I know they are being cared for.” Staff had a good understanding of abuse and how to protect people from abuse. They were confident that when reporting any concerns they would be responded to and action taken.

People were supported in having their health needs met safely through having safe and secure arrangements in place for the administrations and management of medicines. Staff had received training in administering medicines and demonstrated knowledge of medicines and their uses.

People told us there was adequate staff available and how responsive they were when requesting assistance. One person told us “I know they are always there if I need them. I try and do a lot for myself but they always check if I need any help. Sometimes there are little things I cannot manage and they do them for me.” We observed the availability of staff in communal areas and at lunchtime to support people having their meal.

People spoke warmly of care staff: “They are all very kind and friendly.”, “Staff are always thoughtful and asking me how I am.” Staff supported and assisted people in a sensitive and caring manner. People said they were treated with dignity and respect and their privacy was respected.

There were opportunities for people to take part in meaningful activities if they wished. There was a welcoming environment and people were encouraged to maintain their links with their community, family and friends. One person told us “It is very good because I get to see my family and keep in touch.”

People were able to express their views and make suggestions about improvements in the quality of the care they received. People felt they could voice their concerns and would be listened to and action taken to address any worries, concerns or complaints.

Improvements had been made in the quality monitoring of the service. There were a range of audits in place and actions taken where improvements had been identified. The manager had identified where improvements could be made and staff spoke of an open environment with an approachable manager.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.