The inspection took place on 23 and 29 November 2018 and was unannounced.

The Old Library is a residential care home for up to 30 older people, some of whom may have dementia related conditions. At the time of our inspection 25 people were receiving a service. The home has three floors and lift access is available. There is parking available to the rear of the building and a patio area. There is a large lounge with a designated dining area one smaller lounge.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff continued to protect people from avoidable harm, were knowledgeable about safeguarding and able to raise concerns. Steps were taken to minimise risk where possible. Staff supported people to manage their medicines safely.

Systems were in place to recruit staff safely. They were supported through on-going supervision and accessed training relevant to people's needs, to ensure these could be met.

Staff worked in partnership with health and social care professionals in the monitoring and promotion of people's health. People were supported to maintain a nutritious diet and offered choices at meal times.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring; they promoted people’s independence and treated them with dignity and respect.

People’s care plans were kept up to date and reflected their individual needs and circumstances. People were supported in line with their preferences and supported to engage in social and leisure activities.

The provider had a system in place for responding to people's concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided. There was a positive culture within the service and people felt the registered manager was approachable.

Further information is in the detailed findings below.

This unannounced inspection took place on 25 April 2016. The service was last inspected on 15 September 2014 when the service was found to be compliant with the regulations inspected.

The Old Library Residential Home Limited is registered with the Care Quality Commission to provide accommodation and personal care for up to 30 older people, some of whom may be living with dementia. The service is based on three floors and has access to these via a lift. The service is located close to the town centre of Cleethorpes and there is parking available to the rear of the building. At the time of our inspection there were 23 people using the service.

There was a registered manager in place. 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.

Staff had been safely recruited and received training about the protection of vulnerable adults to ensure they knew how to recognise and report issues of potential abuse.

Assessments about potential risks to people had been completed to ensure staff knew how to manage these safely. People received their medicines from staff who had been trained to ensure they knew how to administer these to people safely.

Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. Staff demonstrated a positive understanding for the promotion of people’s personal dignity and privacy, whilst involving them in making active choices about their lives. People’s private records and information was maintained in a confidential manner

Staff were provided with a range of training and development opportunities to help them develop their careers and enable them to effectively carry out their roles. Staff involved people and obtained their consent before carrying out interventions and best interest meetings were held when people lacked the capacity to make important decisions for themselves. People received a choice of nourishing home cooked meals which they said they enjoyed and community based health care professionals told us they had a good working relationship with the service.

People were provided with a range of opportunities for social stimulation and interaction. A complaints policy was in place to ensure people could raise any concerns about the service when required. People and their relatives were involved in the planning of their support that was reviewed on a regular and ongoing basis.

Regular management checks were carried out to enable the quality of the service people received to be assured and enable the identification of changes to be made where this was required. The registered manager was aware of their responsibilities and submitted notifications about incidents affecting the health and welfare of people who used the service to the Care Quality Commission as required.

This inspection was carried out by a social care inspector over one day. We were accompanied by a member of staff from the local authority contracts department, following an allegation of concern that people's care and welfare may not be being appropriately met in the home.

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 safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment in the home was maintained and checked regularly. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. There was evidence that assessments concerning people’s capacity to make informed decisions were carried out under the Mental Capacity Act 2005, to ensure their human rights were protected.

There were enough staff available to meet the needs of the people who used the service. There was evidence recruitment checks were carried out of new staff to ensure they were safe to work with people who used the service.

Is the service effective?

People told us they were happy with the support they received and had no complaints. Care staff told us they enjoyed their work and we observed they worked well as a team. We saw care staff interacted with people with warmth and humanity in a professional way.

A range of training was provided to ensure staff were able to carry out their roles. We saw that individual professional supervision with staff included discussion and consultation about their personal training and development needs together with assessments of their individual competencies and skills.

Is the service caring?

People were supported by kind and attentive staff. We observed care staff demonstrated consideration and compassion for people’s individual needs. We saw care staff spending time with people, involving them in decisions about their support and providing one to one support when required, to ensure their people’s personal dignity was promoted.

We saw a range of care plans had been developed from people’s assessments, that detailed support required to meet their individual needs in accordance with their personal wishes and preferences

Is the service responsive?

People’s needs had been assessed before they moved into the home. People’s care records confirmed their interests and individual needs had been recorded and care and support had been provided that overall met their wishes.

We found health care professional’s advice was sought and that people's care needs were kept under review and that care plans, risk assessments and support plans were updated when required

Is the service well-led?

There was a quality assurance system in place to enable the service to be monitored. We saw regular audits on different aspects of the home, to enable the service to learn and develop.

The registered provider consulted with people about how the service was run and took account of their views. We saw regular meetings took place to enable people and their relatives to participate and be involved in the life of the home.

What people who used the service and those that matter to them said about the care and support they received:

Relatives told us they were satisfied with the service provided. One relative told us they were, “Definitely happy with care provided by staff.” They told us, “You can’t get a nicer bunch of girls.” and that, “XXXX has come on in leaps and bounds.”

A relative told us there were, “Always staff available” to respond to people’s needs and that staff were, “Quick at getting medical attention” when this was required.

We saw that staff talked with people and involved them in decisions about their support to ensure their wishes and needs were respected. We saw that staff demonstrated consideration for people’s individual needs and spoke with kindness and courtesy, to ensure their dignity was maintained.

We observed there was a relaxed and welcoming atmosphere throughout the service on the day of our visit. We saw that people looked comfortable and well cared for and that staff spoke with them in a friendly and caring way. We observed that staff interacted compassionately with people to ensure they were provided with choices about their support.

People told us that staff helped them be as independent as possible and that they felt safe in the home. One person told us, “Staff really are very good…they look after me very well” whilst a visiting relative said, “Things couldn’t be better.”

People told us that staff took prompt action to get medical attention when this was required. One person told us, “They have them here (medical staff) in no time at all.” A visiting practice nurse told us that staff worked well with their team and that they were, “Proactive and followed advice.”

We saw that adequate stocks of food supplies were maintained and managed. We saw the use of pictorial menus to help people make choices about their meals. We observed the day’s choices were displayed in the dining area of the home. We saw drinks and fresh fruit were available throughout the day, with additional drinks and snacks offered by staff.

We saw the acting manager had taken appropriate action to resolve safeguarding issues that had been raised. We found evidence of subsequent management action with disciplinary procedures implemented where required, to ensure staff were correctly performing their roles.

We found the building was warm, clean and tidy on the day of our visit and we saw that action was taken to ensure it was appropriately maintained. People told us they were comfortable in the home and happy with the facilities provided. We found that bedroom corridors were painted in different colours, to help people identify their rooms and orientate themselves around the home and be familiar with their surroundings.

People who used the service and relatives told us they had confidence in and trusted the staff. One relative told us they visited on a daily basis. They told us, “I can’t praise the staff enough.” We found staff files contained completed application forms, covering details of gaps in previous employment, qualifications and past experience, and evidence of checks to ensure new staff were able to safely carry out their roles.

People told us they were satisfied with the service provided and were confident that action would be taken to resolve issues when this was required. There was evidence of compliments made about the service on display. We saw a recent comment that stated, “Special thanks for the dedicated and loving care given by all the staff at the Old Library Care Home.”

People who used the service told us how they liked living in The Old Library. One person said, “I’m very happy here and they treat us very well. The owner takes us to the pictures on Tuesday by car. I like preparing for the Summer Fayre and it’s the parade soon. My relatives take me out shopping.” A relative told us, “The staff are very aware of dignity. Staff encourage people to participate in activities. Our relative likes to do regular reminiscence with staff individually as well as in a group. She also goes when singers visit each month.”

People spoke positively about their experience of the service and the care they received. A person told us, “I’ve been here only a short time but I like it here, I have no problem with the care.” A relative told us, “The standard of care has been excellent. I saw how sensitive staff were in giving care. As a family we are more than happy with the care and the love and devotion that he gets.”

People we spoke with said they felt the care they received was provided safely. One person told us, “They are very good staff and very polite. They say, ‘just come to us, don’t be afraid.’” Another person said, “I find all the staff are brilliant.” Relatives felt the home was a safe place. A relative who visited the service regularly told us, “Father is absolutely safe in here. When you walk in unannounced staff continue to act in exactly the same way which is reassuring.”

People we spoke with felt the provider listened to them and acted on their concerns. One person told us, “I do complete surveys, but not sure how often. If there is anything we are not sure of we go to the staff or the manager.” A relative we spoke with said, “I attend the relative meeting. The last one in June the deputy chaired. We had a very useful meeting. I did a questionnaire for relatives given out at the last residents’ meeting. I would know what to do if I had a complaint. I had one cause of complaint which was dealt with very satisfactorily.”

During the site visit on 29 March 2011 people we spoke to told us all their needs were being met by patient and supportive staff. They can contribute to their plans of care and told us staff can give them access to other health professionals when the need arises.

They told us the food was always good and they were never hungry and could have hot and cold drinks when ever they wanted to.

Their personal rooms are always clean and tidy and they have been able to contribute to the recent refurbishment programme by choosing colours for different parts of the home and their own personal furnishings such as curtains and bed linen. They told us that the provider has set up regular meetings to ask their opinions about the running of the home and sends them regular survey sheets. They can also have a personal meeting should the need arise or there are changes to their individual care plans.