This inspection was unannounced and took place on 16 and 18 August 2017.

The Towans Care Home is registered to provide care and accommodation for up to 28 older people. At this inspection there were 27 people living at the home. The home has a number of people who wish to live a more independent lifestyle within the safety and security of the care home. The provider offers respite (short stay) care.

The home is an older building; it has two floors with communal spaces such as lounges, conservatory and a dining room on the ground floor. There was a garden which people were able to freely move to. At this inspection two people were sharing a bedroom which was their choice because they were married. Everyone else had their own individual bedroom. People were able to personalise their bedrooms.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

The home now requires improvement to ensure people were safe. There were enough suitable staff to meet people’s needs and to spend some time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The provider, registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe and senior staff understood the processes they should followwith regard to reporting concerns. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. However, some staff required further training and competency checks to observe medicines being administered. People told us and we saw their healthcare needs were met. People received support to eat and drink sufficient amounts.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them. People were supported to have a dignified death because their needs and wishes were respected by staff.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There were individual and group activities daily to provide a range of opportunities. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were always a range of opportunities for them to raise concerns with the manager and designated staff.

The home continued to be well led. People, relatives and staff spoke highly about the management. The manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The manager was proud of the links they had developed including the use of social media.

Further information is in the detailed findings below.

There were 21 people living at the home at the time of our visit.

Eight people told us they were happy living at the home. One person said "They treat me really well and always respect my wishes". We saw that people had a good rapport with staff and there was lots of gentle humour between staff and people at the home.

We observed staff gaining people's consent in a skilled way. We saw people being given choices in relation to food, how they chose to spend their day, and their daily routines.

We reviewed five care plans and saw that detailed assessments of people's care and support needs had been completed. We saw that people's individual care plans contained detailed risk assessments that ensured care and support that was given was safe.

We noted that people were cared for in an environment that was clean and well maintained and free from the risks of cross contamination.

We observed a wide range of activities at the home. People said "I really enjoy the activities but I always have a choice if I want to join in or not". We noted that there was one to one time for people and a programme of group activities. We saw that staff joined in the activities to ensure that each person was able to participate as fully as possible.

There was a formal process of quality monitoring in the form of quality assurance surveys and audits of services. We noted that improvement or action was taking place following the outcome of the residents' survey.

We carried out this inspection due to concerns received and we found during our inspection the concerns that had been raised to us were unsubstantiated.

During our visit we observed that The Towans Care Home was a pleasant home, where staff and people who lived in the home interacted well with each other. We spoke with eight people who lived in the home who told us that they thought the care that they received was good. One person told us what it was like to live in the home. They said “Everyone is very good here, can’t fault them, they are lovely, there is brilliant humour, everyone gets along”.

We spoke with two relatives who regularly visited the home and asked them what they thought of the home. They told us “The staff are lovely, atmosphere is so bright and cheerful, staff always go out of their way to encourage my mum to get out of her room”. Another relative told us that staff would answer the call bells in reasonable time when her mum needed assistance. Both relatives told us that they were able to approach the manager if they had any concerns or wanted to be kept up to date about their relatives care.

During our visit we observed care over the lunchtime period. We saw people had a choice of drinks and people had their food served how they preferred. People had recently discussed in a residents meeting that they preferred their meal was served on a plate before it was given to them. We saw that this was being accommodated. We saw the food served was of good quality. People told us they always enjoyed their meals and could ask for an alternative if they did not like the main meal of the day.

We visited The Towans Care Home to follow up on the compliance action from our last inspection. This involved talking to all available members of staff to check their knowledge on how to report abuse to the external authorities and whether staff had received and understood the protecting vulnerable adults training.

On this occasion we did not need to talk to any people who live in the home.

During our visit we spoke with a number of people using the service. They told us that they were able to make decisions about their lives and that they were treated with respect by staff working at the home. They said; “I can choose exactly what I want to do”, “The staff never tell you what to do, they ask you what you would like to do”.

People living at the home also told us; “The staff are very respectful and very kind”.

Two people told us that they had made an informed decision to move to the home. They told us that they had been provided with information about the home and had been able to visit the home before making a decision to move there. One person told us that they had used the home’s ‘respite’ facility before decided to move to the home on a permanent basis.

The staff we spoke with were aware that each individual must be supported to make their own decisions and that they should be supported to make choices about their lives. We looked at a number of care plans and these contained information about people’s assessed needs and preferences although none had been signed or agreed by the individual and there was no information regarding people’s preferences for end of life care and following death.

We found the atmosphere in the home to be ‘relaxed’ and ‘inclusive’. People appeared relaxed in the presence of staff and communication was noted to be kind and respectful.

People living at the home told us “all the staff here are so kind”, “They will do anything for you, they are so very kind”.

They also told us; “They are so respectful when helping me to have a bath”, “I like to get up early and the girls always bring me a cup of tea when I wake up”.

We were able to see that each person had access to a call bell. Those people not in their bedrooms were seen to be wearing a ‘pendant’ call bell. People spoken with confirmed that staff responded to call bells promptly during the day and at night.

Staff interactions with people using the service were noted to be kind and respectful. It was apparent that staff knew each individual well and that they were aware of peoples’ assessed needs and preferences.

The home ensures that people have access to appropriate health care professionals. People living at the home confirmed that the home “will always get the doctor when needed”.

During our visit the person in charge requested a GP visit for one individual who was feeling poorly.

The person in charge told us that they have “very good” support and input from doctors and specialised health care professionals.

During our visit we observed the senior carer on duty administering the morning and lunch time medicines in a safe and appropriate manner. The staff member took time to explain the medicines to each individual and remained with each person until they had taken their medicines.

Medicines were dispensed to each individual from a trolley which was locked when left unattended. We observed the staff member making an appropriate entry in the medication administration record only after the medicine had been taken by the individual.

We were informed that only senior care staff who have been appropriately trained are involved in the management and administration of peoples’ medication. A list of these staff along with their signature and initials was made available.

Each person spoken with during our visit was very complimentary about the provision of food at the home. They told us; “there is plenty to eat and you can always have snacks if you want them”, “the food is very good and you never go hungry here”. “The staff know what I like and what I don’t like”.

People told us that they were asked about their meal preferences the day before. People confirmed they were offered choices although on the day of our visit, each person was provided with the same meal.

On the morning of our visit we asked people if they knew what was for lunch and nobody did. Menus were not displayed for people.

We observed staff offering assistance to an individual in an appropriate and unhurried manner.

People were offered a choice of hot drinks throughout the day and cold drinks were seen to be available in communal areas and individual bedrooms.

People living at the home appeared relaxed and comfortable in the presence of staff and nobody spoken with raised any concerns regarding the way they were treated or of the care they received. People said, “the staff are very kind here”, “They are all so kind and caring”, “I feel very safe well cared for here”.

During our visit we were able to speak with a number of staff working at the home and they were able to demonstrate a good understanding of what constituted abuse. Staff told us that they “would not hesitate” in reporting abuse where suspected or witnessed however, staff were not aware of how or who to report concerns to outside of the home. Staff were not aware of Somerset’s policy on safeguarding adults and the policy could not be located during our visit.

We did not have access to a staff training matrix but all care staff spoken with during our visit confirmed that they had not received any formal training on safeguarding adults from abuse.

During our visit we viewed all communal areas and a selection of bedrooms and we found the standard of cleanliness to be very good with no malodours.

We were able to see that staff had access to a good supply of protective equipment such as gloves and aprons and that these were being used appropriately as ‘single use’.

People told us that they felt “well looked after”. Staff confirmed that they did not experience any concerns in meeting the needs of people living at the home.

People commented on the kindness of the staff. They also told us that, although staff were “very busy”, they did not feel rushed when receiving assistance from staff.

Most of the people we spoke with told us that since the activity coordinator left in April of this year, there was not much going on in the home. They said; “the activities used to be really good but now all we do is sit around”. They also said; “there isn’t anything going on, I just watch television”, “It would be really nice if we could have the activities back, there used to be so much and we used to have entertainers come in”. The home is currently in the process of recruiting a new activity coordinator.

The Towans has been suitably adapted and extended to meet the needs of older people. Bedrooms are for single occupancy and we were able to see that people are able to personalise their rooms. We found bedrooms to be very comfortable furnished and some people had chosen to bring items of their own furniture with them.

People told us; “I am very happy here and I love my room”, “I like to sit in my room as I have all my things around me and I have a lovely sea view”, “It was very hard leaving my home but I could bring some of my furniture with me and it makes it feel more like home”.

Mobile and fixed hoists are available to assist people with their mobility needs and people have access to appropriate numbers of assisted bathing and toilet facilities. We were able to see evidence that all equipment had been regularly serviced by outside contractors.

A call bell system is installed throughout the home so that people can call staff for assistance as required. People told us that staff responded promptly to call bells. “I sometimes have to use my call bell at night and the staff come quite quickly”, “I don’t need to use my bell much but the staff always come when I need them”. During our visit we saw that people had easy access to their call bells. Read the full inspection report (PDF)

This inspection was unannounced and took place on 16 and 18 August 2017.

The Towans Care Home is registered to provide care and accommodation for up to 28 older people. At this inspection there were 27 people living at the home. The home has a number of people who wish to live a more independent lifestyle within the safety and security of the care home. The provider offers respite (short stay) care.

The home is an older building; it has two floors with communal spaces such as lounges, conservatory and a dining room on the ground floor. There was a garden which people were able to freely move to. At this inspection two people were sharing a bedroom which was their choice because they were married. Everyone else had their own individual bedroom. People were able to personalise their bedrooms.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

The home now requires improvement to ensure people were safe. There were enough suitable staff to meet people’s needs and to spend some time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The provider, registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe and senior staff understood the processes they should followwith regard to reporting concerns. All staff informed us concerns would be followed up if they were raised.

People continued to receive effective care. People who lacked capacity had decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. However, some staff required further training and competency checks to observe medicines being administered. People told us and we saw their healthcare needs were met. People received support to eat and drink sufficient amounts.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them. People were supported to have a dignified death because their needs and wishes were respected by staff.

The home remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There were individual and group activities daily to provide a range of opportunities. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were always a range of opportunities for them to raise concerns with the manager and designated staff.

The home continued to be well led. People, relatives and staff spoke highly about the management. The manager continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The manager was proud of the links they had developed including the use of social media.

Further information is in the detailed findings below.