The inspection took place on 21 June, 2018 and was unannounced, which meant that nobody at the service knew we would be visiting. At the last inspection in April 2016, the service was rated overall Good, but was rated Requires Improvement in responsive. At this inspection we found the service was rated overall Requires Improvement.

Town Moor House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Town Moor House is a 28 bed home providing care and support to older people. The home also provides care and support to people living with dementia. The home is a converted older property near the centre of Doncaster.

At the time of our inspection the service had a registered manager. 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.

People told us they felt safe. Staff were knowledgeable regarding safeguarding and were aware of how to identify possible abuse and the correct procedures to record and report. Risks associated with people’s care had been identified and staff were knowledgeable on how to manage the risks but documentation was not always reviewed or updated when needs changed.

We observed that there were enough staff available to meet people’s needs in a timely way.

Medication systems were robust; however, we identified issues that meant these were not always followed by staff.

Accidents and incidents were monitored and the registered provider ensured lessons were learnt. However, the monitoring could be more detailed to ensure a thorough analysis.

The service was clean and had a maintenance programme. Some areas required attention however; these had been identified by the registered provider. We also found the environment did not always meet the needs of people living with dementia.

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. The management team were aware of who had an authorised Deprivation of Liberty Safeguards or if any conditions were attached. Consent to care and treatment was sought in line with current legislation. However, we identified that best interest decisions were not always considered.

Staff received training on a regular basis. Staff were knowledgeable about their role. People received a nutritious diet, although documentation for recording this could be improved. People had access to healthcare professionals and staff followed their advice.

We observed staff interacting in a positive way with people. People told us the staff were very kind and caring. Staff were observed to be kind and considerate, the interaction we saw was very respectful. People’s privacy and dignity was respected. However, staff did not always respect people when they were discussing care and treatment in communal areas.

People received care and support that met their needs. Staff were aware of people’s needs and preferences. However, the care delivery could be more individualised and person centred.

A range of activities took place. People told us about the activities that they took part in and told us they were very good. People told us they felt able to raise concerns and complaints and were listened to. The registered provider learned lessons from complaints received and took appropriate actions.

Audits were in place to ensure policy and procedures were followed. However, we found they had not identified all the areas for improvement and could be more detailed. The registered provider

The inspection took place on 16 February 2016 and was unannounced. The home was previously inspected in June 2014 and the service was meeting the regulations we looked at.

Town Moor House is a care home which provides care and support for up to 28 older people. It is situated in Doncaster within easy reach of bus stops, shops and other amenities. At the time of our inspection there were 25 people using the service.

The service had a registered manager in post at the time of our inspection. 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 provider had a policy to protect people from abuse. Staff had received training in this area and were knowledgeable about how to recognise and respond to abuse.

We saw that people received their medicines in a safe manner. We looked at records in relation to medicine management and found each person had a medication administration record (MAR) in place. This clearly evidenced when people had been given their medicines.

Care plans we looked at contained risk assessments, highlighting any risks associated with the persons care and how best to manage the risk presented.

We saw that there were enough staff around to ensure people’s needs were met. Staff worked well as a team and were able to respond to people’s needs.

Staff we spoke with told us training was of a good standard and it assisted them to carry out their role. We saw a training matrix which highlighted what training staff required and when it needed to be completed.

People were supported to make decisions about their care and their choice was respected. Care plans included information about people’s likes and dislikes.

People received a nutritious and balanced diet. Snacks and drinks were offered throughout the day.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support.

We observed staff supporting people and found they were kind and caring and knew the people very well. We saw staff asked people what they would like and only proceeded with the persons consent. Staff we spoke with knew how to maintain dignity and respect. One care worker said, “It is important to involve people in their care. It is all about the person.”

We saw staff interacting with people and found this was mainly in line with their care plan. Care plans were reviewed on a monthly basis and we saw that where appropriate changes had been made to reflect the person’s current needs.

The provider had a complaints procedure displayed in the entrance are of the home. We spoke with people who used the service and their relatives and they told us they did not need to complain. People felt able to talk with staff if they needed to raise a concern and felt it would be dealt with appropriately.

During our inspection we saw the registered manager interacted well with staff and people who used the service.

We saw audits took place to ensure policies and procedures were being followed.

People who used the service were involved in the development of the home and were able to contribute ideas.

At this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People who used the service told us the staff were very kind. One person said, “The staff are very kind and I could tell them anything, they are easy to get on with.”

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We spoke with people who used the service and they told us the standard of care was very good.

People were provided with a choice of suitable and nutritious food and drink. Care plans contained people’s preferences regarding food, drinks and snacks. We spoke with people who used the service and they told us the food was very nice.

Is the service caring?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at care records and found that people’s needs had been assessed and care plans had been devised to meet their assessed needs.

We spoke with people who used the service and they told us they were satisfied with the care provided. One person said, “The staff are very caring and know just what I need.”

Is the service responsive?

We saw that care plans were reviewed regularly and any changes were made to ensure people’s needs were met.

The provider took account of complaints and comments to improve the service. The provider had a complaints procedure and logged complaints and the outcome. The provider had received four complaints in the last year. These had been resolved.

Is the service well-led?

We saw that audits had been completed and where actions had been identified these were addressed.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. We spoke with people who used the service and they told us that they were asked their opinion in how the service was run. We spoke with the registered manager who told us a quality assurance questionnaire was sent out on an annual basis and they took action on comments raised.

We spoke with four people who used the service and one relative. People spoke positively about the standard of care they received. One person told us "I'm looked after very well." A relative told us "Mum has settled in and is getting stronger." Throughout our inspection we observed good interactions and found people who used the service appeared relaxed and happy in the care of the staff.

We looked at the management of medicines. We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People we spoke with told us staff gave them their medicines at the correct times each day. We observed two people being given their medicines and saw the senior care worker administered medicines in a safe and caring way.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We looked around various parts of the service. We found it was clean and free from odours. The provider had a refurbishment programme in place to ensure living areas were appropriate for people with dementia.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff we spoke with were aware of their roles and responsibilities and of other members of the team. Records showed a training programme was in place to ensure staff kept up to date with current practice.

During our inspection we spoke with people who used the service and their relatives. People spoke positively about the care and support they received. They told us they liked living in the home and confirmed they were well supported to make choices and decisions about their care. One person said: "Good standard of care, nothing to complain about." Another person told us: "Very happy, staff are lovely and kind."

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed on a monthly basis and updated as required. Six monthly reviews also took place with people who used the service and their relatives. This ensured people were involved in planning their care and treatment.

There were effective systems in place to reduce the risk and spread of infection. People we spoke with told us the home was spotless. We found the home was clean and well maintained.

There were enough qualified, skilled and experienced staff to meet people’s needs. During our inspection we observed staff were able to meet people's needs in a timely way.

People were given support by the provider to make a comment or complaint where they needed assistance. People we spoke with confirmed they could raise any concerns with staff and these would be acted on.

People said that they liked living at Town Moor House. They said the staff members were friendly and helpful.

They told us when they first came to look around the home they were encouraged by the friendliness of staff and the lack of “unpleasant smell around the place”. One person said, that in some places there was too much air freshener that could be to suppress the unpleasant odour.

People told us that they were involved in the planning of their care and that they were able to make changes to their care plan.

They said that most of the time there was sufficient staff around and they felt safe at the service.