Abbeyfield Silverdale & District Society Limited was inspected on the17 and 23 April 2018 and the first day of the inspection was unannounced. Abbeyfield Silverdale & District Society Limited is registered to provide personal care for up to 22 older people who require support with personal care. At the time of the inspection there were 21 people receiving support.

Abbeyfield Silverdale & District Society Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is situated in the village of Silverdale. It is a large detached property in its own grounds in a residential area overlooking the sea. The home is set on two floors with a lift to the first floor. There are large gardens surrounding the home which are accessible to people who live at the home.

At our last inspection in April 2016 the service was rated ‘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.

The registered manager completed a series of checks and investigations to identify where improvements were required in the quality of the service provided. Staff told us they were informed of the outcomes of these. We noted some of the checks were not documented, therefore action plans were not developed. We have made a recommendation regarding improving the audit and investigation recording process.

The home was introducing an electronic care record system. We found that the system was in use and information from paper based records was being transferred to the electronic system. Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found one care record required updating as information was not consistent with the person’s needs. Prior to the inspection concluding we were informed this had been done. We have made a recommendation regarding the documenting of people’s needs and wishes.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they wanted to enable people to live happy lives. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and spoke highly of the level of involvement they were offered.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

People told us they were happy with the way their medicines were managed. We observed medicines being administered and saw this was carried out in a safe way. Access to medicines was restricted to staff who had received training to ensure medicines were administered and managed safely.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Abbeyfield Silverdale & District Society Limited.

People told us they could raise their views on the service provided and they felt involved in the running of the home. We saw minutes of meetings where people at the home were informed of changes and were asked their opinion on the service provided.

People told us they had a choice of meals to choose from

This inspection was carried out on the 14 March 2016 and was unannounced. We last inspected Abbeyfield Silverdale & District Society Limited in July 2014 and identified no breaches in the regulations we looked at.

Abbeyfield Silverdale & District Society Limited is a registered society and an exempt charity for tax purposes. The society owns a home in the village of Silverdale. The home is a large detached property in its own grounds in a residential area overlooking the sea. The home is set on two floors and accommodates up to 22 older people. There are large gardens surrounding the home which are accessible and used by people living there. There are a range of aids and adaptations suitable to meet the needs of people living there. Parking is available in the grounds of the home.

The home is managed by a registered manager. A registered manager has 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 were happy living at Abbeyfield Silverdale and the care met their individual needs. People described staff as ‘very pleasant’ and told us they trusted staff.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document the measures required to reduce risk. Staff were knowledgeable of the measures in place and we observed these were followed these to ensure people’s safety was maintained.

We found medicines were managed safely. We saw people were supported to take their medicines in a dignified manner. There were systems in place to ensure medicines were stored securely.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. We saw staff could undertake tasks supporting people without feeling rushed. People told us they were supported promptly.

Staff received support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet people’s needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We saw people were offered a variety of foods and people told us, “It’s fine.” And, “It’s alright.” We saw people were offered a choice of meals and snacks throughout the day.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate.

We saw staff treated people with respect and kindness and relatives told us they were involved in their family member’s care planning.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we saw people were supported to carry out activities which were meaningful to them.

There was a complaints policy in place, which was understood by staff. People told us they would speak with staff if they had any concerns.

We saw systems were in place to identify if improvements were required. People who lived at the home were offered the opportunity to participate in annual questionnaires and the registered manager completed audits to identify if improvements were required. In addition the registered provider also monitored the quality of service by carrying out quality assurance checks.

During our inspection we looked at the way people were cared for and supported, how people were safeguarded from abuse, cleanliness and infection control, the way staff were supported to carry out their duties and the quality monitoring systems in place. We spoke individually with a four people living at the home, two relatives, the registered manager, the general manager, the care and training coordinator, the housekeeper, a senior carer and a care worker. Care practices were also observed for a short period, during the course of the inspection.

This helped 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.

Is the service safe?

People were treated with respect and dignity by the staff team. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that the management and staff team learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

There was an advocacy service available if people needed it. This meant that when required, people could access additional support.

People told us that they were pleased with the level of care that was being delivered to them and that their assessed needs were being met. From our observations and through speaking with staff it was clear that there was a good understanding of each person’s assessed needs and that personal preferences were accommodated. One person told us, “This is a jolly good place to live”. Another person said, “I am quite happy here. You get every attention they cannot do enough for us”.

Health and care needs had been assessed and people had been involved, as far as they wished, or were able, in writing their plans of care. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, each had been signed by the person or a close relative, to confirm their understanding and agreement to the content.

The relatives we spoke with confirmed that that were able to see people in private and at a time of their choice. These people were also very positive in their comments regarding the care provided at Cove House and confirmed that they had good communication with the staff team.

Is the service caring?

People were supported by kind, caring and attentive staff. We saw that care staff showed humour, patience and gave encouragement when supporting people. One relative, when asked what the service did well, commented, “The overall care, compassion and kindness shown to people”. Another relative said, “They (the staff) always go the extra mile”. A person living at the home said, “It is a very nice place to be. They (the staff) do quite a lot really and they are all very, very kind”. A member of staff added, “Cove House is homely. We try to make it home from home, do activities and outings. The care we give is I think, very good. It is good enough for my family, for my dad.

People using the service and their relatives and friends had been given opportunity to complete satisfaction questionnaires. This, along with the regular resident meetings and open general meetings, helped people to formally have their say and influence change.

Health and care needs had been assessed and people had been involved, as far as they wished, or were able, in writing their plans of care. Although some people spoken with were unsure about their current care plan, they were unconcerned by this. On the care plans we looked at, each had been signed by the person or a close relative, to confirm their understanding and agreement to the content.

Is the service responsive?

The people we spoke with said they were very satisfied with the arrangements in place to support social activities and social interactions. Social care needs had been given high priority. However it was also acknowledged that some people preferred spending time alone in their bedroom and this was respected.

People said that they knew how to make a complaint if they were unhappy about anything. Although formal complaints were infrequent, documents were available to record the complaint, the name of the person making the complaint, the process of investigation and the outcome. We saw that there was an ‘open door’ policy with people expressing their views, or queries as they arose. This meant that any concern or query could be dealt with immediately. People living at the home and the relatives we spoke with confirmed this to be the case.

Is the service well led?

The service worked well with a range of health professionals to make sure that people received their care in a joined up way. Records were kept of all health professionals visits in respect of each person, which included the reason for the visit and the outcome.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a consistent service at all times.

Staff also told us that they felt very well supported by the registered manager, general manager and the wider Abbeyfield Silverdale and District Society organisation. We were also told that the staff team worked well together for the benefit of the people living at the home. We saw that the staff team was stable meaning that people living at the home were cared for and supported by staff who knew them well.

A wide range of routine audits and internal quality control measures were in place including structured overall monitoring of the service by the Trustees. This helped to ensure that a consistent service was maintained that helped to protect people and keep them safe.

There were 21 people living at Abbeyfield Silverdale when we inspected. To help us understand their experiences of living in there, we talked with people, observed the care they received and the way staff interacted with people.

People told us that they were happy at Abbeyfield Silverdale. They said that they received care and support when they wanted it. We saw that staff assisted people with personal care discretely and sensitively, in a timely manner. We heard staff talking with people in a kindly way.

We briefly observed people having their meal. The mealtime was relaxed and unhurried, with people able to take their time over their meal. We saw that staff were aware of the dietary needs of people living in the home. People said that the food was good and plentiful.

People told us that they had the aids and adaptations they needed. Equipment was maintained and regularly serviced.

We saw satisfactory numbers of staff on the inspection to respond to people's needs. People told us that staff assisted them in the way they wanted and when they wanted them to.

Systems were in place for monitoring the quality of the service people received. People living in the home and relatives told us that they were well supported by the senior staff team.

We spoke with a range of people about the home. They included the manager and deputy manager, staff members and a number of people who lived at the home. There were no visitors during our time spent at the service. We received responses from external agencies including social services in order to gain a balanced overview of what people experienced.

People we spoke with told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs. Staff confirmed with us they also involved relatives, where possible to ensure people received the right care and support. This was confirmed when we looked at two records, which included evidence of involvement in care planning and review. One person told us, “I think staff involve me in planning what I need here.” Another told us, “Staff are always asking what I need.”

When asked about routines in the home people we spoke with told us it was relaxed and, "Staff are always around when you need them."

We spent time in various parts of the home throughout the inspection where we saw staff talking with people in a respectful manner. We saw staff spent time with people on an individual basis. One staff member told us, “It’s nice to be able to spend time with residents. They like it as well.”

During the course of the visit we spoke with three people living at the home, the deputy manager, three members of the care staff team and two relatives who were also visiting. Some time was also spent observing how staff responded to people as part of the day to day life at the home.

We saw that people living at Cove House were relaxed and comfortable. Staff were observed to be respectful and considerate when assisting people. It was clear that there was a good relationship between people living at Cove House and the staff team that supported them.

One person living at the home told us, “You do what you want when you want; everything is fine the food is marvelous. Its fine, very good, the girls are ever so good. I am very comfortable they are very good, very gentle and very kind”.

A relative spoken with commented, “We have been really quite impressed with some of the things going on, no quibbles at all. The staff are really friendly, there is a good relationship with the family, the food is good and mum seems happy. They are also good at social activities”.

People using the service, a relative and members of the staff team all spoke very highly of the care and support provided at Cove House. Comments included: Cove house is like home from home, it feels like a family, there is a family atmosphere”. Another person told us, “It is all very good, the carers are very caring. It all works really well, really nice”. A third person said, “Nobody complains, on the whole it is very good”.

We were also told that health professionals such as the GP are contacted quickly when required and that relatives are kept informed of any changes or health issues. One relative spoken with explained that her mother’s dependency needs had changed over time but that she had been fully involved in discussing changes to the care plans and felt that her views and wishes had been listened to and taken into account.

A relative told us, “I feel **** is safe here”.

A fairly recently appointed member of staff told us that a thorough recruitment process had taken place prior to her being offered employment at the home. However we found some discrepancies in the recruitment processes adopted that could pose a risk.

People we spoke with confirmed that they were encouraged to voice their opinions and suggestions for improvement and that their thoughts and views were taken into account.

People living at Cove House expressed full satisfaction with the service provided stating that they would feel comfortable in expressing any worry or problem.