Aldersmead Care Home 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. Aldersmead Care Home provides facilities and services for up to 38 older people who have physical health care needs and who may also be living with dementia. This includes people who have had a stroke or live with a chronic health condition like Parkinson’s or diabetes. Aldersmead Care home is one of three care homes within the registered organisation.

At the time of this inspection 26 people were living in the service. This inspection took place on 8 December 2017 and was unannounced.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At the last inspection undertaken on the 24 August 2015 the service was rated ‘Good’ overall with a breach of one regulation. This was because staff were not consistently providing care in a respectful way. At this inspection we found this regulation had been met and the service continued to be rated ‘Good’ overall.

Medicines were stored and handled safely. However we found for people who were prescribed ‘as required’ (PRN) medicines suitable guidelines were not always in place to guide staff on the safe and consistent administration of these medicines. This was identified to the registered manager as an area for improvement.

People were happy with the care and support they received. Family members were also complimentary about the care and support provided to people and them. Visiting professionals provided very positive feedback on the staff and the delivery of care.

People were looked after by staff who knew and understood their individual needs well. Staff were kind and treated people with respect, promoted their individuality and independence whenever possible. They spoke to them in an appropriate way, promoted communication and took a genuine interest in what they had to say.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse or discrimination. Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people's needs could be met in a timely and safe fashion. The registered nurses attended additional training to update and ensure their nursing competency.

People were supported to eat and drink a variety of food. They were provided with choice of freshly cooked meals and drinks each day. People’s health was monitored and staff responded when health needs changed. People were supported to attend healthcare appointments and were referred to external healthcare professionals when needed. People were supported to take part in a range of activities maintain their own friendships and relationships with people who were important to them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. People were given information on how to make a complaint and said they were comfo

The inspection was carried out on 24 August 2015 and was unannounced.

Aldersmead Care Home can accommodate up to 38 people. It is registered to provide nursing and personal care to older people and people living with dementia.

There were 34 people living at Aldersmead Care Home at the time of our visit. There was a registered manager, who was present on the day of our visit.

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 accommodation was over three floors with two lifts. The building was well maintained and decorated to a good standard. We found inconsistencies in staff providing a caring and respectful approach with people.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS).

DoLS protects the rights of people ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The home had taken steps to make sure that people were safeguarded from abuse and protected from risk of harm. Staff had received training in how to safeguard adults and knew what action to take in the event of any suspicion of abuse.

Medicines were managed and stored appropriately. Staff received regular training and their competency in giving medicines was assessed, to ensure people received their medicines as prescribed.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised.

Regular environmental and health and safety checks were carried out to ensure that the environment was safe and that equipment was in good working order.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People’s needs had been assessed to make sure that there was enough staff on duty during the day and night to meet people’s individual needs.

People’s health needs were assessed and monitored. Health records were written in an accessible way. People were supported to have a balanced diet. Staff understood people’s likes, dislikes and cultural preferences.

New staff received a comprehensive induction, which included specific training such as Dementia Awareness, End of Life, Parkinson’s Disease, Wound Care, Palliative Care, Pressure Sore Awareness, Choking Prevention, and Compassion Awareness.

Staff were trained in areas necessary to their roles and completed additional specialist training such as how to communicate effectively and support people to make sure that they had the right knowledge and skills to meet people’s needs effectively.

Each person who lived in the home had a different way of communicating their needs. Staff understood how to communicate in a personalised manner with each person who lived in the home.

Staff spoke with people in a respectful manner, treated them with kindness and encouraged their independence.

People’s care, treatment and support needs were clearly identified in their care plans and included people’s choices and preferences. Staff knew people well and understood their likes and dislikes. Clear guidance was in place to identify the triggers and action to take when people displayed behaviour that may challenge themselves or other people.

People were offered an appropriate range of activities, which included in-house activities and trips in the community. People were supported to keep in contact and visit friends, family members and people who were important to them.

Staff understood the aims of the home were motivated and had confidence in the management of the home. One employee stated ‘Great manager, on top of everything’.

Systems were in place to review the quality of the service and included feedback from people who lived in the home, their relatives and staff. Improvement plans were developed where any shortfalls were identified to make sure that improvements were made and sustained.

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

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key 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 eight people who lived at the home, a visiting professional, the registered manager and four staff supporting them. We also reviewed records relating to the management of the home which included, five people's care and health records, three staff recruitment records, policies and procedures, accident, complaints and audit reports. At the time of our inspection there were 32 people living at the home, many of whom had reduced memory or a dementia. Because they could not talk to us about their experiences of living at the home we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the home for three hours during the morning and afternoon.

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

Is the service safe?

At our previous inspection we raised concerns about the cleanliness of parts of the home and some infection control measures. The manager and provider responded promptly to these concerns. As a result, at this inspection we found that people had been cared for in an environment that was safe, clean and hygienic. The laundry had been completely refurbished and cleaning audits and schedules introduced to ensure people lived in a clean and safe home.

Systems were in place to make sure that the manager and staff learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the home to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection the manager told us that no one who lived at the home was subject to a DoLS. However, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty and how to submit one.

At our previous inspection we raised concerns that some people were at risk of isolation. In response, people at risk were given the opportunity to move to rooms on the ground floor of the building. People told us that staff now regularly checked on them and that they did not feel lonely.

Is the service effective?

The home had care planning systems in place that ensured people received the care and support that they needed. People told us that they were happy with the care that had been delivered and their needs had been met. One person told us, "It's very nice here. It's peaceful and I am comfortable. I have a special mattress. Staff notice if I look uncomfortable when they help me in bed and get me another pillow. They are very good". Another person told us, "I have no complaints, the care you get here is good". It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

The home had good systems in place for sharing information with other agencies that made sure people received the care and treatment they needed. For people with reduced memory or a dementia the home had additional documents that went with people if they visited a hospital. This ensured hospital staff knew about the needs of people who may not have been able to communicate or remember important information.

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. One person told us, "The staff are marvellous. They are happy, kind and caring". Another person told us, "He (pointing to a member of staff) is lovely. Nothing is too much trouble for him".

We saw that staff showed patience and gave encouragement when supporting people. For example, we saw a member of staff sitting with two people in a quiet area of the home. The member of staff concerned had noticed that the two people appeared anxious when they were in part of the home where a large number of other people were sitting. They quietly and discreetly offered to take the two people to another part of the home and then spent time talking to them both. Both people responded positively to this.

Is the service responsive?

People’s needs had been assessed before they moved into the home and on a regular basis thereafter. This meant that they received the care and support they needed at the time they needed it.

People benefitted from meaningful activities and engagement with staff. We observed a number of activities taking place during our visit. When armchair exercises involving a ball were taking place we noted that staff attempted to involve everyone present, regardless of their abilities. For example, staff were seen using a sponge ball and placing this in the hands of a person with poor eyesight. Staff encouraged the person to feel the texture of the ball as they could not see very well. People told us that they were very happy with the activities provided by the home. One person said, "We have entertainers come in on a regular basis. We go out in the garden when its nice outside". Another person told us, "As you get older you don't want to do as much. I like to find a comfy chair and relax. The staff ask me if I want to join in. Sometimes I do and other times I don't".

The home worked with other agencies and services to make sure people received their care in a joined up way. A visiting healthcare professional expressed the view that, "The home is good at acting quickly on advice given".

Is the service well-led?

The manager was clearly passionate about the health and wellbeing of people who lived at Aldersmead Care Home. This was reflected in the care that we observed people receive and the commitment staff demonstrated. When one member of staff did not provide support to a person in a kind and caring way the manager took immediate action to safeguard the individual. The manager informed us, "We as a company have a zero tolerance of abuse".

We saw there were systems for monitoring the quality of services provided and the manager demonstrated a commitment to making improvements to the quality of service provided to people.

We spoke with 10 of the people who lived at the service or their relatives. We also spent time observing the interactions between staff and people. We found staff to be positive and friendly. Staff spent time with people providing reassurance and support. We found that people's health and personal care needs were being managed safely by the service and that staff had a good understanding of their roles and responsibilities in this area. People told us that they were happy with the service they received in relation to their health and care needs. For example, one person said, "They are all very approachable here, they help me get dressed".

We found instances when care was not being delivered in line with the assessed needs of people. People had care plans and assessments that detailed activities and social stimulation that staff should support them to participate in. However, in some instances we found that these were not being followed. People told us that they enjoyed the activities that took place at the service but that they would like more opportunities to participate in activities outside of the service. For example, one person said, "I just do my crosswords and read, I have books in my room but I never get out there aren’t any trips out”.

People told us that staff respected their wishes with regard to the care they wanted. For example what time they wanted to get up in the morning and if they wanted to self administer their medicines.

Safe infection control procedures were not being followed. Although most people told us they were happy with standards of cleanliness at the service records demonstrated that a number of people had raised concerns about laundry and domestic issues since January 2013.

We found that people had been made aware of their rights to raise concerns and complaints. One person told us, "We had a situation where we didn’t want X (family member) to keep having their hair cut so often. We spoke to the manager and she acted upon this so yes we felt listened to”.

Some people were not able to verbally express their views on the service they received. We gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff. We also listened to how staff spoke to people. Staff acted promptly to meet people's care needs and spoke to people in a kind and respectful way.

We spoke with six of the 26 people who lived at the service. Everyone told us that they were happy with the care and support they received. One person told us, "I've been here for respite. It's very good accommodation and the meals are lovely. I'm very satisfied". People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. As one person explained, "I've been here for a couple of years and I haven't got a lot to grumble about. The staff are very good, they speak kindly and treat you nice". Our evidence gathered during this inspection supports the comments made by people who were receiving a service.