About the service: We carried out an unannounced comprehensive inspection of Ar-Lyn Residential Home on 20 February 2019. Ar-Lyn is a ‘care home’ that provides care for a maximum of 13 predominately older people. At the time of the inspection 13 people were using the service.

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.

What life is like for people using this service: The management team and staff knew people well and understood their likes and preferences and health needs. Staff were aware of people's life history, and their communication needs. They used this information to develop positive, meaningful relationships with people. Relatives told us they were welcome at any time and any concerns were taken seriously and responded to.

People told us they felt safe. One person said, “The main thing is that I have someone to help me when I need it. It gives me piece of mind.” Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. The environment was safe and people had access to appropriate mobility and moving and handling equipment as needed. There was enough staff on duty at the right time to enable people to receive care in a timely way.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. One said, “I think we work well together as a team and feel supported.”

People, relatives, staff and professionals gave us positive feedback about the quality of people's care. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with examples of continuous improvements made in response to findings. People, their relatives and staff told us the registered provider was approachable, organised, listened and responded to them and acted on feedback.

More information is in Detailed Findings below

Rating at last inspection: The service was rated Good (report published 10 September 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At our last inspection we rated the service Good. At this inspection the service remained Good.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out this unannounced inspection of Ar- Lyn on 28 July 2016. Ar- Lyn provides residential care for up to 13 older people. On the day of the inspection there were 13 people using the service. The service was last inspected in June 2015. At that inspection we found there were breaches of regulations. This was because the way medicines were being stored and recorded did not ensure people were protected. Hazardous cleaning products were being stored in areas of the service where people had access and were not being protected from potential harm. There was not an effective system to monitor and mitigate risks when auditing medicines and equipment servicing certificate. At this inspection we found improvements had been made in these areas and the service was now meeting the relevant requirements’.

The service does not have a condition to have a registered manager as the registered provider manages the service on a day to day basis. 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.

On the day of the inspection visit there was a calm and relaxed atmosphere in the service. We observed people had a good relationship with staff and supported people in a caring and respectful way. People were being cared for by competent and experienced staff. A family member told us, “This has been a really good place for (person’s name) to live. I don’t know what I would do without them. The staff are wonderful.”

The service had taken action to improve how it stored and recorded medicines. There were now safe arrangements for the management, storage and administration of medicines. It was clear from the medicine records that people received their medicines as prescribed. Where hazardous items had been stored in open and accessible areas they were now kept in safe and secure lockable facilities.

Checks had been made and were in date for the maintenance and servicing of gas, electric and fire systems. All other equipment used by the service to support people were well maintained and regularly serviced as per equipment guidance.

Staff understood the needs of people they supported, so they could respond to them effectively. They told us they felt supported and had the resources they needed to carry out their role. Comments included, “(Providers name) are always around and if we need any more support they are there for us” and “Having worked here for a long time I can say for sure we (staff) get all the support we need. It is run for the benefit of residents”.

Staff supported people to be involved in and make decisions about their daily lives. There were systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was to protect people and uphold people’s rights where they faced restrictions due to lack of mental capacity.

People were able to take part in a range of activities of their choice. On the day of the inspection visit people were enjoying listening to music, reading, knitting and generally speaking with each other. Where people wanted to stay in their rooms this was respected by staff. There were regular entertainers visiting the service as well as garden party events and birthdays were always celebrated.

There were safe recruitment procedures to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. The recruitment process identified applicants had the appropriate skills and knowledge needed to provide care to meet people’s needs.

People were protected from the risk of abuse because staff had received training to help them identify possible signs of abuse and knew what action they should take. Staff told us they supported people in a way that kept people safe.

Staff were supported by a system of induction training and completing care certificate standards to

We carried out this unannounced inspection of Ar-Lyn on 30 June and 6 July 2015. Ar-Lyn is a care home that provides residential care for up to 13 people. On the day of the inspection there were 13 people using the service. The service was last inspected on 8 July 2013. At that time we found no concerns.

The service does not have a condition to have a registered manager as the registered provider manages the service on a day to day basis. 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.

We found people were not always kept safe due to unsafe medicines storage and recording procedures. The registered person did not ensure people were protected against the risks of unsupervised access to medicines, because medicines were not stored securely and appropriately. We found a number of people’s medicines left in areas which people had access to, including an open and accessible office and two bathroom cabinets. People received medicines which had been dispensed twice. Initially by the pharmacist to the service and secondly by the registered person placing medicines into a monitored dosage system for staff to administer. This meant peoples medicines were not administered in accordance with medicine regulation and good practice guidance. Locking systems for keeping medicines safe were not suitable as recommended by the Royal Pharmaceutical Society recommendations for handling medicines in social care.

Some audit systems did not minimise the likelihood of future risk. For example a gas installation servicing certificate was over twelve months out of date. The registered person confirmed they would act on this issue with immediate effect. However it showed not all servicing certification was monitored to ensure the safety of people using the service. In another instance medicines no longer in use had not been returned to the pharmacy when they had been stopped or the person was no longer at the service. This showed not all medicine audits were complete.

The registered person was working towards developing staff training needs to meet the new care certificate. This sets standards for the induction and training for staff working in health and social care roles. Two staff members said they had recently attended health and safety, food hygiene and first aid training. The registered person agreed some training required updating and said they would to take action to address this.

Our findings were that people were being cared for by competent and experienced staff, people had choices in their daily lives and their mobility was supported appropriately. Staff working at the service understood the needs of people they supported, so they could respond to them effectively. We observed care being provided and spoke with people who lived at the service, their families and healthcare professionals who visited the home regularly. All spoke positively about the staff and the registered person and felt they were meeting people’s needs. One person told us, “It’s just like one big family here, everybody gets along well”. A family member told us, “They (staff) are the best. We could not wish for more kindness and care for our (relative).”

People living at the service had the mental capacity to make informed decisions for themselves. The registered person had systems in place to act in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, should a person require an application to be made. However, the procedures associated with this were currently under review in order to update the guidance for staff.

People were protected from the risk of abuse because staff had a good understanding of what might constitute abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

The service had an effective recruitment process in place to ensure new staff were safe to work with people requiring care and support. Pre-employment checks had been completed to help ensure people’s safety. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

People told us they knew how to complain and would be happy to speak with the registered manager if they had any concerns.

There were a variety of methods in use to assess and monitor the quality of the service. These included a satisfaction survey, informal meetings with people living and working at the service and care reviews. Overall satisfaction with the service was seen to be very positive.

The provider and head of care were away on holiday at the time of the inspection. A family member was deputising in their absence.

We spoke with four people who used the service and spent time observing people and staff during the day. Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs.

We saw people’s privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff.

We observed staff had positive interactions with people. People told us staff answered their call bells promptly and we saw this to be the case. One person told us the staff were “polite and friendly”. Another person said,”I am very happy here, no complaints”. People told us the food was good and they were offered choices. One person said they would prefer the main meal to be in the evening as it was a long time between tea and breakfast. We were told visitors were welcome. One person said “I can go to bed when I want, if I wanted to go out someone would take me”.

No one we spoke with said they had any involvement with the review of their care plan.

We heard care staff ask people what they would like to do and they shared ideas if people could not make a choice.

All of the people we spoke with said the management team were very approachable. We were told the head of care had recently received the citizen of the year award for St.Ives.

We spoke with seven people who lived at Ar-Lyn and one visitor to the home to seek their views of the service provided.

People told us that staff were kind and helpful. One person told us that they were very satisfied with the care that they received from the staff and that they felt safe and secure in the home. Another person told us that staff were always available when they needed help and that they provided care in a kind and caring way.

The people we spoke with all said that they enjoyed the food they received. We were told that the food was varied, home cooked and that they were not offered food that they did not like.

We saw that staff interacted with people in a polite and pleasant manner. The home had a warm and welcoming atmosphere during our inspection visit. We saw that the furnishings and décor were domestic in style and provided a homely and comfortable environment.

Staff were able to tell us, in detail, the care required and preferences and choices of the people who used the service.

We saw during our visit that the home was clean and odour free.