Bare Hall is situated in a residential area of the town and close to all local amenities. The home is a detached, grade 2 listed building that is registered to accommodate up to a maximum of 32 people. The majority of bedrooms are for single occupancy although there are a number of twin bedrooms for those who have made a positive choice to share. Some bedrooms are provided with en-suite facilities. There is sufficient communal space with two adjoining lounges, a conservatory and a dining room.

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

People who lived at the home told us they were happy with their care and liked the staff who looked after them. We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards people in their care.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems. A visiting healthcare professional told us they had no concerns about the care provided at the home.

We saw people who lived at the home were clean and well dressed. They looked relaxed and comfortable in the care of staff supporting them.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We saw staff assisting people with mobility problems. They were kind and patient and assisted people safely.

The service had sufficient staffing levels in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs.

We found staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs. During the inspection we observed ten staff members attending health and safety training.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The service had information details about advocacy services on display in the reception area for people and their families if this was required. This ensured people’s interests would be represented by professionals outside of the service to act on their behalf if needed.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with

This inspection was undertaken by a Pharmacist Inspector. During the inspection the Pharmacist Inspector gathered evidence to help answer one of our five key questions; Is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records.

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

Is the service safe?

On 07 January 2015 a Pharmacist Inspector for the Care Quality Commission,visited Bare Hall Residential Care Home. The visit was carried out to check if improvements had been made following the previous review of compliance which was completed in August 2014.

The pharmacist inspector looked at the medicine charts of all 24 people living in the home and found that the administration of medicines was not always recorded accurately. There were two ‘gaps’ in the records. One person was prescribed a variable dose of medicine (take one or two tablets) and staff did not record the actual dose administered. The instructions for another person’s medicine were not being followed as staff often gave less than the prescribed dose while recording that the full dose had been administered.

The home’s medicine policy had recently been updated. However, regular medicine audits were not carried out to check that policy was being followed. For example, the policy stated that the reason for medicines being prescribed ‘when required’ should be recorded. There were no written guidelines (protocols) to help staff decide when to administer medicines prescribed ‘when required’ and in most cases the reason for administration was not recorded. This meant medicines might not be used in the way the doctor intended.

Is the service safe?

People told us they felt safe and their rights and dignity were respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. One person we spoke with said, “The place is always spotless and smells fresh. I am very happy with the standard of cleanliness in place”. Equipment had been maintained and serviced regularly ensuring people were not put at unnecessary risk.

People did not always receive their medicines at the times they needed them and in a safe way. Medicines were not always administered and recorded properly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to administration of medicines.

Is the service effective?

People’s health and care needs had been assessed with them, and they were involved in writing their plans of care where possible. Specialist dietary needs had been identified where required. People said their care plans were up to date and reflected their current needs. The premises had been sensitively adapted to meet the needs of people with physical impairments. People visiting the home confirmed that they were able to see their relative in private and that visiting times were flexible.

Care plans had risk assessments completed to identify the potential risk of accidents and harm. Staff members we spoke with confirmed guidance was provided to ensure they provided safe and appropriate care. We found care plans were flexible, regularly reviewed for their effectiveness and changed in recognition of the changing needs of the person.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were very happy with the care being provided. One person said, “I am very happy and settled. The staff are very attentive and the food is excellent. We have good activities organised. I really enjoy the quizzes. I like to keep my mind occupied.” Another person said, “The staff look after me really well. I love it here.” Care plans had been maintained recording the care and support people were receiving. Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

People spoken with said they were happy with their care and had no complaints. Records showed admissions to the home were well planned. Information about people’s care and dietary needs had been recorded. We also saw potential risks to people’s health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care.

We saw people received regular health checks with their General Practitioner and the outcome of these visits were recorded on their care records. We found a range of activities were organised to keep people entertained. People told us they enjoyed participating in these and they had fun with staff.

Is the service well-led?

The service had quality assurance systems in place. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

The inspection was carried out by a pharmacist inspector. We set out to answer the key question; Is the service safe? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff and looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with the management of medicines. We found some shortfalls in records about medicines and there was insufficient information to ensure that medicines were always given safely or to best effect. Some medicines were not stored securely, allowing the possibility of mishandling or misuse.

However all the medicines people needed were available in the home and unwanted medicines were disposed of promptly and safely. We saw that staff administered medicines in a friendly and respectful way.

You can see our judgements on the front page of this report.

On 25th February 2014 CQC accompanied Environmental Health staff in an advisory capacity, during an investigation following an accident at the home. Following the investigation, the provider was advised that there was a failure to implement an effective system for assessing a resident’s care needs and communicating this to care staff.This inspection on 20th March 2014 was to check whether the provider was protecting residents by proper assessment and care planning.

We found some documentation lacked sufficient detail. Care planning was incomplete, meaning staff had no clear instructions about what personal care they should be providing. We found some risk assessments in place which were not being followed and which contained information which did not match that in other records.

We observed care in the home and talked with five residents and one person visiting the home. We found that all the residents were happy with their care, and had no complaints. They told us the staff were “lovely” and “very caring”. One said “This is a really relaxed and comfortable place to live”. The visitor said “M. looks really well. I have no concerns about anything”. We saw that staff were kind and patient when working with people.

People told us what it was like to live at Bare Hall Residential Care Home and described how they were treated by staff and their involvement in making choices and decisions about their care. People also told us about the quality and choice of food and drink available and how they made their views known about the quality of care delivered.

During the course of the visit we spoke individually with three people living at the home. We also spoke with the registered manager, the cook on duty, three members of the care staff team, the administration assistant and the home’s independent advisor.

People told us they were happy living there and that staff were always kind, polite and respectful. Staff spoke in a friendly way and there was a relaxed and comfortable atmosphere. One person told us, “No complaints at all about the staff they work hard, they make life a bit easier for me”. Another person said, “I get on very well with all the staff and can talk with them. It’s better than I expected, we are very, very well looked after. Nothing is too much trouble”.

We were also told that the meals served were well cooked with plenty of variety. People told us that they always enjoyed their meals. One person said, “The food is absolutely excellent, well cooked and very good variety. There are two chefs, they are both very good.

People spoken with told us that they felt their privacy, dignity and independence were respected and that staff were very kind and caring. One person said, “Yes we are very well looked after here, they are all very good. I have found nothing wrong at all. I have been given all the help I need.” People also told us that they were able to make decisions about what they wanted to do and that staff listened and acted on what they said.

It was observed that there was a positive relationship and interaction between the staff team, the people they supported and the relatives that visited. One relative told us, “Staff are always informative, helpful and very obliging.”

People spoken with gave positive feedback about the service and the qualities of the staff team. People felt confident that staff understood their individual needs and requirements and were able to meet them very well.

One person told us, “The staff are very good, they do all they can to help. I am quite happy here.” A relative commented, “It is just like a family here and we are part of it.” The same person spoke very positively of the staff team and the service provided.

A member of staff said, “We take a lot of notice of our residents and help them to feel as comfortable and happy as they can. Its like a nice family here, everybody gets on and the staff group work well together.”

When asked, people living at the home said they felt safe living there. We observed that people appeared comfortable in their surroundings and engaged well with staff. People spoken with also said that knew who they would speak with if they did have any concerns. However people were also very clear in telling us that they had no concerns whatsoever about the home or the staff team that supported them.

Service users and relatives give us general feedback about staff and the registered manager being very approachable, with one relative telling us that any minor issues were quickly resolved.

This inspection visit took place on 21and 28 May 2015 and was unannounced.

When we last inspected the service we found breaches of legal requirements relating to the management of medicines. This was because we found that appropriate arrangements were not in place to administer medicines safely or to record the administration of medicines. During this inspection visit we found arrangements for storing, administering and recording medicines met legal requirements.

Bare Hall is situated in a residential area of the town and close to local amenities. The home is a detached, grade 2 listed building that is registered to accommodate up to a maximum of 32 people. At the time of our inspection visit there were 25 people who lived there. The majority of bedrooms were for single occupancy although there are a number of twin bedrooms for those who have made a positive choice to share. Some bedrooms were provided with en-suite facilities. There was sufficient communal space with two adjoining lounges, a conservatory and a dining room.

There was a registered manager in place. 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 were well cared for by kind and attentive staff. They told us there were sufficient numbers of staff to meet their needs and staff were responsive when they needed them. Observations made during our inspection visit confirmed sufficient staff were on duty to enable people to move around the building safely. We saw staff were available to support people when needed and call bells were answered quickly. One person we spoke with said, “I feel safe in the home. The staff come quickly if I ring my call bell.”

Care plans we looked at confirmed the registered manager had completed an assessment of people’s support needs before they moved into the home. We saw people or a family member had been involved in the assessment and had consented to the support being provided. People we spoke with said they were happy with their care and they liked living at the home.

We saw the service had safeguarding policies and procedures in place to protect the people in their care. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with said they were receiving safe and appropriate care which was meeting their needs.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members could commence their employment. Staff spoken with and records seen confirmed a structured induction training and development programme was in place.

Staff had received training and were knowledgeable about their roles and responsibilities. However, the training for some staff including moving and handling was dated. Training must be provided to ensure staff involved in the moving and handling of people are safe and not placing people at risk from poor handling. We have made a recommendation about this.

The environment was well maintained, clean and hygienic when we visited. No offensive odours were observed by any members of the inspection team. The people we spoke with said they were happy with the standard of hygiene in place. Equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. The cook had information about people’s dietary needs and these were being met.

Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. People told us they received their medicines at the times they needed them.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Discussion with the registered manager confirmed she understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included annual satisfaction surveys, house meetings, care reviews and audits. We found people were satisfied with the service they received.