Bodmeyrick Residential Home provides accommodation and personal care for up to 28 older people. It is not a nursing home. At the time of our inspection there were 25 people living at the home.

At the last inspection, the service was rated Good. However, they had a breach of regulation 13 due to not having Deprivation of Liberty Safeguards in place for people who were not free to leave unsupervised. This inspection found improvements had been made and the service was now meeting all the regulations.

At this inspection we found the service remained Good.

Why the service is rated good:

The service continued to provide safe care to people. One person commented: “The staff keep me safe.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed.

Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

The service was caring and people had built strong relationships with each other and staff. People engaged in a wide variety of activities and spent time in the local community going to specific places of interest.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and made continuous improvements in response to their findings.

We carried out this inspection to follow up on an outstanding compliance action. We found that improvements had been made and we could be more assured that people were cared for by staff that were supported to deliver care safety and to an appropriate standard.

On the day of our visit we were told there were 28 people living at Bodmeyrick Residential Home. We spoke with three people living at the home and observed several others spending time in the sitting and dining rooms. We spoke with the deputy manager who was the person in charge at the time of our visit and six staff. We looked at records relating to staff training and the care records of one person using the service. We also spoke with a visiting health care professional.

Below is a summary of what we found. The summary describes what we observed, were told and the records we looked at.

Is the service safe?

Safety had been increased because all staff were receiving the training and support they required to work to an appropriate standard. This included protection from abuse and how to move people safely.

Is the service effective?

The service was effective because people received care based on best practice. This was because staff had the knowledge and skills to provide effective care. A health care professional said they had no concerns about the care provided at the home and staff always followed the advice provided.

Is the service caring?

We observed people receiving respectful care and support. People were offered choice and their needs and wishes responded to. For example, one person wanted a specific seat cushion for comfort. People told us, "The girls look after me so much" and "Quite a decent lot. We have a laugh and a joke."

Is the service responsive?

The care records we examined provided detail about the person as an individual and the care they required. This information helped staff respond to them as an individual. Staff were able to describe the specific needs of that person and how they were able to respond to those needs.

Is the service well-led?

The provider had ensured improvement in staff training and systems were in place so this would continue. Staff told us they could take issues about training to senior staff and management and support would be provided. This indicated a positive culture at the home.

This inspection was carried by one inspector in one day. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

Yes, we judged the service was safe.

People told us they felt safe and secure. The people we spoke with were very positive about the staff who worked with them. People told us staff were caring and supportive. For example, one person said “The staff are excellent, they make me feel very cared for.” Similarly visitors and staff we spoke with, were all very positive about care practice in the home.

We saw that the home was well designed and maintained. Decorations and furnishings were well maintained and comfortable. Records showed equipment was regularly serviced.

On the day of the inspection the home was clean and on the whole there were no unpleasant odours. The people who used the service all said they were happy with the standard of cleanliness. People said the laundry service was run to a good standard.

We inspected the staff rotas, which showed that there were sufficient staff on duty to meet people’s needs throughout the day and night. The majority of people said call bells were always answered promptly. People said staff were unrushed and patient with them.

Records were generally to a satisfactory standard. For example everyone had a care plan and there was evidence these were regularly reviewed. We have suggested records of visits from some medical professionals could be improved. Health and safety records were comprehensive and showed appropriate checks are always completed to ensure the building and equipment were safe.

Is the service effective?

Yes, overall we judged the service was effective, although improvement was required regarding training delivery.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People said staff met their needs and responded promptly when they needed assistance.

People had access to doctors, district nurses, chiropodists and opticians.

People were positive about the meals provided. From our observations we found people received appropriate support at meal times.

We recognised staff had recently undertaken a lot of training over the last few months. However we were concerned that there were shortfalls in training delivery for example first aid, dementia awareness and manual handling. We were told people were happy with care standards and from our observations care standards were good. However, we were concerned about the risk (for example regarding risk prevention if there was limited manual handling training, and also what would happen if a person was injured, if there were limited staff trained in first aid techniques). Although we did not see any signs of poor practice, we were concerned if staff had not received formal training regarding dementia this may limit their understanding of the needs of people with this diagnosis.

Is the service caring?

Yes we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected. There was a programme of activities available for people. The home had an activities co-ordinator who worked at the home three days a week.

People who used the service said they were supported by caring and professional staff. We were positive about the care practices we observed. Comments from people who lived at the home included “the staff are very polite and respectful” and “the care is very good, staff are helpful and will always take enough time.” A relative told us “I am very happy with the care here. My mother is very happy,” and “I have no concerns…the staff will always communicate with me if they have any concerns.”

At the inspection we used our ‘Short Observational tool For Inspection’ (SOFI) tool to observe care during lunchtime. From the exercise we judged the care given during the observation period to be to a good standard: for example staff were attentive to people’s needs, they provided appropriate support and they were professional in their conduct.

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example a person who lived in the home told us “I have no bad reports, the staff are very good.”

The home had good links with local health services. For example a general practitioner told us staff would appropriately contact the surgery and district nurses when it was necessary.

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service and their relatives were all positive about the management of the home. People told us the staff and management were approachable, and would resolve any problems if they voiced any concerns. One person told us “the manager is open and friendly… she is efficient and things run smoothly. If there are problems she nips them in the bud.”

The home had a satisfactory quality assurance system to monitor the quality of the service and ensure suitable improvements took place where this was necessary.

We carried out a comprehensive inspection on 28 and 30 September 2015.

We last inspected the home in October 2014 to follow up on a breach of regulation found at an inspection carried out in June 2014. We found at the October inspection that staff support had increased and so the breach had been met.

Bodmeyrick Residential Home provides accommodation and personal care for up to 28 older people. It is not a nursing home. There were 25 people using the service at the time of the inspection; two of them were in hospital.

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.

Staff had not acted to gain authorisation to deprive people of their liberty. This is where a person was subject to continuous supervision and control, such as monitoring people’s movements. This was because the provider was not aware of a Supreme Court judgement which had widened and clarified the definition of deprivation of liberty. However, staff were knowledgeable and effective when people did not have capacity to make decisions and so those decisions had to be made for them in their best interest.

People were protected through the arrangements for staff recruitment, training and supervision. Staff said their training equipped them for their work. Staffing numbers ensured people’s physical, emotional and social needs could be met. People said it was “not long” between using their call bell to ask for staff support and the staff member arriving to help.

Staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare.

Medicines were handled safely for people. Medicines management was very well organised.

People received a nutritious diet and their likes and dislikes were well catered for. Where concerns about diet were identified these were followed up quickly, such as protecting people from choking and ensuring they had plenty to drink.

People were treated with respect, dignity and their privacy was upheld. A visiting health care professional told us, “Staff are really nice here and treatment is always in private.” Staff were very attentive and quick to check people were alright, and respond when needed. One person told us, “We are well looked after.”

People’s needs were assessed and their care planned with their involvement when possible. Regular meetings with community nurses ensured care and treatment options were properly considered. A district nurse said, “(The staff) do anything we ask. I can’t fault them”.

A strong management ensured the quality of the service was under regular review. This included looking at people’s experience of being at the home and all aspects of safety. The service ethos was to provide people with a “home from home”; this expectation was led from the top and clear for staff to follow.

There was one breach of regulation. You can see what action we told the provider to take at the back of the report.