About the service: Bonaer Care Home is registered to provide nursing care and was supporting 27 people on the day of our inspection.

People’s experience of using this service:

People were relaxed and comfortable at Bonaer Care Home and relatives were complimentary of the care provided. Staff were attentive and provided support at a relaxed pace.

People told us they felt safe in the service and staff had a detailed understanding of their role in protecting people from all forms of abuse or discrimination. Risks in relation to choking and pressure area care were managed appropriately.

Staff were recruited safely and there were enough staff available to meet people’s needs. Both care and domestic staff responded immediately to people’s requests for support and care was provided compassionately at a relaxed pace. Induction training for new staff was provided in line with national recommendations and updated regularly.

Care plans were informative and included information about people’s backgrounds to help staff understand their individual needs. The service employed an activities coordinator and an Occupational therapist and there was a varied programme of group and individualised activities available for people to participate in if they wished.

The service was well-led. The well-established staff team were highly motivated and told us the registered manager was supportive and compassionate. Action had been taken to address and resolve issues identified during our previous inspection and there were appropriate quality assurance systems in place.

At our previous inspection the service was rated Requires Improvement. (Report published 20 March 2018)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Bonaer Care Home provides nursing care for up to 31 older people with a range of health care needs and physical disabilities. At the time of our inspection 29 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.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

We carried out this unannounced inspection on 30 November 2017. At this routine comprehensive inspection we checked to see if the provider was complying with the regulations.

During the inspection we found that risks in relation to choking and pressure area care were not always managed appropriately. One person who was at risk of choking and had been prescribed liquid thickeners did not receive these on the day of our inspection. Another person who was at risk of pressure sores was in bed on a pressure relieving mattress that had not been turned on. In addition, we found that eight pressure reliving mattresses were set to the incorrect weights. This meant the service was in breach of the requirements of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

These issues were raised with the registered manager during feedback at the end of our inspection. The manager took prompt action to address these issues in the week following our inspection. Evidence was subsequently provided that demonstrated additional training in relation to the use of liquid thickeners had been provided, a choking policy developed and procedures introduced to ensure all pressure reliving equipment was operated correctly.

The atmosphere in the service on the day of the inspection was friendly and calm. Staff responded promptly when people asked for help and support was provided at a relaxed pace. Throughout our inspection we saw that staff provided support with compassion and kindness. People told us they felt safe and comfortable living at Bonaer. There comments included, “I feel safe”, “Everything about this home is wonderful" and "You couldn't think of a better place." Staff understood local safeguarding procedures knew how to recognise and report the signs of abuse.

Staff supported people to maintain relationships with friends and family. During our inspection a relative was invited to attend the service Christmas lunch and a table was set in the service conservatory to accommodate people to dine with visiting relatives in privacy. Relatives told us, "It’s lovely being able to have a meal with mum" and "There are no visiting restrictions, I even stay and have a meal with my relative and "The staff make us feel so welcome."

The environment was clean. There were appropriate cleaning schedules in place and two domestic staff on duty each day. Personal protective equipment was used appropriately to manage infection control risks. Where people were supported using hoists they had been allocated individual slings to further reduce the risk of cross infection risks.

People’s medicines were managed safely. Medicines administration records had been fully completed and there were appropriate procedures in place for the ordering, storage and disposal of medicines.

Staff were sufficiently skilled to meet peoples’ needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

There were enough

During our inspection we spoke with the registered manager, five people who lived at Bonaer Care Home, four members of staff, and two people who were visiting the home on the day of our inspection. People who lived at the home told us they were “very well looked after” and one person said “I am happy here”

The registered provider had ensured contract and terms and conditions were agreed and copies sent to the person and/or their representative so they were aware of the amount they were paying for the service.

We saw the care plans informed and directed staff. People we spoke with were very complimentary of the staff and the care they received.

The registered manager had ensured the people who had been recruited were of good character by completing the necessary pre employment checks.

Staff stated they felt supported. We saw evidence that training was provided regularly in house and by external companies and/or professionals.

People who lived at Bonaer were very complimentary of the staff, providers and meals. We spoke with eight people that lived in the home and three visitors. Comments included “couldn’t be looked after better”, “It’s the best care home I have been in”, “The care mum has received has been fantastic”.

We saw records of visits from members of the multi professional team and were told the home had good relationships with general practitioners (GP's). On the day of inspection we saw that a “best interest” meeting had taken place in order to ensure that care and treatment of an individual was being provided in their best interests.

We inspected the home’s storage and recording of controlled drugs. We audited the controlled drugs and found that the controlled drugs register and the amount of medication in the home balanced.

We were concerned that in the recruitment files, there was not sufficient evidence of references from previous employers. In two cases the references were inadequate and the management team had not sought to risk assess the person prior to commencing employment.

Supervision is a vital tool used between an employer and an employee to capture working practices. It is an opportunity to discuss ongoing training and development. Staff had not received supervisions.

Bonear is a care home which provides accommodation for up to 31 people who require nursing or personal care. At the time of the inspection 31 people were using the service. Most people who lived at Bonear required general nursing care due to illness. Some people also had dementia, physical or sensory disabilities.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 inspected Bonear Care Home on 21 and 22 September 2015. The inspection was unannounced. The service was last inspected in May 2013 and was found to be meeting the requirements of the regulations.

People told us they felt safe at the service and with the staff who supported them. People told us, “It is a home from home…It’s handsome, absolutely beautiful, I could not be happier wherever I was,” “Staff fit in with the people” and “Couldn’t be better; very good.” A relative told us; “We consider ourselves lucky (person’s name) is here...” and “I have never seen anything which has caused us disturbance or alarm.”

Staff had been suitably trained to recognise potential signs of abuse and subsequently take suitable action. Staff received other suitable training to carry out their roles. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

The medicines system was well organised, and people said they received their medicines on time. People had access to a general practitioner, and other medical professionals such as a dentist, chiropodist and an optician. However records of some medical support were not always consistently kept. This made it difficult to check whether people wanted or needed to see practitioners such as a dentist or an optician.

There were satisfactory numbers of staff on duty. The majority of people and all of the staff who worked at the home, said there were enough staff provided. Some people and some visitors said staffing could be “stretched” at times. This appeared to be due to staff needing to attend to specific individuals who had higher care needs, or if there were staff holidays. We have made a recommendation about staffing levels.

People who used the service told us staff were caring, worked in a respectful manner and did not rush them. For example people said “I can’t fault them,” (the staff), and “They are brilliant, they answer to every need.” People said they could spend their time how they wanted, were provided with a range of choices, and were able to spend time in private if they wished. Activities were available for people each day. Some people said activities could be improved if more external trips were offered.

Staff were suitably trained and supported to provide end of life care. For example there were well established links with specialist community services such as MacMillan cancer care. The service had signed up and achieved the Gold Standard Framework. This aims to provide optimal care for people approaching the end of life.

Care files contained suitable information such as a care plan, and these were regularly reviewed. Suitable systems were in place for ensuring people’s capacity to consent to care and treatment was assessed in line with legislation and guidance for example the Mental Capacity Act (2005).

People said they enjoyed the food. For example: “It’s lovely food…….I can’t fault it. If you don’t fancy it they ask you (what else you want) and they will do it,” People had a choice of eating their meals in the lounge or their bedrooms. People said a choice of meals was offered. People said they were regularly offered, a hot or cold drink throughout the day..

Nobody who we met raised any concerns about their care. Everyone we spoke with said if they did have concerns, they would feel confident discussing these with staff or with management. People said they were sure that staff and management would resolve any concerns or complaints appropriately.

People felt the home was well managed. For example we were told by a relative: “It is very well run”. The owners are heavily involved in the day to day running of the home. There were satisfactory systems in place to monitor the quality of the service.