Boulters Lock Residential Home is a care home without nursing situated in a residential part of Maidenhead, Berkshire. It is part of a group of services collectively called Hartfordcare. The service has three principles: care, comfort and companionship. The location is registered to accommodate 32 people. People who used the service are older adults, some with dementia. At the time of our inspection, 30 people lived at Boulters Lock Residential Home.

At the last inspection, the service was rated good.

At this inspection we found the service remained good.

Why the service is rated good:

People were protected from abuse and neglect. The service had satisfactory assessment, mitigation and documentation of any risks to people. This helped prevent harm. There was safe staff deployment. People’s medicines were safely managed. The service had improved recruitment checks of new workers before they commenced their roles. We made a recommendation about staff personnel files.

Staff received appropriate support to perform their roles. The service was compliant with the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

We found the staff were compassionate and dedicated to care. We saw staff engaged with the people who used the service. People’s right to privacy was respected and their dignity was respected.

We found care plans were person-centred and contained appropriate details. The service helped people to have an active life in the community. We made a recommendation about complaints management at the service.

The service had a positive workplace culture. There was good oversight of the service’s care from the registered manager and the provider. The provider ensured that the quality of the care was regularly assessed. Where people’s care could be improved, the provider made appropriate changes to facilitate this. The service was receptive of feedback and recommendations we provided at our inspection. We made a recommendation about the duty of candour requirement.

Further information is in the detailed findings below.

This inspection took place on 1 April 2015 and was unannounced.

Boulters Lock Residential Home is a care home providing accommodation and personal care for up to 32 older people some of whom may be living with dementia. At the time of the inspection there were 31 people living at the service.

There was no registered manager in post when we carried out the inspection. However, a manager had been appointed and was managing the day to day running of the service. They were in the process of applying to become a registered manager with the Care Quality Commission (CQC). 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 provider’s recruitment and selection procedures were not followed robustly. Information relating to staff employed at the service and required under the regulations was not always available. Staff said they felt well supported by the manager and told us they were listened to if they raised concerns. However we found that staff had not always had regular opportunities to meet with their line manager to discuss their work and plan their personal development. The manager had noted this and had begun to take steps to address this by planning regular meetings and appraisals. Staff made positive comments about communication and team working.

People, their relatives and visitors told us they were happy with the care provided at the service. Care was focussed on individuals and designed to meet the specific needs and preferences of people living at Boulters Lock Residential Home. There were systems in place to manage risks to people and staff were aware of how to keep people safe by reporting concerns promptly through procedures they understood well.

People and their relatives told us staff treated them with kindness and compassion. Visitors were welcomed to the service and made to feel at home. People told us they were respected and they were consulted about their care. People’s needs were reviewed regularly and up to date information was communicated to staff to ensure appropriate care was provided. The quality of the service was monitored regularly by the manager and the provider. Feedback was encouraged from people, relatives and visitors.

People who could not make specific decisions for themselves had their legal rights protected. Best interests meetings involving relatives and healthcare professionals had been held for people when appropriate and decisions were made in accordance with legislation. The requirements of the Deprivation of Liberty Safeguards (DoLS) were being met. The DoLS provide legal protection for vulnerable people who are, or may become, deprived of their liberty. At the time of the inspection, three applications had been approved under DoLS for people’s freedoms and liberties to be restricted. The manager had made further applications in view of the recent changes to DoLS.

Staff were trained appropriately to meet people’s needs. New staff received induction, training and support from experienced members of staff until they felt confident to work independently and the manager was satisfied with the standard of their work. Training was refreshed and updated regularly.

There were activities available for people on an individual or group basis. People could choose to join in or opt out and their decision was respected. Links with the community were maintained through contact with local scout groups, day centres, garden centres and luncheon clubs. Outings were organised as well as exchange visits with another residential home.

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

At an inspection on 23 September 2013 we found the provider had not completed all relevant recruitment checks before staff began work. This meant there was a risk that people could be cared for by staff who were not suitable for the role.

At our inspection on 31 December 2013 we found the provider had completed all required recruitment checks for staff employed by the service. We did not speak with people who use the service at this inspection, but we did discuss recruitment procedures with the manager.

Since our last inspection the provider had completed an audit of all the recruitment files of staff employed by the service. Gaps identified in employee's work histories had been investigated, and explanations recorded. All recruitment checks required by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were completed appropriately. This meant people were cared for by staff who were suitable to support them.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. At the time of our inspection the registered manager was in the process of de-registering as manager for this service.The manager we spoke with was completing required documentation prior to registering as manager for the service.

We observed staff talking with people who use the service to ensure they were supported as they wished. Care plans reflected people’s preferences for care and support. One relative of a person who uses the service said “Staff are approachable. They listen to and support people. I’m very happy with the care provided.”

We found documentation regarding people’s care and welfare was updated regularly. This ensured staff were aware of changes to people’s support needs. A relative told us “Staff try their hardest to get things right. There’s good communication. They’ve picked up on changes to X’s needs very quickly.”

The provider conducted regular maintenance checks to ensure the home remained safe. All the people who use the service and relatives we spoke with told us they liked the homely atmosphere.

Recruitment checks were undertaken. We found some of the information required in accordance with the requirements of schedule 3 of the Health and Social Care Act 2008 was not available. We did not see documented evidence of identification or investigation of gaps in employment history. The provider had ensured Criminal Record Bureau (now known as the Disclosure and Barring Service) checks had been satisfactorily completed.

We saw information was stored confidentially. Documents were recorded and updated appropriately to ensure information reflected the current needs of people who use the service.

During the visit, we spoke with two people who use the service. They told us the staff were clear at explaining what they were doing and treated them with respect.

The people we spoke with told us they were happy with the care they received. They told us they liked the service provided and were kept involved by the staff.

The people we spoke with told us that they had no concerns about the care they received. They also told us they were happy with the staff and that there were enough staff around to help them.