Caton House is a ‘care home’. 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.

Caton House is located in a residential area of Milton Keynes and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for older people who may also be living with dementia and can accommodate up to 64 people at the service. When we visited there were 57 people living at the service.

At the last inspection in May 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection

There was a registered manager in post. 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 a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Risk assessments were in place to manage potential risks within people’s lives, whilst also promoting their independence.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Adequate staffing levels were in place. Staffing support matched the level of assessed needs within the service during our inspection.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Specialist training was provided to make sure that people’s needs were met and they were supported effectively.

Staff were well supported by the registered manager and senior team, and had regular one to one supervisions. The staff we spoke with were all positive about the senior staff and management in place, and were happy with the support they received.

People's consent was gained before any care was provided. 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

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. People and their family were involved in reviewing their care and making any necessary changes.

A process was in place which ensured people could raise any complaints or concerns. Concerns were acted upon promptly and lessons were learned through positive communication.

The provider had systems in place to monitor the quality of the service. Actions were taken and improvements were made when required.

:This inspection took place 19 April 2016 and was unannounced.

The inspection was carried out by two inspectors and an expert by experience.

Caton House Residential and Nursing Home provides nursing and personal care for up to 64 older people. Most people who use the service are living with dementia. Caton House Residential and Nursing Home is owned and managed by Sanctuary Care Limited.

There was a registered manager in post.

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 felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

Effective recruitment processes were in place and followed by the service.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received a comprehensive induction process and on-going training. They were well supported by the manager, deputy managers and the provider and had regular one to one time for supervisions.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professional when required, including opticians and doctors.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well.

People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

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We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

This is a summary of what we found:-

Is the service safe?

People were being cared for in an environment which was clean and hygienic. People’s needs had been assessed on admission to the home and risk assessments were in place.

Is the service effective?

On our arrival, we found the manager to be away on holiday, the deputy manager was in charge and lead with the inspection.There were nine care staff, one senior care and two nurses to provide care for the 61 people living in the home. They were supported by a number of staff providing catering, domestic, administrative and maintenance support.

It was clear from our observations that staff had a good understanding of the needs of the people who used the service. We found that care plans were written in a ‘person centred’ style which reflected people’s individual personal needs and preferences. Activities were offered on a daily basis and there was a ‘friends’ association which offered additional activities and raised funds.

Is the service caring?

One person who used the service told us “They look after me very well”. We observed positive interactions between staff and people who used the service. Staff showed patience and understanding and encouraged people to be as independent as possible.

Is the service responsive?

We spoke with relatives of people who used the service. All were happy with the care their relatives received, one relative told us “I had a recent small issue which I raised, but it was resolved quickly, my relative gets all the care required”.

Recently returned relatives surveys showed people were able to speak to staff who were providing care to their relatives.

Is the service well-lead?

Quality assurance processes were in place to ensure that people received a good quality service. Records showed that staff had attended training and were supported with regular supervisions by the manager.

Many of the people who used the service at Caton House Nursing Home were unable to speak with us because their dementia had impaired their ability to communicate. We spoke with visiting relatives and one person told us “I can give nothing but praise for the staff, they are wonderful”. Another person told us that the day care service was excellent and that their relative had used this before becoming a resident at Caton House.

We saw staff interact positively, respectfully and with genuine warmth towards people. We saw that people were enjoying the entertainment that was provided. We observed staff providing care to people and we spoke with staff that were very knowledgeable about peoples needs. We saw that medicines were stored and administered safely. We noted that when complaints had been raised these had been responded to and investigated promptly.

We found that the atmosphere on the first floor was not as relaxed as it could be as the noise of bleeps, and loud telephone bells was quite overpowering. Relatives also mentioned that it was a noisy atmosphere sometimes. We were told that the provider had plans to change the call system to something quieter which will be beneficial to people who use the service.

On the day of our visit to Caton House there were 61 people in residence. We spoke with three people who used the service and three visiting relatives. Many of the people who used the service were unable to speak with us because their dementia had impaired their ability to communicate.

The people we spoke with told us the staff were polite and respectful. We also spoke with some relatives who told us the staff were friendly helpful and polite. During our visit we saw that staff treated people with respect, calling people by their preferred name. We saw people were offered choice, such as what meals they would like and whether they would like to attend group activities.

The three visitors we spoke with all said the staff made them feel welcome and where friendly and polite.

During the visit we spoke to four people who use the service. People said they liked the home and were happy there; additional comments included 'the home had a nice atmosphere and the home was peaceful'.

People said staff were friendly and caring and would generally respond quickly to requests. Some people said they would approach a carer for advice on who to approach should they have a concern; others said they would talk to staff directly about concerns.

People said that care was good at the home and they had generally been involved in agreeing their care. One person said on his arrival to the home staff explained how the home worked and gave him information about the home.

Some people said they fed back views at the home’s monthly residents meetings; whilst others said they chose not to attend these meetings. People said that issues raised at residents meetings would be ‘taken on board’ by the home.

Two people identified a shortage of staff at the home. One person said there was not sufficient staff for the dependency of the people using the service. People said that this has led to some carers taking a long time to respond to call bells and morning coffee not being brought around until mid-day.

People said they could access a range of activities if they chose to which included going out for walks and shopping with family members.

People said the quality of food varies; although you do have a choice.