This inspection took place on 9 May 2018. The inspection was unannounced.

Collyhurst is a care home registered to provide personal care and accommodation for a maximum of 34 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in a residential part of Bedworth and the accommodation is set out over three floors. There were 31 people living at the home at the time of our visit, some of who were living with dementia.

We last inspected Collyhurst in April 2016 when we rated the service as 'Good' overall. However, at that inspection we found some improvements were required in the leadership of the service so the key question of 'well-led' was rated 'Requires Improvement'. At this inspection we found improvements had not been made and systems required better organisation and monitoring to ensure issues impacting on the safety, effectiveness and quality of care were quickly identified and action taken.

The service had a registered manager. This is a requirement of the provider's registration. 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 registered manager knew the service well because they supported people and worked alongside staff on a daily basis. People and staff spoke very positively about the registered manager who they described as approachable and responsive. They felt able to share any concerns with the registered manager, who they were confident would take appropriate action. However, this 'hands on' approach meant the registered manager did not always have time for the managerial and administrative aspects of their role. Quality audits and checks were not consistently effective.

There were enough staff to meet people's individual needs and keep them safe. The registered manager assessed risks to people's health and welfare and wrote care plans that minimised those risks. However, some risks to people’s health had not been identified.

People felt safe at Collyhurst and staff understood their responsibility to report any concerns they had about people’s health or wellbeing. Staff received support from their managers, but some training needed to be updated.

The home was adapted, decorated and furnished to meet people's needs. The cleanliness of the home was satisfactory, although one area had not been maintained to the same standards.

People were cared for by kind and compassionate staff, who knew people's individual preferences and how they wanted their care provided. Staff understood people's individual needs and abilities and they received updated information at shift handovers to ensure the care they provided was responsive to people's needs. Staff provided people with opportunities for social engagement and there were plans to improve the provision of activities in the home.

Staff worked within the principles of the Mental Capacity Act 20015. They offered people choice and sought their consent before providing care and support. However, there were no written records of people's capacity to make specific decisions or what assistance they might need to make their own decisions.

People were supported to eat and drink according to their needs, which minimised risks of them not eating or drinking enough. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health, and when their health needs changed. People received their medicines as prescribed, but improvements needed to be made to ensure medicines were stored appropriately to maintain their effectiveness.

We carried out an unannounced inspection at Collyhurst Care Home on 17 February 2016.

Collyhurst Care Home provides accommodation for up to 34 people who require personal care. The home has three floors with 29 bedrooms and a bungalow in the grounds with five further bedrooms. There is access to a well maintained garden area. At the time of our inspection there were 28 people living at the home, one person had been admitted to an acute hospital and five rooms were vacant.

Collyhurst Care Home had 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.

Everyone we spoke with told us they felt safe living at Collyhurst. Staff we spoke with were able to confidently describe a good understanding of the types of abuse that may occur and knew how to report this should they need to. We looked at the care records of five people who lived at the home. There were personalised assessments for identified risks for each person. However, the care records were difficult to navigate as they were bulky and contained a lot of information which could have been archived, as no longer up to date or relevant.

There were processes to manage risk in connection with the operation of the home, but the records were not consistently completed, to demonstrate action was taken. For example, the cleaning schedules for the home were not completed consistently.

There were enough qualified, skilled and experienced staff to meet peoples’ needs. Recruitment and selection processes ensured staff were suitable to work with people who lived at the home.

Medicine records showed that people received their medicines as prescribed, however there was no policy to guide staff on the administration of medicines which were given ‘as required’.

Staff did not centrally report incidents or accidents so this meant records could not be audited to analyse the data to identify any trends or patterns. Incidents and accidents were recorded in the individual care records only. There was clutter and items which did not belong in corridors which presented a tripping hazard and the chairs in the lounge were worn, stained and had malodour.

Not all of the staff had received training on the Mental Capacity Act 2005 (MCA), however they were aware of the Deprivation of Liberty Safeguards (DoLS) and demonstrated an understanding of the requirements of the MCA.

There was plenty of choice of food and people could have drinks and snacks whenever they wanted them. People were offered drinks and snacks throughout the day. However, feedback was not recorded from people about the quality and quantity of food offered.

The staff were very caring and ensured people’s privacy and dignity was protected. They knew the people they were caring for well. This included knowledge of people’s likes and dislikes, how they could communicate, their backgrounds and the relationships that were important to them.

Activities for people were limited to the availability of the activity co-ordinator, however peoples’ needs were assessed and care and support was planned and delivered in line with their individual care plans. People told us they were supported to access healthcare services.

All of the staff we spoke with said that staff morale was very good and that the registered manager was approachable and responsive to suggestions made to improve the quality of service. Some systems and processes were not established or operated effectively to ensure that audits assessed, monitored and improved the quality and safety of the services.

A single inspector carried out this inspection. 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, staff and carers told us.

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

Is the service safe?

People were provided with a choice of suitable and nutritious food and drink. We saw menu plans that gave people a choice of nutritious food. Checks were made on people’s weight to ensure they were not at risk from malnutrition.

People were being cared for in an environment that was safe, clean and hygienic. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. One of the people we spoke with said, “It’s my home, I feel safe.”

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe. Training included health and safety and manual handing training. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service. We saw they followed the infection control procedures and wore gloves and aprons when appropriate.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and first aid training.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their identified needs were being met. People told us that staff were, “always” checking if they needed anything. We observed staff’s interaction with people and saw that they were attentive to their needs.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, “I have no complaints, the staff are nice.” We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw people had access to activities that were important to them. We saw the care plans were regularly updated and people were given the opportunity to change their mind about what they wanted to do.

Is the service well-led?

The registered manager was clear about the aims and objectives of the service and checked what people thought about the service. We saw that the service had responded to feedback from people and staff.

Our inspection visit was unannounced so that nobody who lived or worked at Collyhurst knew we were coming.

We spoke with five people who all told us they were happy with their care and spoke highly of the staff. People told us that they did not have to wait when they needed assistance from staff. One person said, “You only have to ask once for help and it is there.”

We spent time watching how care and support was provided and how staff communicated with people. We observed natural and relaxed conversations and interactions between staff and people. One person told us, “Staff are lovely. They look after us very well.”

Every person had a plan of care, based on their physical health and other care needs. People's plans described what people needed help with, what they could do for themselves and how they should be supported.

Our review of the staff rotas at different times over the previous month showed that minimum staffing levels identified and planned for had been met.

Care staff were positive about working in the home. We spoke with three care workers who told us there were regular training sessions to enable staff to develop their skills and knowledge.

During a tour of the home, we noted that all areas of the home were clean and tidy and the environment was pleasant for both staff and people using the service.

We found that important records about the care and support provided to people were complete and up to date.

During our visit we spoke with six people who use the service, one visiting relative, the manager and four staff members.

Our observations showed that staff interacted well with the people in the home. They spoke to people in a respectful manner using their preferred names and responded promptly to people's requests.

People told us they were happy with the care provided and enjoyed living at Collyhurst. Comments included; “It’s a lovely home, you’re well looked after,” "You couldn't wish for a better home," and “All the staff are lovely, we are all treated equally.”

Staff and people living at the home told us that they felt there were enough staff on duty. One person living at the home told us that they never had to wait long for staff to arrive if they had rung their call bell for assistance. They said, “If you need them in the night, they’re there.”

When we spoke with staff about the people they were caring for, they were able to provide information about people's support that matched what was in assessments and care plans. This helped to show that they had access to information about supporting people appropriately and safely.

We carried out this review to check on the care and welfare of people using this service.

We spoke with six people and three visitors about their experiences of the care and support being provided. People we spoke with were complimentary about the care, treatment and support they received. They told us staff were attentive and when they needed anything staff were very willing to help them. One person commented, "The staff are very kind and caring and nothing is too much trouble".

A visiting family member told us that the staff always make them welcome. They told us their relative's needs are fully met and that they always look well cared for. They stated they have no concerns about the home. Another visitor told us the care is “first class.”

We spoke with people about activities and we were told there was “plenty to do” at the home and they are “never bored.” We observed an activity session that was taking place in the main lounge of the home during our visit, and saw that it was very well attended. One person told us, “there is always something going on, but you are not forced to join in if you don’t want to.”

People told us they felt safe and able to report any concerns they may have. We were told that, “all the girls (staff) are kind, nothing is too much trouble.” People said they get the help they need as there are enough staff on duty.

People told us they were very happy with the service. They felt listened to and had a say in how the home is run. For example, they decide what meals should be on the menu and what external entertainers they would like to ask back to the home.

When we looked around the home we saw people's rooms were clean and suitably furnished. People had been able to personalise their rooms and bring in small items of their own furniture if they wished. One person told us, “This is my home, I am very comfortable here.”

We spoke with staff about training to ensure that they had the skills to meet the needs of people living in the home. Staff spoken with told us that they were well supported by the manager and other staff. Comments received included; “We all work well together here, the manager is very flexible” and “I look forward to coming to work.”