The inspection took place on 6 and 7 March 2017.

Culrose provides accommodation and care for up to 20 older people, some of whom may have developed dementia while using the service. At the time of our inspection, there were 17 people using the service. There are some bedrooms on the first floor, in the older part of the building, accessible by a lift. The majority of bedrooms and all of the communal space, is on the ground floor.

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.

At the last inspection, the home was rated Good. At this inspection, we found the home remained Good.

Why the home is rated Good…

Staff understood how to keep people safe from the risk of harm or abuse. Risks to people's safety were assessed and staff followed guidance for minimising these. There were enough staff to support people safely. Recruitment processes contributed to protecting people from the employment of staff not suitable to work in care. People received support to take their medicines safely and any concerns about medicines management were addressed.

Staff were competent to carry out their roles and to support people effectively. 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. People were supported to eat and drink enough to keep them well and had a choice of meals. Staff monitored people's health and wellbeing and ensured people could access professional medical advice promptly when it was necessary.

People were supported in a caring way by staff who had developed compassionate relationships with them. Staff respected people's choices, privacy and dignity, and encouraged people to maintain their independence.

Staff were aware of people's preferences, what was important to them, and their hobbies and interests and responded to these. They supported people to maintain their interests and to keep in touch with their friends and family. People were confident that, if they needed to, they could make a complaint about their care and have their concerns investigated and addressed.

There was stable and consistent leadership within the home, contributing to good staff morale and teamwork. People's views were taken into account in the way the service was operating and there were regular checks to see what improvements could be made to ensure a good quality service.

Further information is in the detailed findings below.

A single inspector carried out this inspection. The focus of the inspection was to answer the 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 people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

Risk assessments for care needs were completed and provided appropriate actions for the identified risk to be reduced.

The premises were not maintained and safe for people to work and live in or to visit. We found that there were a number of issues that had not been identified and put people at risk. However, equipment used at the home and by people living there had all been serviced and properly maintained.

Not all of the recruitment checks and documents that were required before new staff members started work were available or obtained. However, staff records showed that new staff members received training to carry out their role. We have asked for improvements to be made.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. While no applications have needed to be submitted, policies and procedures were in place. Work was in progress to review these in line with recently received guidance. Relevant staff had an increased level of knowledge to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that staff members helped them with everything they needed assistance with. One person’s family member said they were not actively consulted about their relatives' support, care and treatment. However, they were satisfied with the care their relative received. Care records mostly reflected people’s care needs and preferences, although we found that occasionally people’s needs had no or little information to guide staff.

Health needs were responded to and people had access to health care professionals if they needed this.

There was enough space around the home and in people’s own rooms for them to spend time together or alone and to see visitors in these areas.

Is the service caring?

People said that most staff were polite and kind, although they also felt that occasionally staff could be ‘short’. Staff members knew people’s care needs and their personal preferences.

Our observations showed that staff members were respectful towards people living at the home. People told us that staff were respectful and that their privacy was maintained.

Is the service responsive?

We saw that people's individual physical and mental support, care and treatment needs were assessed and mostly planned for. Their individual choices and preferences regarding their support and care were valued and respected.

People's individual support and care needs were being met. People who used the service said that their health needs were responded to well.

Is the service well led?

Improvements had been made since our previous inspection, which we carried out on 30 August 2013. This was in respect of analysis of satisfaction surveys and accident/incident reports. Appropriate actions had been taken following accidents, although actions were not clearly described for the results of the satisfaction survey. Relatives of people who used the service were also provided with opportunities to share their views about the standard and quality of the service provision.

We spoke with four people who used the service; they confirmed that they were asked for their consent before care was provided. One person said, “Before they help me, they ask me if I want a wash and what clothes I want to wear.” People told us they were satisfied with the cleanliness of the service.

We were told by the registered manager that people’s needs were assessed to ensure they could be met by the service before they moved in. One member of staff said, “I went to assess someone in hospital and involved them, their family and the ward staff to find out their needs.”

Discussions with the catering staff told us that people received adequate nutrition to meet their needs. We saw that people were offered snacks during the day. One person said, “They know my preferences and if I don’t like something on the menu then they give me something else.”

We found that there were shortfalls in the recording of people’s care, including care plans not being reviewed, how their weight was monitored and decisions people had made about their care.

We saw that a people who used the service had been asked to complete a survey about their views of the service. The survey was not dated and there was no evidence that their views had been acted upon.

We spoke with three people at the service. They told us they liked living at the service. One person told us, "My mother used to live here before me." Another person told us they, "Like to sit outside in the summer."

The service was involved in the local community. It had taken part in the 2010 and 2011Christmas tree festivals and people were able to attend clubs in the village.

People's needs were assessed before they moved into the service and regular reviews were carried out. Results of quality assurance surveys were used to improve the service. Staff in the service received induction training and regular supervision.

During our visit we spoke with several people who lived in the home. They told us that care was very good and that staff were kind and knowledgeable. Two people told us that there were enough staff on duty to help everyone. One person told us that staff were always available when they needed them. This person also told us that staff, “Rushed me to hospital when I was unwell. They are really good.”

People felt respected and stated that staff always knocked on their door before they entered their room.

Two people confirmed that care plans were discussed with them.

People stated that they would prefer to be in their own homes. They were satisfied with the care that they received.

The inspection took place on 3 February and 20 March 2015 and was unannounced. It was carried out by one inspector. Our previous inspection, carried out on 30 April 2014 had identified

five regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to people not always being treated respectfully, some care needs not being planned for, maintenance of the premises and grounds being required, gaps in recruitment records and auditing systems.

The provider had submitted an action plan to tell us what action they were taking to remedy these concerns. During this inspection we found that satisfactory improvements had been made. The provider was no longer in breach of these regulations.

Culrose Residential Home provides accommodation and care for up 20 older people. At the time of this inspection 15 people were living in the home.

A registered manager was employed at 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.

Staff knew how to keep people safe and how to reduce any risks to their welfare as far as was possible. They understood the signs of potential abuse and what action would be required should they have any concerns.

There were enough staff on duty to meet people’s needs in a timely manner. Effective recruitment procedures were in place to minimise the risk of recruiting staff unsuitable for the role. People’s medicines were managed effectively and they received their medicines when they needed them.

Staff received training and supervision to help them provide a good and informed standard of service to people.

People enjoyed the food they received and could choose what they could have to eat or drink. If people needed support with eating or drinking, this was provided.

Staff treated people respectfully and were mindful of ensuring their dignity and privacy was upheld. People’s opinions were sought on an ongoing basis and they were confident any concerns would be dealt with fairly if they had any cause to complain.

The service accessed the support of health professionals when necessary. When people’s needs changed action was taken to ensure their changed needs were met by staff. Staff were confident they had the skills and experience to support people safely. Changes to people’s care and support were discussed with them and implemented promptly to ensure their welfare was maintained.

The manager had been at the home for several years and was well regarded by people living there, their representatives and staff. The home had a friendly and welcoming atmosphere. Staff worked in a calm and relaxed manner which people appreciated.

People’s views were sought about how the service was run and their suggestions and comments were taken into account and implemented where possible.