This inspection took place on 20 and 22 September 2016 and was unannounced. Dorrington House (Wells) is a care home providing personal care for up to 38 people, some who live with dementia. At the time of our visit 37 people were living at the service.

The home has had the current registered manager in post since January 2016. 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 were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were usually enough staff available to meet people’s needs although people sometime had to wait when there were sudden shortages. Recruitment checks for new staff members were obtained before new staff members started work.

Although medicines were securely stored, temperature checks of storage areas showed high temperatures, which put the effectiveness of medicines at risk. Medicines were safely administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Staff members understood the MCA and presumed people had the capacity to make decisions first. Where someone lacked capacity, best interest decisions had been made.

Most people enjoyed their meals and were able to choose what they ate and drank. Guidance for staff about how much people should drink each day was not always available and records showed that some people did not drink enough. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. Staff responded well to people’s needs and support was nearly always available. Care plans contained enough information to support people with their needs.

A complaints procedure was available and people were happy that they did not need to make a complaint. The manager was supportive and approachable, and people or other staff members could speak with him at any time.

The provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

This inspection was carried out by a single inspector. 35 people were using the service at the time of our inspection. As part of our inspection we spoke with three people who were receiving support, four relatives, the manager, and five staff working at the service. We also observed people receiving support and looked at the support plans for six people. We used the evidence collected during our inspection to answer five questions.

Below is a summary of what we found.

Is the service safe?

People who we spoke with told us they felt safe and that they liked the staff. One person said, “I feel safe here.”

People were protected from the risk of abuse as staff had received training and were clear about their responsibilities to recognise and report any concerns. This meant that people were protected from the risk of harm.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had a system in place to demonstrate that they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone’s behalf is recorded, including the reasons why it has been made, how the person’s wishes have affected the decision and how they were involved in the decision making process.

There were effective recruitment and selection processes in place. appropriate checks were undertaken before staff began work.

Is the service effective?

People we spoke with told us that they were happy with the service which they received. The relatives we spoke with told us that overall, the service met the needs of their family members.

Staff worked closely with professional health staff to ensure that people’s needs were met. Care plans were personal to each individual and were reviewed on a regular basis. Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks.

One of the staff we spoke with said, “I get good support from everyone. It’s team work.”

Is the service caring?

We spoke with three people who used the service. Each person said that they liked the staff. We spoke with four relatives. One person’s relative said, “I find all the staff very good. They are kindness itself.” Relatives said that the management team kept them well-informed about the needs of their family members.

Staff told us how they supported people with their personal care and daily living needs. They were able to talk about people’s likes and dislikes.

During our inspection, two relatives expressed concerns about the quality of communication from some staff with those people living with dementia. One relative said, "I think communication might be an obstacle, although staff do their best under the circumstances."

Is the service responsive?

People’s needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people’s likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities of their choice and were encouraged to participate in activities within the local community.

Is the service well led?

Staff told us they felt well supported by the management team. They told us they received guidance from the management team.

The majority of relatives we spoke with told us they felt the service was well-managed. Some relatives we spoke with said they were confident to raise any concerns or complaints they had with the manager and knew they would be resolved. One relative said, "The manager is very approachable.” Some relatives we spoke with were not satisfied with the complaints process.

The provider had effective quality assurance and audit systems in place to monitor all aspects of the service and ensure improvements were made where necessary.

We spoke with four people living at Dorrington House. One person we spoke with living at the home told us “It’s a good crowd here.” Another said “The staff are excellent, they look after me well.”

People's care needs were assessed and from these assessments care plans were drawn up. The care plans reflected people's preferences and rights. For example, one person was supported to take regular walks in the town. Their right to make an informed decision about the risks involved had been respected and plans had been put in place to manage the associated risks.

All the people we spoke with enjoyed the food, however one person found the choices a bit repetitive at times. We observed the lunchtime period in one of the dining areas. Where people needed support to eat this was provided and we found that staff were attentive to people's needs.

We reviewed staff records and found that staff were trained, supervised and appraised on a regular basis. This meant staff were properly supported to provide care and treatment for people living in the home.

There was an effective complaints procedure in place which was publicised to people living in the home and to any visitors.

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. Their name appears because they were still a registered manager on our register at the time.

We spoke with 12 people receiving care and accommodation and with two visitors to this service.

People reported that they felt respected and involved by staff. The visitors confirmed that they were consulted with about the care that their relatives were receiving and felt able to talk to staff if they had any concerns.

People told us that they were satisfied with the care, attention and kindness shown by staff. For example one person told us that, “Nothing is too much trouble for the staff”. They confirmed that they were well looked after and that their independence was promoted wherever possible. For example one person told us that, “The staff are very kind”.

We found that people expressed their views and were involved in making decisions about their care and treatment. We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from unsafe or unsuitable equipment because the provider had systems and processes in place to ensure the safety, availability and suitability of equipment. We found that decisions about care and treatment were made by the appropriate staff at the appropriate level.

We visited the home on 01 July 2011 and spoke with several people who live there. They told us that generally they were happy with the home and care offered to them. One person stated:” I really cannot say a bad thing about the home. They are so good to us. They help me move in my electric wheelchair when I call them, it is enough just to pull a call bell and they come.” She added: “ I would love to go out more, but could not afford to pay for extra staff to go with me”.

Another person explained that there was a remote call bell and that this was placed next to her when she is in her room.

Another person told us: “I knew this home from before, one of my relatives was here and I chose this home as they are really good.”

When asked about communication with staff she stated that they get on quite well and explained: “Although some of them are foreign, they ask if they do not understand something, but they are really good.”

People with whom we spoke told us that food was “fine”, “good” and “no problems at all”.

People told us that they felt safe in the home.

People that were spoken with told us that they felt that their needs were appropriately assessed and met. They told us that they were provided with the opportunity to participate in activities that were of interest to them. Two people told us about the outings that they had attended from the home with their relatives and how important to them these outings were. Another person regretted that he did not have much of an opportunity to go out to the local centre.

All people were very complimentary regarding staff and stated that staff were excellent.

People were satisfied and stated that they had all what they needed in their bedrooms and that they liked communal areas. “We can sit together and talk, it is not isolating living here”, as one person commented.

They all liked the food and were happy with the choice and quality of food provided.

People stated that they could see a doctor or a nurse or any other health professional if they needed.

One person said that she was quite hot in the lounge, while the person next to her stated that it was “quite pleasant here, I don’t like it too hot, so it’s nice here.”

They all said that the place was clean.

They all commented that they felt safe in the home. One person explained further: “We have a call bell to call them (staff) and the fire alarm is there, when we have fire practice.”