This was an unannounced inspection which we carried out on 7 December 2016.

We last inspected Enhanced Elderly Care Services Fellingate Care Centre in August 2015. At that inspection we found the service was not meeting all of the legal requirements in force at the time.

Enhanced Elderly Care Services Fellingate is a purpose built care home that provides personal and nursing care to a maximum of 81 older people, including people who live with dementia. At the time of inspection 74 people were living at the home.

A registered manager was 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.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. Other people could tell us they felt safe. People appeared contented and relaxed with the staff who supported them. People and relatives said staff were kind and caring. Staff had more time to interact and engage with people and not just when they carried out tasks.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff received opportunities for training to meet peoples’ care needs and in a safe way. A system was in place for staff to receive supervision and appraisal and there were robust recruitment processes being used when staff were employed.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were able to make choices where they were able about aspects of their daily lives. People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. People received their medicines in a safe and timely way.

Staff supported people who required help to eat and drink and special diets were catered for. Some activities and entertainment were available for people and people were being consulted to increase the variety of activities and outings.

A complaints procedure was available. People told us they felt confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the registered manager was supportive and approachable. People had the opportunity to give their views about the service. Feedback was acted upon in order to ensure improvements were made to the service when required. The provider undertook a range of audits to check on the quality of care provided. Records had been updated and they were regularly reviewed to reflect peoples’ care and support requirements.

This was an unannounced inspection carried out on 17 August 2015.

We last inspected Fellingate Care Centre in August 2014. At that inspection we found the service was meeting all legal requirements.

Fellingate Care Centre is an 81 bed care home that provides personal and nursing care to older people, including people with who live with a dementia related condition.

A manager was in post who was in the final stages of the registration process with CQC to become registered manager for 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.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care.

Regular checks to the building were carried out to ensure it was safe and fit for purpose.

People received their medicines in a safe and timely way

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

Menus were varied and staff were aware of people’s likes and dislikes and special diets that were required.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves.

Appropriate training was provided and staff were supervised and supported.

Staff knew the people they were supporting well. Care was provided with patience and kindness and people’s privacy and dignity were respected.

Care records did not always reflect the care and support provided by staff.

Activities and entertainment were available for people.

People were not always supported to maintain some control in their lives. Information was not available in a format that helped them to understand if they did not read to encourage their involvement in every day decision making.

People had the opportunity to give their views about the service. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

Audits were carried out to assess the quality of the service provided to people.

Staff said the new manager was very approachable. Communication was effective to ensure staff were kept up to date about any changes in people’s care and support needs and the running of the service.

We found one breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 (Part 3) in relation to good governance with regard to record keeping.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask:

.Is the service safe?

.Is the service effective?

.Is the service caring?

.Is the service responsive?

.Is the service well-led?

This is the summary of what we found.

Is the service safe?

Risk assessments were in place. Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe.

Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

The necessary checks were carried out to ensure the building was safe and fit for purpose.

People who used the service said they felt safe.

Is the service effective?

We saw the service provided care to some older people with dementia and cognitive impairment. The service was quite well-equipped to meet these specialist needs.

People commented how helpful and friendly staff were. Relatives told us the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people.

Is the service caring?

We observed the interaction and noted the kind and caring way staff supported people, especially people with dementia. One relative commented. "The lasses are great." and; "Staff are all very caring." Another commented. "The care is excellent." Staff were helpful and offered people information and support about their care. We observed staff interacted well with people. It was evident that staff had developed a good understanding of people’s communication needs and how best to communicate with them.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they moved into the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure people's support plans were kept up to date. This helped ensure staff provided the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in decision making with regard to their care. They were kept informed and given some information to help them understand the care and choices available to them, this was developed to include and involve people with dementia.

Information collected by the service gave staff some insight into the interests and areas of importance to the person. Activity provision was developed to help ensure activities reflected people's interests and provided stimulation to people with dementia, if they wished to become involved.

Regular meetings took place with staff and people who used the service and their relatives to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff said they felt supported by the manager and advice and support was available from the management team.

We saw there was a focus from management on the provision of individual care and support to people who used the service. There was an emphasis about individualised care and support to people. One person said; "They are respectful. I can get up and go to bed when I like, I decide. I do go along with what it said but if there was anything that I was not happy about then I would say so."

We saw people had the opportunity to comment on the quality of the service and that they felt able to speak to the manager and staff about any issues. Comments included; "The care is excellent." Another person commented; "The staff are very kind and friendly." And; "We are well looked after."

People’s needs had been properly assessed and were being met by staff. Clear records were kept of people’s care and treatment.

The people we talked with were happy with their care and spoke highly of the manager and staff. Our observations confirmed that people experienced appropriate and personalised support in meeting their needs.

We found the improved recording of medicines meant they were now accurate and showed people received their medication safely.

Proper systems were in place to make sure only suitable staff were employed to care for people in the home.

Systems were also in place to check the quality of the service provided, and to make any necessary improvements.

Care and other records in the home were kept in a professional way, and were informative and accessible.

People living at the home, and their relatives, agreed to the care they received and spoke positively about how they were supported. Their comments included, “I really can’t find fault with the care so far”, and, “It’s a lovely place and everyone’s very helpful”.

We found that care was delivered by skilled staff who had planned how they would meet individual needs and manage risks to personal safety. However the recording of medicines was not fully accurate and did not demonstrate that people were always given their medication safely.

People told us they were happy at the home and felt able to report any concerns they might have. They said, “I haven’t had any problems”, and, “I definitely have no complaints”.

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.

People using the service told us that the food provided at the home had improved and they enjoyed their meals. Their comments included, “It’s much better now”; “I look forward to seeing what’s on the menu”; and, “She’s a good cook”. Most of the people we spoke with were aware that a choice of meals was available to them.

People using the service told us about the food provided at the home. Their comments included, “I enjoy most of the meals”; “It is okay I just eat what is given”; “I like the breakfasts best”; and, “It’s not too bad, some meals are nice”. Most people we spoke with said they were not asked about their preferred choice of meals and did not always know what was on the menu. One person said, “I think you can ask for something different if you don’t like it”.

People using the service told us they were satisfied with their care and support. They said, “I get good care”, “I’m well looked after”, and, “They look after me, I’m safe here”. They said they were happy living at the home and that staff were kind. Professionals who were visiting the service also gave positive comments about the care provided. Staff told us they received a good level of training and support to meet people’s needs.