This inspection took place on 08 December 2016 and was unannounced. The home provides accommodation and care for up to 55 older people, including people living with dementia. There were 52 people living in the home when we carried out our inspection.

There was 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.

People felt safe living at Fleming House Care Home with Nursing and they were very much at the heart of the service. People received excellent care that was based around their individual needs and that ensured care was personalised and responsive. Staff understood and were able to meet people’s needs. People’s support was planned proactively in partnership with them to ensure it met their individual needs.

The home was designed to create a suitable environment for people living with dementia. Walls were painted with outside scenery including hanging baskets, windows, bicycles and animals and wall lights in the hallway were enhanced with a painting of a lamppost underneath. People’s rooms had the appearance of an authentic front door and people were asked what colour door they would like. This meant that the doors provided a sense of home and ownership as well as assisting people remember where their room was located promoting independence.

The home had introduced its own pub called ‘The Fleming Arms.’ People were very happy with the pub and its appearance was outstanding and was used to provide many activities and gave a great opportunity for social interaction. The pub was well used and created a high degree of engagement and people clearly enjoyed themselves when they attended the pub.

The home was responsive to people’s needs and wishes. People were able to choose what activities they took part in and suggest other activities they would like to complete. The home had introduced a ‘Gentlemen’s group’ focused on the needs of the men within the home. The home were in the process of raising funds to be able to provide a professional nail bar for people in the home to enhance their experience while having their nails painted.

The registered manager developed and promoted community involvement within the home. In the summer the home involved the national citizenship scheme which involved local children completing a makeover for the garden and home. When this was completed an afternoon tea party was held on the last day for people and their families to view the changes. The registered manager told us, “It was lovely seeing the young people interacting with the residents and the residents really enjoyed it.”

Relevant recruitment checks were conducted before staff started working at Fleming House to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People were cared for by a motivated and well trained staff team, who always put people first. Staff received regular support and received regular one to one sessions of supervision to discuss areas of development. Staff informed us they completed a wide range of training and felt it supported them in their job role. New staff completed an induction programme before being permitted to work unsupervised.

People received personalised care from staf

There were 49 people living at Fleming House on the day of this inspection. The manager informed us there were 21 people with a diagnosis of dementia. We spoke with five people who use the service and observed the care and support provided in communal areas. We also spoke with three visitors, eight staff and the manager. Two relatives and five staff provided written feedback following our visit. We found that the service assessed, planned and delivered care for people with dementia in a considered and sensitive way. They cooperated effectively with other providers to ensure that the safety and welfare of people was protected when their health care needs changed or when they moved between different services. The service was well led and continually assessed the quality of the care provided.

We observed that staff worked knowledgeably and sensitively to meet people’s needs. People and their relatives we spoke with gave positive comments about the staff. For example: “Everybody takes time to say hello as they pass, or pop into their rooms to see if they’re O.K”. Some had commented that there had been times when there appeared to be too few staff. Others indicated that this had improved. A relative told us “In almost four years of daily visits I have rarely found management and staff wanting, under sometimes difficult circumstances”. Another person’s relative said “We as a family are happy with the care our father gets” and “If we do have a problem we go and talk about it, to get it sorted”.

During this visit we spoke with five people who used the service, six members of staff, a deputy manager and the registered manager. At the time of our inspection there were two registered managers for Fleming House. The organisation had informed us that the previous manager had left. However, the previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received.

The majority of people confirmed that they felt involved in making decisions about their care and that their views and experiences were taken into account. One person told us that they were encouraged to attend regular residents meetings, where they were given information and able to give feedback. Another person said they were “always involved in everything going on” and “given support to be as independent as possible”. People we spoke with confirmed that their care and welfare needs were being met and that they were satisfied with the way staff provided support. They confirmed that staff responded promptly to requests for assistance. They made positive comments about the staff, for example describing them as “great, very helpful and pleasant.” People knew what to do if they had any concerns about the service they received. One person told us that if they had any concern or cause for complaint, then they would speak to staff and they were confident their concerns would be dealt with promptly.

This inspection took place on 09 & 15 October and was unannounced. The home provides accommodation for up to 55 older people. Some people may be living with dementia or have mental health care needs. There were 45 people living at the home when we carried out our inspection.

The home had a registered manager who had been registered since August 2011. 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.

We brought this inspection forward, due to safeguarding concerns raised by the local council safeguarding team about people living in the home. We looked at the concerns raised and found these were not confirmed at the time of our inspection.

We found people’s safety was compromised in some areas. People and staff felt there was not enough staff at mealtimes and there was a potential risk of people not receiving personal care if required during meal times.

People and staff did not have confidence in the emergency call bell system. People told us they sometimes had had to wait a long time for the bell to be answered. There weren’t enough pagers available at the time of our inspection. However the registered manager informed us that new pagers were on order.

Care plans were not always representative of people’s current needs and although some contained a lot of individual detail others did not have the current information. Where care plans had been reviewed, the information in them had not always been updated.

Risks assessments had been completed for the environment and safety checks were conducted regularly of gas and electrical equipment. People felt safe. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

People were supported to receive their medicines safely from suitably trained staff. Relevant checks were conducted before staff started working at Fleming House to make sure they were of good character and had the necessary skills. Staff received regular supervision and appraisals where they could discuss their training and development needs.

Staff sought consent from people before providing care or support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights and liberty were not restricted unlawfully. Decisions were taken in the best interests of people.

People received varied and nutritious meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu of the day. However, people did not always have their fluid intakes recorded appropriately.

People were cared for with kindness, compassion and sensitivity. We observed positive interactions between people and staff. The home had been recognised by a national agency because they had demonstrated they provided high quality and effective end of life care.

People and their families (where appropriate) were involved in assessing, planning and agreeing the care and support they received. People were encouraged to remain as independent as possible. Their privacy and dignity was protected.

People were supported and encouraged to make choices and had access to a wide range of activities tailored to their specific interests. ‘Residents meetings’ and surveys allowed people to provide feedback, which was used to improve the service.

There was an open and transparent culture at the home. There were appropriate management arrangements in place. Staff and people were encouraged to talk to the manager about any concerns. Regular audits of the service were carried out to assess and monitor the quality of the service.