We inspected Four Acres and spoke with the registered manager and four care staff about the support they gave to people who lived at the home. During the inspection we also spoke with four visiting health professionals. These were a phlebotomist (Phlebotomists are clinical support workers who collect blood from patients for examination in laboratories, which helps provide information to diagnose illness), a general practitioner (GP), a social worker and a podiatrist (specialist in foot care). Speaking with these people helped answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well led?

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with five people and a relative of a person who lived at the home.

Is the service safe?

We inspected this service previously in May 2013 and identified improvements were required in several different areas. These included the safe care and welfare of people, how the service monitored and assessed the quality of its service and records that supported the care people needed. We found the provider had made changes following our previous inspection and improvements had been made in all these areas.

People told us they felt safe living at the home. People told us the staff were kind and friendly towards them and provided the care and support they needed. One person said: "The staff are lovely here".

People told us they were involved in their day to day care decisions and staff helped them to maintain their own levels of independence. One person said: "I can do most things myself but need a little help now and again".

People’s records had been completed at the required intervals and people’s care records matched their individual care needs. We found people had appropriate risk assessments in place that made sure people were not placed at additional risk. We found people had appropriate risk assessments in place that made sure any risks were managed.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We were told that no DoLS applications had been made. We saw records that showed some staff had received training in the Mental Capacity Act. The registered manager told us that they were arranging further training for staff in the Mental Capacity Act in light of the recent High Court judgement around MCA and DoLS.

Is the service effective?

People’s health and care needs were assessed and people had been involved in planning the care they received. We found care plans had been reviewed regularly and matched the care people required. We found care plans supported staff to deliver care and support to meet people’s needs.

People were involved in how their care was delivered. Staff asked people for their consent before any care or treatment was provided. People’s mobility and other needs were taken into account in relation to their environment. This enabled people to move around freely and safely and with the level of support that met their needs.

We found the provider had an effective recruitment system in place that made sure the staff employed were suitable and qualified to support people.

Is the service caring?

Staff were attentive to people’s needs throughout our inspection. We saw staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Four Acres. People told us that staff respected their choices and staff helped them to promote their own independence as much as possible. One person said: “I want to be able to do as much for myself as I can and the staff help me to do this”.

We found people’s preferences were supported. People were free to make their own choices about food, drinks, bedtimes, personal care, clothes they wanted to wear and where they wanted to spend their time in the home. People told us they did not have to wait long when they needed help or support. People told us the staff were very supportive and friendly.

Visitors we spoke with confirmed they were able to see people in private and that they could visit their relatives whenever they wanted.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors and podiatrists. People were supported to participate in activities inside and outside of the service that were personal to them.

People told us that they were asked for their views about the service they received. All of the people we spoke with were satisfied with the service they received.

Is the service well led?

The service worked with other health professionals and community services to make sure people received the appropriate levels of care they needed. We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service that people received. People told us they were able to speak with staff and managers and felt able to raise any issues or concerns they had.

When we visited Four Acres we spoke with five people who used the service and three visiting relatives to obtain their views about the home. We also spoke with a visiting professional, the manager, the area manager, four care staff, the chef and a member of the domestic staff.

People who lived at the home and their relatives told us, “I like living here, everything is perfect” and “Always nice atmosphere when we walk in.”

We saw staff were kind and attentive when delivering care. We looked at four people’s care plans and saw their care and welfare needs were not always met due to the lack of information available for care staff.

We saw that people were provided with a good choice of food. Some people told us they were not always happy with the choices available to them.

People told us they felt safe, but one visitor raised concerns about their relative’s care.

Care staff had received training to enable them to look after people safely. Care staff had not been given the opportunity to meet with the manager on a one to one basis, but we saw regular staff meetings took place.

We saw the home met with people to enable them to give their views about their care. However, the provider did not always listen to the concerns of care staff and relatives.

We saw records and documentation were incomplete for people who lived at Four Acres. This meant there was not enough information to direct care staff on how to look after people safely.

This inspection took place on 4 and 5 August 2015 and was unannounced.

Four Acres is a two storey residential home which provides care to older people including people who are living with dementia. Four Acres is registered to provide care for 39 people and at the time of our inspection, there were 37 people living at Four Acres.

A registered manager was 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 and associated Regulations about how the service is run.

All the people we spoke with told us they felt well cared for and safe living at Four Acres. People told us staff were respectful and kind towards them and staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care and asked people for their consent before any care was given.

Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required. Care records reflected people’s wishes and how they preferred their care to be delivered. Risk assessments provided information for staff to keep people safe, although these were not always accurate when people’s needs changed. People received support from staff who had the knowledge to care for them. People’s personal and confidential information was kept safe and secure.

People told us they received their medicines when required. Staff were trained to administer medicines and had been assessed as competent, which meant people received their medicines from suitably trained and experienced staff.

The provider had effective recruitment procedures that helped protect people. All the necessary checks had been completed on potential staff before a decision was made to employ them at the home.

Staff understood the need to respect people’s choices and decisions. Assessments had been made and reviewed to determine people’s individual capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interests’ with the involvement of family members and appropriate health care professionals.

Staff were caring and compassionate in their approach to people. People were given choices about how they wanted to spend their day so they were able to retain some independence in their everyday life. Family and friends were able to visit when they wished and staff encouraged relatives to maintain a role in providing care to their family member.

There was a range of activities available for people living in the home that promoted their health and wellbeing. Staff responsible for providing activities were enthusiastic and encouraged the wider community to be involved.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). The registered manager had contacted the local authority and submitted applications to make sure people’s freedoms and liberties were not restricted unnecessarily. At the time of this inspection, no applications had been authorised under DoLS.

There was an audit system that identified and improved the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received and if they suggested improvements, these were acted upon. People’s concerns were listened to and supported by the provider, manager and staff who responded in a timely way.