Rating at last inspection: Requires improvement (Published 4 December 2017).

About the service: George Edward Smart Homes is a care home that can provide personal care for up to 60 people aged 65 and over, some of who may be living with dementia. 50 People lived in the service when we inspected.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People and their relatives described the service as a ‘Hotel’. When we asked what this meant people explained that they received support they needed in the way they liked when they asked for it. People said staff knew them very well and could anticipate their needs and that support was delivered in a timely way. People described excellent provision of activities and events that were tailored to their needs. People were supported through technology to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing.

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 treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. The registered manager agreed that more work to help people living with dementia to find their way in the service would be beneficial. Cleanliness and health and safety were well managed.

Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. Staff recruitment was safe. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm.

The registered manager and management team were well respected. They supported the team to deliver high quality person centred care. Lots of checks were completed to ensure people were safe and that their experience was positive. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

How the trustees or provider monitored the service so they provided leadership to the registered manager was being developed. This would ensure appropriate governance was in place.

A full description of our findings can be found in the sections below.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 31 August, 7 September and 29 September 2017. The first day of inspection was unannounced; the second and third days of inspection were announced.

George Edward Smart Homes is registered to provide care for up to 60 people. Personal care and accommodation is provided to older people for long term, or respite care, nursing care is not provided. At the time of our inspection 51 people were using the service. The service comprises of two large buildings over two floors which are linked together

At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in their assessments relating to the Mental Capacity Act and this action has been completed.

At the time of our inspection the service had 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. We have referred to the registered manager as the manger throughout this report.

At this inspection we found the service required improvement in the domains of safe and well led, therefore required improvement overall. This is the first time the service has been rated Requires Improvement

We found a breach of regulation in relation to staffing. We found that sufficient numbers of staff were deployed during the day but night staffing levels were inadequate, particularly in the eventuality of a crisis or emergency. This was discussed with the manager who immediately implemented an additional sleep over night staff whilst a permanent position was recruited to. You can see what action we told the provider to take at the back of the full version of the report.

The manager did not have a dependency tool in place to support them to deploy staff effectively. After discussion the manager devised and implemented a dependency tool to inform them of the staffing levels required to meet people's needs.

We have made a recommendation about the provider’s responsibilities in relation to good governance of risks to the people they are providing a service to.

The manager had systems in place to ensure that safe recruitment processes were followed. Disclosure and barring checks were in place and two references were obtained for all staff prior to their employment commencing.

Medicines were safely managed. People's medicine administration records (MARs) were accurate and updated by staff once people had their prescribed medicines. The manager completed audits of medicines management to help them identify and address any errors.

Staff were well trained and had access to support. This included induction, on-going training, regular supervision and the completion of annual appraisals. This allowed staff to obtain skills and knowledge and share their personal and professional needs with their line manager.

Staff understood how to protect people from risks associated with harm and abuse. Safeguarding procedures and policies were in place and staff were aware of their responsibilities to identify and report any allegations of abuse to the local authority.

Risks to people's health and well-being were identified. Staff had access to risk assessment outcomes and guidance to support them to reduce risks and keep people safe.

People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice. People were cared for within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were involved and consulted when planning their care.

Staff respected and protected people’s dignity and privacy. For example, staff knocked on doors before entry. People said staff knew them well and treated them with kindness and compassio

This inspection took place on 24 March 2015 and was unannounced.

George Edward Smart Homes is registered to provide accommodation and personal care for up to 60 older people. It is owned and run by a Charitable Trust. The home comprises of two connected properties, Combe Hay House which was purpose built as a care home in 1958, and Fawcett House, built in 1967. The home is set in landscaped gardens on the outskirts of Scarborough in North Yorkshire. There is private parking on site.

There was a registered manager employed at this 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 told us that they felt safe at this service. Staff understood what it meant to safeguard people and we saw that they had been trained in safeguarding adults. They had the skills and knowledge to look after people well although falls were not always managed safely. People could not always reach their call bells to summon assistance and there were no other aids available to alert staff when people had fallen. The use of telecare would help staff manage falls more effectively.

The service had been maintained and kept clean to a very high standard. medicines were managed safely.

The service had not always worked within the principles of the Mental Capacity Act 2005 because they had not carried out mental capacity assessments and made best interest decisions for those people who lacked the mental capacity to make decisions for themselves. You can see what action we have asked the provider to take at the back of the full version of this report.

People’s care and support needs had been assessed before they moved into this service. Care plans were detailed and reviewed regularly. There was a varied programme of activities for people to enjoy.

People knew who to speak to if they wished to make a complaint.

There was a quality assurance system in place and audits had been carried out.

We visited the George Edward Smart Homes to carry out a planned review. We met people who used the service and a visitor and we spoke with staff.

People said members of staff were respectful to them and they respected their privacy. They also said they could make their own choices about what they did and how they spent their time.

People spoke highly of the staff and the care they received. One person said “I have had the best support and care.” A relative who told us they had been fully involved in important decisions about their relative’s care said “It has been like coming home; people here have been so helpful.”

People were aware of the meetings that took place in the home and they told us they had completed questionnaires in the past. All of the people we spoke with said they were happy with the service they received and said that if they were unhappy they could approach the staff to talk about this. We found the service had taken action to respond to suggested improvements.

We found that the premises were maintained to a good standard of repair and refurbishment. Effective systems were in place to safeguard people and to promote their welfare. We found that appropriate checks were in place to make sure that staff were recruited safely.

People using the service spoke positively about the care provided at the home and staff. They said that the facilities were wonderful and care staff could not do enough for them. One person described the home as a “piece of heaven.”

People told us that members of staff were kind and patient. Comments included “the staff are very kind, they look after us very well," “the care is one hundred per cent,” and “nothing to fault it, really excellent.”