Gough House is a care home registered to provide personal care and accommodation for up to 16 older people. A number of people who lived in Gough House were in the early stages of dementia.

We carried out a previous inspection of this service on 15 and 16 October 2015 where we found improvements were required in relation to staff’s understanding and implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We also found the auditing systems in place had failed to identify the concerns we had found. At this inspection on 6 December 2016 we found action had been taken to respond to our concerns and improvements had been made.

This inspection took place on 6 December 2016 and was unannounced. At the time of our inspection there were 13 people living in Gough House. People had a range of needs, with some people living with dementia.

The service did not have a registered manager. The registered manager for this service had left but had not yet deregistered. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

A new manager had started at the service five weeks prior to our inspection but had not yet registered with the CQC. Since the manager had started at the service they had made a number of improvements in relation to the standard of care being provided, the activities offered to people and the management of records.

Staff had the competencies and information they required in order to meet people’s needs. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

The manager was in the process of introducing new care plans for people which contained more detailed information about their histories, individual needs, preferences and interests. The manager was then using this information to develop more comprehensive and personalised activity plans for people to ensure they had stimulation and activities that met their desires, interests and needs.

Staff treated people with kindness and respect. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and provided people with affection and humour. Staff spent time with people individually and knew people’s needs, preferences, likes and dislikes. Staff understood people’s preferred communication methods and used these to involve people in their care and support them to make choices.

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report any concerns. Safeguarding information and contact numbers for the relevant bodies were accessible to staff and people who lived in Gough House.

Recruitment procedures were in place to ensure people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record)

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible, protect their welfare.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The service understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards, and put them into practice to protect people. The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.

The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it. This meant when required people could access additional support to make decisions.

Care plans reflected people’s current individual needs, choices and preferences. People’s health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people’s needs changed.

People we spoke with said, “Staff are excellent, they really are” and “Staff are brilliant.” A visiting health care professional person told us, “Staff are excellent. I have no worries about the home, it’s very good”

People’s choices for end of life care were respected by staff. People had access to the specialist palliative care services they needed. People had the equipment they needed to meet their end of life needs.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be.

Is the service responsive?

We found the service responsive because, where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People, and those that matter to them, were encouraged to make their views known about their care, treatment and support.

Emotional support was available to people, their families, friends and staff.

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met. The registered manager understood their responsibilities and was supported by senior management to deliver what was required.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had an effective quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

People told us, “I’m quite sure my opinions are listened to” and “They listen to all of us, they’re very good like that.” One relative told us, “We can make suggestions. They keep you informed if there are any events going on.”

There were effective arrangements to continually review safeguarding concerns, accidents and incidents.

Emergency plans were in place and understood by all staff. Staff knew and understood what was expected of them.

During our visit we spoke with three people who used the service and two members of staff. People who spoke with us said they enjoyed living at the home. We were told “I lived here a couple of years ago and then moved back in recently because I knew how caring the staff were.” We observed that the home was quiet with a friendly, relaxed and homely atmosphere.

We saw there was information for people in the reception area of the home so that people were aware of the activities available.

We observed that at lunchtime people were very social and interacted with each other during their meal. We saw that staff joined in the lunchtime meal creating a family atmosphere. People we spoke with told us that they enjoyed the food and could make choices about meals.

We saw there were sufficient staff on duty to support the people who used the service. The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw that people were treated with respect and dignity, ensuring that people were supported to maintain their independence as much as possible. One person told us "I do for myself but its nice to know the staff are there."

We saw that Gough House was well maintained with sufficient infection control measures in place to safeguard people against the risk of infection.

During our visit we spoke with nine people who used the service and two relatives of people who used the service. People told us they could chose how to spend their day. We saw there was information for people in the reception area of the home so that people were aware of the activities available.

One visitor told us they had always been welcomed in the home and staff members were always polite and caring. They told us the “the staff are very good, you couldn’t wish for a better place.”

People we spoke with told us they were happy and safe at Gough House. One person told us, they had lived in the home for quite a while and felt very happy with the way the home was run. Another person commenting on the home told us, “I cannot think of anywhere better than here.”

The staff we spoke with had a very clear understanding of the care needs of people who lived in the home. We saw people were treated with respect and dignity, for example, staff were observed to make good eye contact and used touch to reassure people.

Staff told us they were aware of the home’s policies on recognising and reporting abuse and would not hesitate to report any concerns to the manager. Regular audits of the premises, care practices and documentation were carried out to maintain the health safety and wellbeing of people at the home.

We observed the atmosphere and general ambiance of the home to be friendly, calm and relaxed

We had some conversations with several people during lunch and in the corridors and were told that they were all well and that “everything is fine” and “they were being well cared for”. The findings in this report update our findings in the previous report dated March 2011.

This inspection was unannounced and took place on 15 and 16 October 2015. Gough House is a care home that provides accommodation for up to 16 older people. On the day of our inspection there were 14 people using the service. One person was in hospital during our inspection.

There is 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 found people’s rights were not fully protected as the registered manager had not followed correct procedures where people lacked capacity to make decisions for themselves. Deprivation of Liberty Safeguards (DoLS) applications had not been made to the local authority where people lacked capacity and were subject to continuous supervision and lacked the option to leave the home without staff supervision.

People told us that they felt safe living at Gough House and we saw that the premises were being maintained in a safe condition. We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage issues of a safeguarding nature. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the quality of training provided for them. One staff told us, “I am doing my NVQ and this will help me progress in my job with the skills I need.” The training matrix evidenced that staff had completed the majority of training that was considered to be essential by the home.

Staff had been employed following the home’s recruitment and selection policies. This ensured that only people considered suitable to work with older people had been employed. We saw that there were sufficient numbers of staff on duty to meet people’s individual needs.

Staff that had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.

People’s nutritional needs had been assessed and people told us that their special diets were catered for, and that they were happy with the meals provided at the home. We saw there was a choice available at each mealtime, and that people had been consulted about the choices available on the home’s menu.

People told us that staff were caring and this was supported by the relatives and health care professionals who we spoke with.

There were systems in place to seek feedback from people who lived at the home, relatives and staff. There had been no formal complaints made to the home during the previous twelve months but there were systems in place to manage complaints if they were received.

People who lived at the home, relatives and staff told us that the home was well managed. The registered manager and senior management had systems in place to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. We found the audits were not always effective at identifying shortfalls in the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.