Guild House is a care home without nursing for up to 35 older people, some of whom are living with dementia. At the time of this inspection on 23 October 2018, there were 32 people living at the service.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated any risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good. Why the service is rated Good:

The service continued to meet all the fundamental standards and had a registered manager as required. The registered manager was present and assisted us with the inspection.

People continued to receive responsive and person-centred care. Staff took the time to know people as individuals and their preferences about how they wished to be cared for.

The provider's values and ethos were known and shared by the staff team. Staff felt motivated in their roles and proud to work at Guild House.

People continued to protected from harm and abuse. The provider and registered manager took a 'lessons learnt' approach to accidents, incidents, concerns and complaints and used these to make continual and ongoing improvements to the service.

People received their medicines safely and consideration was given to whether people were able to administer their own medicines.

There was a holistic view of dignity, which included considering people's self-esteem and helping to reduce feelings of social isolation.

The registered manager and provider used a range of internal and external quality assurance measures to ensure people received a high standard of care.

People had access to a range of social and leisure opportunities and were part of their local community.

Further information is in the detailed findings in the full report.

This inspection was unannounced and took place on 30, 31 December 2015 and 04 January 2016.

Guild House provides care and support to older people, some who live with dementia. It can accommodate 35 people. At the time of the inspection 34 people were living at the service. Accommodation was provided across three floors each with its own dining room, lounge and bedrooms with personal bathrooms. A passenger lift was available to help people get to the first and second floors. People who lived with dementia were supported on the first and second floors. The home is required to have a registered manager in post.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was registered as manager of the service with CQC in February 2015.

We carried out a comprehensive inspection of this service In October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches in safeguarding, consent, recruitment and monitoring the quality of the service. We undertook this comprehensive inspection to check they had followed their plan and to confirm they now met legal requirements. This inspection found that the provider was meeting their legal requirements.

Risks to people’s personal health were managed effectively as risks to them and their changing needs were recognised. Staff worked with community health professionals to maintain people’s well-being. People felt safe at Guild House and had good relationships with the staff who supported them. A range of activities were available to them including trips out and outside entertainers. People spent their day as they wished and enjoyed regular visits from their relatives. They had plenty to eat and drink and any special dietary needs or requests were met. People had confidence in the staff and their skills. They felt listened to and never had to wait long for assistance.

Staff felt supported in their roles, had clear job descriptions and arrangements were in place to support the staff with new lead roles within the home. They were clear about their responsibilities to people and felt well-prepared to meet their needs. There were enough staff; they were not rushed, had time to talk with people and to meet their needs. Staff benefitted from working alongside experienced colleagues who provided them with ongoing supervision and guidance. Learning needs and staff knowledge were explored and staff were supported to gain appropriate qualifications in social care. Staff knew people’s personalities, likes and dislikes and understood their changing needs. Staff cared about the people they supported and were proud of the service they provided.

The culture at Guild House was in a period of transition as staff were becoming accustomed to the significant changes in the way the service was managed. All staff upheld the provider’s values. The registered persons provided clear leadership to staff; they were passionate about the quality of the care provided to people. Managers provided clear leadership to staff; they understood people’s needs and knew what was going on in the home on a day to day basis. Quality assurance processes were robust and action plans were in place to improve the service. The provider was supportive and was in regular contact with managers to oversee running of the service. Community contacts were well established. Legislation and local policies and some national best practice guidance were referenced, to set and measure standards of care.

During our visit we spoke with six people living in the home and two visiting relatives. We also spent time observing people in communal areas and in particular on Grace Wing, which was the unit for people with advanced dementia. People we spoke with told us they were happy living in the home and were able to make choices about their daily living. People told us, “Its lovely here” and “They are very kind, the staff are marvellous”. A relative we spoke with told us, “Brilliant, cannot fault the home”.

We observed that people were able to choose where they spent their time, either in their rooms or a choice of different communal areas. We observed staff supporting people to move between floors to take part in activities or to have a change of where they wanted to spend their time. We saw that staff interactions were respectful and at the pace of the person they were working with.

Care plans were personalised to each individual's needs and detailed how staff should work with people to meet those needs. Risk assessments had been completed where appropriate and all care records were regularly reviewed. Appropriate arrangements were in place in relation to the recording of medicine.

There were enough qualified, skilled and experienced staff to meet people’s needs. People’s complaints were fully investigated and resolved, where possible, to their satisfaction. People’s personal records were accurate and fit for purpose.

The people and their relatives that we spoke with were highly complementary about the support they received at Guild House. Consent for care and treatment was consistently sought from people or their relatives who acted on their behalf when needed and lawful. People’s care and welfare needs were met by staff who regularly sought support and advice from external health professionals, in a timely manner. People told us that staff were caring and had the right attitude. We saw that all appropriate checks had been carried out when staff were recruited. Care was provided in an environment that was safe, well maintained and met people’s needs. People’s views and feedback were sought when reviewing the quality of the service and regular quality audits were carried out. There were some omissions in record keeping that needed to be improved.

This was an unannounced inspection which was carried out over two days on 27 and 28 October 2014. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to the Mental Capacity Act 2005, safeguarding adults from abuse, staff recruitment, staff support and in how the provider monitored the services and care provided. You can see what action we told the provider to take at the back of the full version of the report.

This service was last inspected on 3 April 2013 and at the time was meeting all the regulations assessed during the inspection.

Guild House provides care and support to predominantly older people and some who live with dementia. It can accommodate 34 people. At the time of the inspection 32 people were living at the service. Accommodation was across three floors each with its own dining room, lounge and bedrooms with personal bathrooms. A passenger lift was available to help people get to the first and second floors. People who lived with dementia were supported on the first and second floors.

At the beginning of 2014 there were two registered managers who job shared. 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. Although still employed by the provider, at the time of the inspection, neither manager managed the home. One had been absent from work for a long period of time and the other was now in another role within the company. In September 2014 an interim manager had been employed to manage the home.

We observed there to be enough staff with the right skills and experience to meet people’s needs. Staff were aware of people’s individual needs and risks. Although staff knew how to recognise abuse and report incidents or allegations of abuse within the company, their understanding of the county’s wider protocol on reporting safeguarding concerns was poor. There was limited access to up to date information on this. The provider had not ensured that staff had a full and effective understanding of the safeguarding processes. Staff also lacked clear guidance on physical interventions (restraint).

Robust staff recruitment practices had not always been followed. Potentially people were at risk of being cared for by staff who were unsuitable.

People’s needs were monitored well and any changes in these were effectively responded to. People were treated with dignity and respect and their privacy was maintained. People were supported to live their lives in the way they wanted to and were free to make their own decisions.

Staff supported people who lacked mental capacity to retain their life skills and to make simple day to day choices. However, these people had not always had their mental capacity assessed. Whether people were able to make decisions about their care and treatment or whether decisions needed to be made in their best interests this had not always been determined. The levels of control and supervision each person required had not been reviewed to ensure people were not unlawfully deprived of their liberty. Therefore people who lacked mental capacity had not had their rights protected under the Mental Capacity Act 2005.

People received skilful care by staff that had been trained to do this, however staff had not received effective and consistent support. This had resulted in some staff being unclear about their roles and responsibilities. Staff attitudes and competencies were checked through staff supervision and appraisals however, the consistency of this needed to be improved upon. This put people at risk of receiving inappropriate or unsafe care. The interim manager had started to provide sessions where staffs’ training needs and concerns were discussed with them. Some staff had also received feedback on their performance and, where appropriate, issues with staff performance had started to be addressed. Despite this staff had maintained core values which meant people had been treated with respect, compassion and dignity.

Staff who had been responsible for providing leadership had failed to provide this effectively, despite attempts by the provider to resolve this. The interim manager had begun to provide staff with leadership and had put processes in place to start to identify shorfalls in the service but this was very much in its infancy. There had been no on-going monitoring arrangements either within the home or recorded by the provider. The provider therefore did not hold accurate information about where the shortfalls were and was unable to make the required improvements. This put people at risk of receiving care and services that were either inappropriate or unsafe.

People received care which was delivered with patience and kindness and people told us they liked the staff and felt cared for by them. People’s wellbeing was important to staff who supported people in a manner that supported this. People who were important to those who live in the home were welcomed without any restrictions. Where appropriate, staff communicated with relatives or representatives about the person’s health and welfare. People were provided with the privacy they wanted or required. People told us they had not always been involved in the planning or reviewing of their care but said they did feel listened to.

People had access to health care professionals when needed and staff requested a review by appropriate health care professionals when people’s needs required this or altered. People’s choices, wishes and preferences were responded to. Care plans recorded these and gave guidance to staff about how people’s needs were to be met. Some care plans did this well and others did not do this so well. Staff received verbal handovers about what care people needed which included any daily changes. Therefore, weaknesses in the care planning had not meant staff were not aware of people’s needs. The interim manager had begun to identify shortfalls in the care plans and risk assessments and knew where the improvements were needed.

There were activities for people to join in, if they chose to, and people were supported to make good use of the wider community. However, there was a lack of meaningful activities for some people with dementia Better opportunities for meaningful activities were needed for some people with dementia. The provider had been aware of this and told us this would be improved.

Concerns and complaints had been listened to, responded to and investigated. However records did not always show whether proposed actions arising from a complaint had been taken and whether the complainant was satisfied with the outcome. Therefore the provider would not have enough information to know if the complaints had been managed effectively. People who live in the home knew how to make a complaint and there was information for visitors about this. The interim manager told us they maintained an open door policy and people told us they found them approachable.

People had been given opportunities to feedback their views on the services provided and how the home had been managed. Although this feedback had been acknowledged, because of the change in management, it was not possible to make a judgement about whether people’s feedback had influenced how the service had been managed.