This is a care home for 10 people which features eight single rooms and one double. All bedrooms have hand washing facilities and bathrooms and toilets are of easy access on both floors. There is stair lift access to the first floor. The home is situated in a rural area outside Carnforth. There is parking facilities available with views of the countryside on all sides. At the time of the inspection visit nine people lived at the home.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 26 October 2017 and was unannounced.

People who lived at Keersands told us staff were kind and caring towards them. For example one person said, “They are so kind as you can see I need help and they do it so gently and confidently. They are lovely people.”

We observed during the inspection visit staff and the management team providing support to people to the bathroom and sitting chatting with them. We witnessed staff being kind and respectful throughout the day. One person who lived at the home said, “Very kind and caring people.”

Keersands had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care and when outside the building. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

The management team had sufficient staffing levels in place to provide support people required. People told us staff were responsive and available when they needed them. One person who lived at the home said, “We are a small family friendly home everyone is looked after by staff who know what they are about.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

The management team had systems to protect people from unsafe management of their medicines. Recordkeeping was completed correctly and we found staff responsible for medicines were trained and competency tested by regular auditing of medication procedures.

Care records we looked at were informative and reviewed on a regular basis. They were up to date to ensure people received the right care and attention.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People who lived at Keersands told us they had choices of meals and there were always alternatives if they did not like what was offered on the day. We observed at lunchtime people who required support were attended to in a sensitive, caring manner. Comments about the quality of food included, “Excellent no one can grumble.” Another person said, “The home made biscuits and cakes everyday are truly lovely.”

We found people who lived at the home had access to healthcare professionals and their healthcare needs had been met.

People who lived at the home told us they enjoyed a variety of activities and games which staff organised. These included board games, skittles and reminiscence afternoons. One person who lived at Keersands said, “I did some baking at the weekend and really enjoyed it.”

People told us staff were caring towards them. Staff we spoke with understood the importance of high standards of care to give people who lived at the home the best support possible.

The registered manager/owner had information with regards to support from an external advocate should this

The inspection visit at Keersands was undertaken on 07 October 2015 and was unannounced.

This is a care home for 10 people which feature eight single rooms and one double. All bedrooms have hand washing facilities and bathrooms and toilets are of easy access on both floors. There is stair lift access to the first floor. At the time of the inspection visit 10 people were living at the home.

A registered manager was in place. 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.

At the last inspection on 28 May 2014 we found the provider was meeting all the requirements of the regulations inspected.

During this inspection, we found the registered manager had systems in place to protect people from potential harm or abuse. Staff had a good understanding of how to report safeguarding concerns. People told us they felt safe and comfortable whilst living at Keersands. Risk assessments were in place to protect people from potential risks of receiving care and support.

People’s medicines were safely managed and stored. Staff had received appropriate training which was regularly updated to ensure medicines were administered correctly.

We found staffing levels were sufficient in meeting people’s needs in a timely manner. Staff told us their training supported them to work effectively and the registered manager had assisted them in their development. Personnel had been safely recruited to ensure people were protected.

People who lived at the home were given a choice at meal times and could have refreshments whenever they wished. We observed this happened during the day of our inspection visit. One person who lived at the home said about the quality of food, “The food is always good. They do a lot of homemade cooking.”

People who lived at the home were encouraged and supported to maintain relationships with their friends and family members. People who lived at the home told us their relatives were welcomed at any time of the day.

The care plans we looked at were centred on people’s personal needs and wishes. Daily events that were important to people were recorded in their individual care record. This was so staff could provide care and support to meet their needs and wishes. Activities were organised daily and trips out to the local community had taken place.

We found a number of audits were in place to monitor quality assurance. The manager and provider had systems in place to obtain the views of people who lived at the home and their relatives.

On the day of our visit we spoke with the owner/manager deputy manager staff and residents. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 living at the home, staff supporting them and from looking at records. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Keersands.

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

Is the service safe?

Systems were in place to make sure management and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve. There had been no complaints since the last inspection.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The deputy manager had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded as required. They said, “We will be looking to provide more training for staff.”

From our observations during the day, we found people were treated with respect and dignity by staff. People living at the home told us they felt safe. Comments from residents included, “Lovely views with friendly people around to make us feel safe and secure in this home.”

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in developing their plans of care where possible. Relatives views were also sought to ensure people received the right care to meet their needs. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

We spent part of the day in the lounge areas observing staff interaction with residents. People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people. One resident we spoke with said, “It’s a small home which suits me and the owner and staff are so caring it’s like home from home.”

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with there wishes.

Is the service responsive?

We saw literature informing people of the complaints procedure around the home. Residents we spoke with said they knew how to make a complaint if they were unhappy. The manager told us a recording system was in place to investigate, record and reach outcomes for any complaints they received. People could therefore be assured complaints would be investigated and action taken as necessary, if any issues were raised.

Is the service well-led?

Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

There were a range of audits and systems put in place in by the owner/manager to monitor the quality of the care and support being provided. This helped to ensure people received a high standard of care at all times.

We spoke with a range of people about the home. They included the owner/manager, staff and people who lived at the home. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Keersands.

During our inspection we looked at care records and spent time in the lounge with the residents observing the daily routines. We also observed breakfast and lunch being served in a relaxed unhurried manner. The home had a pleasant atmosphere with residents coming and going as they pleased. Residents comments included, “This is a lovely place to be. I am lucky to have such a nice home with lovely staff to help me.” Also, “The food is wonderful and plenty of it all day.”

We discussed residents care and the support they required. Staff members on duty had an awareness of residents care needs and were able to talk about the help they needed. One staff member said, “It’s a small home so we get to know people well. We can soon detect if someone has a problem or is not well.”

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date. Staff training records we looked at confirmed this.

Prior to our visit we contacted Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with a range of people about the home. They included the owner/manager, staff and people who lived at the home. We also had responses from external agencies including social services, in order to gain a balanced overview of what people experienced.

People told us they could express their views and were involved in decision making about their care. They told us they felt listened to when discussing their care needs.

Residents said routines were relaxed and the standard of food was very good. They also said activities organised kept people entertained.

All responses were positive about the care and support the service provides. Comments included,

"The staff have been wonderful to me”

“No complaints, never had to the staff give us everything we want.”

“It’s like a big family home. I like to have my own bits and pieces around me and they encourage me to personalise my bed room.”

We spoke to people living at the home, the manager (owner), staff, and a district nurse visiting the home. We also received comments from other professional agencies such as social services and the Lancashire Council's Contracts Monitoring Team, who told us they currently had no concerns with the service.

Responses we received were positive from people living at Keer Sands comments included, "Staff are wonderful". Also, "No problems at all, good home cooked food and I feel at home". One person we spoke to about the time she moved in said, "We liked it initially because of the friendly atmosphere and homely feeling".

Staff spoken to had a good awareness of individuals care needs and the importance of

treating people with respect and dignity. One person living at the home said,"The attitude of the staff and A... is that they treat you like family, caring, respectful and with dignity".

The manager told us recruitment procedures have been reviewed and updated to ensure all checks are in place and ensure suitable staff are employed. One staff member said, "Induction training and recruitment is completed thoroughly now".

Lancashire Social Services spoken to have no concerns in relation to 'safeguarding' issues at the service.