The Orders of Saint John Care Trust site in Charlton Kings accommodates two homes which were both inspected during this inspection. Grevill House provides accommodation for 50 people who require nursing, residential and personal care over two floors. Adjacent to Grevill House is the Ashley Intermediate Care Centre which offers intensive re-enablement support for 15 people who require rehabilitation following a hospital stay, before they return home. Both services stand in well maintained gardens.

At the last inspection, the service was rated Good. This inspection took place on 16 and 19 June 2017 and was unannounced. At this inspection we found the service remained Good.

People and their relatives were positive about the support and care they received. They praised the staff and told us they were treated with warmth, dignity and respect at all times. Staff understood people’s needs and responded effectively if people’s health and emotional wellbeing changed. Records showed that health care professionals had been contacted when staff needed extra support or advice.

People’s risks had been assessed and were managed in line with their care plans and health care professional recommendations. However, the care files of people who stayed on the Ashley Intermediate Care Centre did not always effectively reflect their support needs or re-enablement goals. Whilst we found staff we spoke with were knowledgeable about people’s care needs and re-enablement goals their care plan did not provide staff with all the information they would need to know how to support people if they were to solely rely on their care plans. At the time of our inspection the provider was taking action to further improve people’s care plans.

People were encouraged to agree to the care and support being provided. People’s mental capacity had been assessed before staff made best interest decisions on their behalf. 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.

Staff felt trained and supported to carry out their role. Their professional development was being monitored and they were encouraged to undertake additional qualifications in health and social care. People were protected from harm and abuse as staff had been trained in safeguarding people and were knowledgeable about reporting any concerns. There were sufficient staff on duty to ensure people’s physical, emotional and social needs were being met in a timely manner. Safe recruitment practices were being used which meant that people were supported by staff of good character.

Systems were in place to ensure people received their medicines as prescribed. Where medicine errors occurred, the registered manager carried out a full investigation, reflected on their findings and carried out actions to reduce the risk of future errors.

The registered manager was accountable for both Grevill House and Ashley Intermediate Care Centre. Monitoring systems were in place to ensure the services were operating effectively and safely. Internal and external audits were carried out to continually monitor the overall services provided. Shortfalls identified in the monitoring of the services were acted on however more time was needed to ensure concerns relating to people’s care plans would always be identified and rectified promptly. The registered manager was planning to review the auditing and monitoring of the Ashley Intermediate Care Centre to ensure people received safe and effective care.

Further information is in the detailed findings below.

This inspection took place on 5 May 2015 and was unannounced. The Orders of Saint John Care Trust site accommodates two homes which were both inspected during this inspection. Grevill House provides accommodation for 50 people who require nursing and personal care over two floors. Adjacent to Grevill House is the Ashley Intermediate Care Centre which offers intensive support and care for 15 people who require rehabilitation following a hospital stay, before they return home. Both services stand in well maintained gardens.

A registered manager was in place as required by their conditions of registration. 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. The registered manager was not available during our inspection, so we spoke with the head nurse and two of the provider’s representatives. We spoke with the registered manager by telephone after the inspection.

People were protected against abuse because staff knew how to report any concerns of abuse to the relevant safeguarding authorities. Risks for individual people had been assessed. Staff were given guidance on how to best support people when they were at risk of harm. Staff had been trained to support and protect the people they cared for. Policies to protect people were in place to give staff guidance. Staff managed people’s medicines well. They were ordered, stored and administered effectively. People who stayed on the intermediate care unit were supported to become independent in managing their own medicines.

People told us they felt there were enough staff to meet their needs. Thorough recruitment checks and an induction programme were carried out with new staff before they provided care to people. Training plans and systems were in place to ensure people were cared for by staff who received regular training and support from their line manager. Staff told us they were supported.

People’s individual needs were assessed, planned and reviewed. Care records gave staff guidance on how people should be supported and on how their risks should be managed. However, people’s social and mental health needs and goals were not always recorded for those people who stayed on the intermediate care unit. People received additional care and treatment from other health care services when needed. Staff encouraged people to have a well-balanced and nutritional diet. A new chef was responding to people’s views and feedback about the meals.

Group and individual activities were provided in Grevill House however, there were limited opportunities for social interactions in the intermediate care centre. People and their relatives spoke highly of the staff and the registered manager. Relatives told us that any day to day concerns, which they had raised, were always dealt with immediately. Complaints were managed effectively and actions were put in place to prevent the concern reoccurring.

Both services were well led. Monitoring systems were in place to ensure the services were operating effectively and safely. Internal and external audits were carried out to continually monitor the overall services provided.

We did not speak to people who used the service. This was a follow up inspection to check on two compliance actions following a previous inspection. We found that medicines stored in a refrigerator were being kept at the correct temperature. We also found that accurate records were being maintained of pressure area risk assessments.

We spoke to four people who were using the service in the care home and two people using the intermediate care unit. We asked them about the care and support they received. They made positive comments about the service such as, "very nice place" and “I am lucky to live here". We found that there had been improvements to the way that people's weight was monitored since our last inspection in the care home. People told us how they were happy with the way they were given their medicines although we did find an issue with the way some medicines were stored in the care home. We found that both the care home and the intermediate care unit were adequately staffed with arrangements to cover any staff shortages. We found that there were systems in place to monitor the quality of the service provided to people. Although there had been some improvement, we still found some shortfalls with records relating to people’s care in the care home.

We spoke to four people who were using the service and asked them about the care and support they received. They made positive comments about the service such as "I'm very happy here it's very comfortable" and "very nice".

People told us how they received enough help to meet their needs. However we did find examples of where the service was not monitoring people’s weight as planned. We found the environment in both the care home and the intermediate care unit had been well maintained. We looked at staff recruitment and found that required checks had been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as “brilliant” and “civil and gentle”.

We found that the service had an effective complaints system and complaints were recorded and responded to appropriately.

We found some shortfalls with records relating to people’s care and with staff recruitment.

We spoke to people who use the service. They told us about the care and support they received at Grevill House. One person said they were “very happy” with the care they received. One person who had experience of other services described the intermediate care centre as "second to none."

People we spoke to made positive comments about the staff, one person described them as “very good indeed.” and another said that they were "very pleased with the staff”. Staff in the Intermediate care centre staff were described as “all very kind ".

They also told us how staff respected their privacy and how the home was kept clean.