We undertook an unannounced inspection of OSJCT Spencer Court on 30 November 2017.

Spencer Court is a care home without nursing in Woodstock, Oxfordshire. The home cares for up to 46 people who are physically or mentally frail. On the day of our inspection 44 people were living at the service. Many of the people at Spencer Court were living with dementia. The home is run by the Orders of St. John Care Trust.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good overall.

Why the service is rated Good:

People remained safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. Risk assessments were carried out and promoted positive risk taking which enable people to live their lives as they chose. People received their medicines safely.

People continued to receive effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

The service continued to provide support in a caring way. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity. People were involved in decisions about their care needs and the support they required to meet those needs.

People had access to information about their care and staff supported people in their preferred method of communication. Staff also provided people with emotional support.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The service was led by a registered manager who promoted a service that put people at the forefront of all the service did. There was a positive culture that valued people, relatives and staff and promoted a caring ethos.

The registered manager monitored the quality of the service and looked for continuous improvement. “The provider and registered manager promoted a clear vision to deliver high-quality care and support within a positive culture that was person-centred. We observed staff working to these values and in this way throughout our inspection and could see the positive impact it had on people

This inspection took place on 17 September 2015. It was an unannounced inspection. The service had met all of the outcomes we inspected against at our last inspection on 29 July 2014.

Spencer Court is a care home without nursing in Woodstock, Oxfordshire. The home cares for up to 46 people who are physically or mentally frail. The home is run by the Orders of St. John Care Trust. On the day of our inspection 45 people were living at the home.

There was 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.

The registered manager lead by example and had empowered staff with lead roles. Their vision that the service should be the best was echoed by staff.

People told us they enjoyed living at the home and felt well cared for. Comments included: Care is excellent, almost over care if you know what I mean”, “Excellent care, absolutely wonderful. Anything I need doing then they are there on the spot” and “Care is very good. They are very good at caring for you here”. The atmosphere in the home was calm, peaceful and homely.

People told us staff knew how to support them. One person said “They take time to get to know you here. This is the best home”. Staff were supported through supervision, appraisal and training to enable them to provide the high level of care we observed during our visit.

Staff understood the needs of people, particularly those living with dementia, and provided care with kindness and compassion. People spoke positively about the home and the care they received. Staff took time to talk with people and provide activities such as and arts and crafts, games and religious services.

Staff understood how to recognise and report concerns and the service worked with the local authority if there were any concerns. People received their medicines safely as prescribed. Staff assessed risks associated with people's care and took action to reduce risks.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 (MCA) which governs decision-making on behalf of adults who may not be able to make particular decisions themselves. People’s capacity to make decisions was regularly assessed.

People told us they were confident they would be listened to and action would be taken. The service had systems to assess the quality of the service provided in the home. Learning was identified and action taken to make improvements which improved people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

All staff spoke positively about the support they received from the registered manager. Staff told us they were approachable and there was a good level of communication within the home. People knew the registered manager and spoke to them openly and with confidence.

The inspection was carried out by two adult social care inspectors. On the day of our inspection there were 46 people living in the home. As part of this inspection we spoke with eight people who use the service, one relative, the registered manager, and seven care staff. We looked at records relating to the management of the home and ten people’s care records. During the inspection evidence was gathered to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service was safe. People told us they felt safe. One person said, “Yes I am definitely safe.”

People received safe and effective care. People’s needs were assessed and care plans reflected their identified needs. We saw that where risks were identified these had been assessed and appropriate action taken. For example, where people were at risk of pressure damage, pressure relieving equipment was in place.

The home had appropriate systems in place to manage medicines. Care workers told us that they had been trained in administering medicines and their competency had been assessed. We observed staff administering medicines. Staff supported people to take their medication in the prescribed way. There was accurate recording of the administration of medicines. All medication was stored in a safe manner.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and would take appropriate action if a person required a DoLS.

Is the service effective?

We found the service was effective. People were supported in a dignified and respectful manner. We saw that care records were person centred and written with the involvement of the person and their families.

People were supported to maintain their independence. We observed people being encouraged to carry out activities. For example, we saw one person was given responsibility for feeding the fish. Another person told us they had enjoyed planting flowers in the garden.

Care staff were supported through supervision and appraisals. Care staff told us they had access to training and felt well supported by both the manager and the care staff team.

Is the service caring?

People told us they felt well cared for. One person told us, “Staff are very caring. Their patience is endless.” People were supported by caring and attentive staff. We saw care workers encouraging people with patience and understanding. People were not rushed and were able to do things at their own pace.

People were supported in a timely manner, with dignity and respect. We observed one person being verbally aggressive towards care staff. Care staff responded in a positive way, engaging the person in conversation about what they would like for breakfast. When the care staff moved away the person was smiling and chatting.

Is the service responsive?

The service was responsive to people’s needs. People’s care plans reflected their needs and preferences.

Where changes in people’s needs were identified appropriate support from health professionals was sought and changes to care needs met. For example one person had been identified as being at high risk of falls. Referrals had been made to the care home support service and recommendations had been implemented to reduce the risk.

Is the service well-led?

The service was well-led. The provider had systems in place to monitor the quality of the service. These included a range of clinical and health and safety audits, monitoring of peoples feedback and reviews of all accidents, incidents and complaints.

A recent monthly monitoring visit and review had identified that mealtimes were not a positive experience for people. We saw changes had been made to address the concerns. On the day of our visit people were supported in a calm atmosphere.

Complaints were responded to in line with the provider's complaints policy and to the satisfaction of the person raising the concern.

We spoke with five people using the service. Each told us they enjoyed living at Spencer Court and that they received good care and support. One person said "all is well here" with another saying "we're treated very well". We found that people were involved in making decisions regarding their care and support.

People's needs were assessed and plans drawn up to meet their individual needs. We found that people were supported in line with these plans. One member of staff told us "all the staff treat people well, as individuals and people".

We found that staff knew how to report any concerns they had regarding people's safety and that they provider responded appropriately to any concerns in order to protect people. The manager who told us "we report all concerns to the safeguarding team and where appropriate the Care Quality Commission, in line with our policies and procedures".

People told us there were enough staff to meet their needs. We found that staff worked flexibly to ensure sufficient staffing was provided. A staff member told us "there are enough staff and people help out whenever needed".

We found the provider had in place systems to assess and monitor the quality of service provided. We were told of changes that had been put in place as a result of comments and complaints and learning from accidents and incidents.

The inspection was carried out on 6th July 2012 as part of the schedule of visits and included reviewing recent information and comments about the service received by the Care Quality Commission(CQC) .

The last inspection of the service by the commission was carried out in 2008 and we had received routine expected information about the service since that period. During the period from March 2012 to the date of this inspection visit there had been three concerns raised about the home. Two of these were incidents reported by the home to the local authority safeguarding team. The incidents were about inappropriate staff behaviour and medication practices. The third concern was received directly by the commission through the public website. The concerns were about the moving and handling practices of staff, times and quality of meals, times people were got up in the morning and the times they were assisted to bed. The informant also stated about the rudeness of staff.

At the time of the inspection visit 41 people were resident in the home. We met and spoke with seven people who used the service, three visitors to the home, three staff and a representative of the provider’s management team.

People told us that they were very happy with the life they had at Spencer Court. One relative stated that they were glad they had made the decision to place the person they cared for at the home.

People we spoke with gave mixed comments about the staff who supported them or who they came in contact with. We were told that people found staff approachable, friendly and helpful. One person said that staff were “friendly-but not exceptionally so.” The provider should note that two people and one visitor expressed experiences of staff speaking abruptly to them. One person felt that staff rushed mealtimes.

People told us they felt safe living in the home and they were confident that they could make their concerns about the service made known to staff and that they would be addressed quickly.