Townsend House is a care home without nursing in Oxford. The home cares for up to forty five older 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 39 people were living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

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 G.P's 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.

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.

This inspection took place on 9 July 2015. It was an unannounced inspection. At the last inspection on 26 January 2015 we asked the provider to take action to make improvements relating to people’s care needs, monitoring the quality of service, supporting people to eat and drink, people’s medicines, treating people with respect, staffing levels, supporting staff, records, and safety and maintenance of the premises. The provider sent us an action plan. At this inspection we found action had been completed and improvements made.

Townsend House is a care home without nursing in Oxford. The home cares for up to 45 older people. The home is run by the Orders of St. John Care Trust. On the day of our inspection 39 people lived 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.

People told us they were cared for by staff who knew their needs. Comments included; “They know what they are doing, no problem” and “They meet my needs perfectly. The carers know just how to help me”. Staff had received training and support to meet people’s needs.

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

People were safe. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service reported concerns appropriately and ensured action was taken to protect people.

People received their medicines safely, as prescribed. Staff carried out appropriate checks before administering medicines in a sensitive and discreet fashion. Records were accurately maintained and all medicines were stored safely and securely.

Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe. For example, in relation to pressure damage or weight loss. This promoted people’s health and wellbeing.

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 and staff demonstrated their understanding of the act in their day to day duties.

People told us they were confident they would be listened to and action would be taken if they complained or raised concerns. The service had systems to assess the quality of the service provided in the home and learning was identified and action taken to make improvements. This improved people’s safety and quality of life.

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 registered manager was visible about the home and spoke with people in a caring, familiar fashion.

We carried out this unannounced inspection on 26 January 2015. The service is registered to provide accommodation for up to 44 older people who require personal care.

We previously inspected the service in November 2013. The service was meeting the requirements of the regulations at that time.

People were not always supported in a respectful way. Staff did not always know people well or respect their preferences in how they wanted to be supported. When people were listening to music in the lounge the television was switched on. The music was not switched off and this created a noisy environment. However, people told us they liked living at the home and were treated in a caring and friendly way. People and their relatives were complimentary about staff. People were supported with their personal care discretely and in ways which upheld and promoted their privacy and dignity.

People told us they felt safe and staff were knowledgeable about the procedures in place to recognise and respond to abuse. However, when people presented with behaviour that could be described as challenging, staff did not always respond in an appropriate way. Some people were not protected against the risk of developing a pressure ulcer because staff did not support them to use their pressure relieving equipment.

People were not always protected from risks associated with the environment because the carpet was in a poor state of repair in some places presenting a trip hazard. Doors to electric or storage areas were unlocked. These should have been locked to keep people safe. Some areas of the home were not clean.

Some people did not receive their medicines in line with their prescription. There were gaps and omissions in the recording of medicine administration and replacement stocks had not always been ordered before they had run out.

People liked the food. Mealtimes were relaxed and unhurried. However, people were not always supported to eat and drink enough and some records relating to nutrition and weight were not accurate, completed or reviewed.

Some people told us there were not enough staff to meet their needs and the rotas showed that target levels of staff had not always been achieved. People were not always cared for by suitably skilled staff who had kept up to date with current best practice because not all staff had attended training or received adequate supervision and appraisal.

People were involved in their care reviews and were supported to make decisions about their care. However, some care plans did not provide sufficient instruction to staff on how they should be supported. Where required, staff involved a range of other professionals in people’s care to ensure their needs were met.

The home had a manager in place who was in the process of registering with the Care Quality Commission to manage the service. Although the manager had some understanding of the changes and improvements that were required they did not always demonstrate good leadership skills. Quality monitoring systems to review the care and treatment offered at the home were not always effective. People, their relatives, visiting health professionals and staff recognised that improvements in the service were taking place.

Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Where restrictions were in place for people we found these had been legally authorised.

We found 9 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see the action we took and what action we told the provider to take at the back of the full version of the report.

We spoke with six people using the service. Each told us they enjoyed living at Townsend House and that they received good care and support. People commented that staff were "very helpful and caring" and "they try very hard to help us". 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 accordance with these plans. One staff member told us "we're here to meet people's needs".

We found that staff knew how to report any concerns they had regarding people's safety and that the provider was able to respond appropriately in order to protect people.

People told us there were enough staff to meet their needs. We found that staff were trained and experienced and able to meet the needs of people supported.

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 learning from accidents and incidents.

People told us that they were happy living in Townsend House and that they received good care. Most people said that they enjoyed the meals served and that there was a good range of activities. They also told us that the staff were very good and responded quickly to call bells.

Staff told us that they felt valued, that training, communication and support was good. They said that morale in the home was good.

We found that the service was compliant with the outcomes we looked at during this inspection.