The inspection was unannounced and took place on 18 July 2017.

Pals Residential Care is registered to provide accommodation and personal care for adults who require care and who may have a dementia related illness for a maximum of 14 people. There were 10 people living at the home on the day of the inspection. There was a registered manager in place but they no longer worked at the home. 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.

During our inspection we observed staff were available to provide advice or guidance that reduced people’s risks. The knowledge staff had about people had not been recorded to ensure there was consistent care for people.

People received their medicines as prescribed and at the correct time. However, we found systems and processes needed to be improved. Staff had not always followed safe practices when administering people’s medicines.

Staff had not been provided with training that reflected the needs of people who lived at the home. The training information showed that staffs knowledge had not been updated since 2012. People told us and we saw their privacy and dignity were respected and staff were kind to them. However, on occasions we saw people had not always received support to have their dignity respected.

People had not always been involved in the planning of their care due and have accurate records of their care kept. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs. This information had not always been followed by the staff or recorded.

People had not always been supported to maintain their hobbies and interests or live in an environment that supported their needs. The provider had not been able to review any concerns raised as no records had been kept. Information was not available for the provider to improve the service.

We found quality monitoring systems failed to be operated effectively to ensure risks were identified and mitigated. The documentation was not up to date and accurate and the quality of the service had not been able to improve. We viewed care documentation and found this was not always accurate, complete and reflective of people’s needs.

People told us they felt safe and free from the potential risk of abuse. Staff told us about how they supported people’s safety. People told us there were enough staff to support them. Staff told us they had time to meet the needs of people living at the home.

People told us they liked the staff and felt they knew how to look after them and were included in day to day decisions about their care and support. People were supported to eat and drink enough to keep them healthy, but more support with choices at mealtimes were needed.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 25 August 2015 and was unannounced.

Pals Residential Care is registered to provide accommodation for 14 people who require personal care. There were 12 people living at the home and one person staying for a period of respite. When we visited and 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 that they felt safe and well cared for. Staff were able to tell us about how they kept people safe and received their medicines when needed. Staff were available to meet people’s care and social needs and people received their medicines when they needed them.

People told us they liked the staff and felt they knew how to look after them. Staff were provided with training which they felt reflected the needs of people who lived at the home. The provider needed to demonstrate how they had assessed a person’s capacity when they had acted in their best interest.

People enjoyed their meals and if required had been supported to eat and drink enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were met. People were helped to attend appointments or had appointments arranged with health services which were not available within the home. People told us they had regular visits from their GP or when needed.

People felt staff knew their care needs and they had been involved in their care and treatment. Staff were able to tell us about the care needs of people and how they supported people’s privacy and dignity. People had been involved in the planning of their care and relatives were involved in supporting their family member’s care. The care provided took into account people’s views and input from the people who were important in their lives.

People had been supported with things to do during the day and live in an environment that supported their needs. People and relatives felt that staff were approachable and listened to their requests in the care of their family member.

The provider ensured regular checks were completed to monitor the quality of the care delivered. We found that some improvements in records and medicines were required. The registered manager was available, approachable and known by people and relatives. Staff also felt confident to raise any concerns of behalf of people. The management team had kept their knowledge current and they led by example.

We inspected Pals Residential Care and spoke with two members of staff on duty. We spoke with the deputy manager and the provider. We spoke with five people who lived at the home. We spent time and observed the care and support people received.

We saw that people were respected by staff. Staff asked people if they were happy with them giving care before they gave it. We saw that people appeared comfortable with the staff that supported them. People told us: “The staff are kind here”. “Staff treat us very well”. We saw that staff were kind and caring in their approach to people who lived at the home.

We saw that staff were aware of each person’s needs and how to give care and support to meet those needs. We found that information had been kept up to date and that plans were in place to support staff to make sure they worked in a consistent way.

People were supported with access to additional medical services as necessary to make sure their health and social welfare was protected at all times.

Recruitment procedures were in place and had been followed to make sure that suitable people were employed to work at the home. Staff told us they: “Love working here, everyone is great”.

There was a complaints procedure in place and on display at the home. The deputy manager told us this procedure would be followed in the event any comments or complaints were received.

We inspected the service on 19 April 2012 and identified failings. We requested an action plan describing what actions the provider would take to make improvements.

We received an action plan that stated the improvement actions would be in place and completed by 24 October 2012.

When we inspected this time we found that the provider had met all the action in their action plan which they submitted to us.

Regular meetings were happening between staff and for people who used the service. We saw that staff supervisions were happening and that the majority of staff had received relevant training to support them to provide appropriate care to people who used the service.

People were protected from the risk of abuse as the provider had taken steps to make sure that staff understood types of abuse, knew their responsibilities and knew how to report concerns.

Quarterly review meetings were happening to assess people's care needs and to ensure care plans and risk assessments reflected people's current care needs. We found that records were presented in a way that made it easy for staff to find appropriate guidance on people's care needs and that records were accurate and up to date.

We spoke with people who used the service. One person told us that the care staff were “most helpful” and that when they first visited the home they immediately felt the “nice atmosphere”.

We were given examples by two people who lived at the home of steps taken by staff to ensure they could continue to do the things they enjoyed doing before they came to live at the home.

We spoke with family members who visited their relatives on the day we inspected and by telephone on the day after our inspection. One relative told us that the staff were “so lovely” and that they “can’t do enough”. Another relative told us that staff had “great respect” for the people who lived at the home.

We were told by one family member that their relative had “blossomed” since going to live at the home.

We saw two care staff help a person mobilise and they gave that person advice on how to use their walking frame more effectively.

People were given the choice of where they wanted to eat their meals. We were able to observe a meal time in the lounge, dining area and one person’s room and we saw that people were supported to eat and drink sufficient amounts to meet their needs wherever they were eating their meal. In addition to this we saw a couple of instances where care staff gave a reassuring word to people in a moment of anxiety and this enabled them to continue to enjoy their meal.

We saw people who used the service responding positively to staff throughout our visit.

We did this visit because the local authority told us they had concerns about the way some aspects of care at the home were provided. Following a visit to the home, staff from the local authority had made safeguarding referrals in respect of pressure area care and nutrition.

During our visit we spoke with six people who were using the service, the deputy manager, a member of the care staff, the cook and the owner of the home. We spent most of our time in the communal areas of the house and so were able to see what was happening throughout our visit. We also looked at a sample of care records to check what guidance they contained for staff.

We found that there was a relaxed and friendly atmosphere and that the staff we met were approachable. People living at the home appeared comfortable with the staff who were patient and polite when speaking to them.

We observed that the three care staff on duty spent most of their time with people and that the pace of the day was leisurely. During the morning the staff organised a game of bingo in the sitting room and in the afternoon we saw them playing cards with people and chatting.

The people staying at the home who we spoke with gave us some positive examples of what life there is like for them. One person told us about being able to have a lie in after a late night. Another told us that the staff were good and that they “wouldn’t swop them for a pot of gold”. One of the people we spoke to told us that they were aware of all the bad news about care homes on the news and that Pals was “nothing like those sorts of places”.

We saw that everyone looked well presented, wearing clean clothes and well fitting footwear. Several ladies were wearing colour coordinated outfits and jewellery and some had make-up on. A man we spoke to was clean shaven. The overall impression was that staff had spent time helping people to look their best.

We found some areas where improvements needed to be made. We saw a person being moved in a way which concerned us that they and the staff could be at risk. A conversation about this with the deputy manager identified that staff had not done training in how to move people safely for three years. We observed that a person at risk of pressure sores had been sitting for over four hours without their pressure relieving cushion.

We identified that whilst staff were doing what they could to encourage a person to eat, not enough attention had been paid to ways to improve that person’s nutrition. Recognised nutritional guidance was not being used to help the service make sure people who were nutritionally at risk got the support they needed and kitchen staff were not being fully involved in this aspect of people’s care.