Pax Hill Residential Home EMF Unit is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Pax Hill Residential Home EMF Unit accommodates up to 26 people with dementia. At the time of our inspection, 15 people were living there. The building had been extensively renovated and areas had been newly built. The building had been thoughtfully furbished using published research into colours suitable for people with a dementia. There were three floors, which provided a mix of communal areas and individual bedrooms.

At our last inspection we rated the service requires improvement in safe and good in all other areas. This meant the service was rated Good overall. We asked the provider to take action to make improvements to staff recruitment and provide appropriate training where staff did not have a good command of English. We also undertook a focussed inspection on 15 June 2017 and found the provider was meeting legal requirements. At this inspection, we found the requirements around recruitment continued to be met. At this inspection we found the service to be Requires Improvement in Well-Led and Good in all other areas. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

Recruitment, staffing, medicine management, infection control and upkeep of the premises protected people from unsafe situations and harm.

Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken. The registered manager worked appropriately with the local authority safeguarding adults team to protect people.

Staff were trained and supported to be skilled and efficient in their roles. They were very happy about the level of training and support they received and showed competence when supporting people.

The premises provided people with a variety of spaces for their use with relevant facilities to meet their needs. Bedrooms were very individual and age and gender appropriate.

Staff promoted people’s dignity and privacy. Staff provided person-centred support by listening to people and engaging them at every opportunity. Staff were very kind and caring and people using the service were calm.

Support plans were detailed and reviewed with the person when possible, staff who supported the person and family members. Staff looked to identify best practise and used this to people’s benefit. Staff worked with and took advice from health care professionals. People’s health care needs were met.

People had a variety of internal activities (such as music therapy) and external activities which they enjoyed on a regular basis.

Relatives’ views were sought, and opportunities taken to improve the service. Staff were supervised, supported and clear what was expected of them.

Audits and checks were carried out in-house, but had not identified the shortfalls we found. Staff needed training about restraint. Although staff knew people well, people did not have clearly written Personal Emergency Evacuation Plans and staff had not taken part in emergency evacuations. We also found the registered manager had informed Public Health England about a suspected outbreak of Norovirus but did not notify the Care Quality Commission. The registered manager took immediate action to address these shortfalls.

People’s legal rights were understood and upheld. People were supported to have maximum choice and control of their lives; the ethos of the home supported this practice.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 05 and 06 April 2016. At this inspection we found that not all of the required information was available in relation to each staff member employed and not all staff were sufficiently competent in English to enable them to communicate effectively with people. This had been a breach of Regulation 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 15 June 2017 to check that they had followed their action plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Pax Hill Residential Home EMF Unit ‘on our website at www.cqc.org.uk.

Pax Hill Residential Home EMF Unit is registered to provide residential care for up to 26 older people who experience dementia. At the time of the inspection there were 16 people living at the service.

The service had a registered manager. 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.

At our focused inspection on the 15 June 2017, we found that the provider had followed their action plan which they had told us would be completed by the 02 May 2016 and legal requirements had been met.

The provider had taken action to ensure that existing staff recruitment files were complete and that the correct information was requested from any new applicants to ensure people’s safety. The registered manager had identified those staff who required support to further develop their English language skills and this was being provided. It will take further time for these changes to become embedded within the service.

The inspection took place on 5 and 6 April 2016 and was unannounced. Pax Hill Residential Home EMF Unit is registered to provide residential care for up to 26 older people who experience dementia. At the time of the inspection there were 19 people living at the service.

The service had a registered manager. 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 provider had completed relevant recruitment checks in relation to staff. However, they had not always ensured that applicants had provided a full employment history or a satisfactory written explanation for any gaps in their employment. Therefore, there was the potential that people might have been placed at risk from the recruitment of unsuitable staff as the provider had not fully assured themselves of their suitability for their role. The provider had not ensured that they had assessed the adequacy of staff’s English language skills. Therefore it could not be established whether staff possessed the required level of competency to be able to communicate effectively with people who experienced dementia.

People and their relatives told us there were enough staff to meet people’s needs. People’s level of dependency was assessed monthly and this information was used to determine the required level of staffing to ensure people’s needs were met safely.

People were safeguarded as staff understood their roles and responsibilities. They had undergone relevant training and had access to written guidance to ensure people’s safety.

People’s relatives told us risks to their loved ones were well managed. Risks to people had been screened, assessed and action was taken by staff to ensure identified risks were managed safely.

Staff who administered people’s medicines had undergone appropriate training. There were processes in place for the safe ordering and disposal of medicines. A staff member was observed not to lock the medicines trolley when administering medicines to people. Although the trolley was always within their sight, there was a potential risk that unauthorised people could have accessed the trolley. This was brought to the attention of the deputy manager who took action to address this with the staff member.

Staff received an induction to their role, training and supervision of their work. The registered manager and the deputy manager had undertaken training in dementia leadership. This enabled them to develop staffs’ practice and improve people’s experience within the service. People received their care from staff who received appropriate support to carry out their role.

Staff had undertaken training on the Mental Capacity Act 2005 and understood the principles of the Act. All of the people accommodated had been assessed as lacking the capacity to consent to their care and treatment at the service. A Deprivation of Liberty Safeguards application had been submitted for each person accommodated as per legal requirements.

People told us they were happy with the food provided and were observed to enjoy their meals. People were offered a variety of nutritious foods and drink across the day which met their dietary needs and preferences.

Staff arranged for people to be seen by a variety of health care professionals as required to maintain their physical and mental health.

People told us staff treated them well. One person told us ”Staff are kind, they treat us properly.” Staff were observed to communicate well with people, using their voice, touch and positioning to facilitate positive communications with people.

People told us staff involved them in making decisions about their care. Staff had access to relevant information about what areas of decision making people were able

The people who used the service all experienced dementia to a varying degree. We spoke with those people who were able to speak with us and used our Short Observational Framework for Inspection (SOFI) tool to observe people’s experiences of the care they received. We spoke with three people and one person’s relative about the care provided by the service. People were positive about the care they received and the interactions we observed between people and staff were positive. People commented “Staff are kind and caring” and “Very nice. No problems.”

We found that staff had sought the consent of people or their representatives to provide their care.

People had care plans and risk assessments in place that identified their care needs and provided staff with guidance about how to meet them. We found that staff were knowledgeable about people’s care needs.

Medicines were administered safely and stored appropriately.

Relevant pre-employment checks had taken place in relation to staff employed to provide the service.

There was a complaints system in place and people had been provided with details of how to make a complaint.