The inspection took place on 19 and 23 August 2016 and was unannounced. We had previously inspected the service in May 2014 and two breaches of regulations were found of the standards inspected. These included potential risk of premises not being safe and maintained and care records not being fully updated. The service had sent us an action plan to show how they intended to meet these regulations. During this most recent inspection, we found the service to be compliant in both the regulations identified during the May 2014 inspection.

Pinehurst is a 23 bed residential care home; when we visited 21 people lived there. It provides accommodation with personal care to older people, but does not provide nursing care.

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.

People told us about the good care they received and were complimentary about the staff. They were confident in the staff’s ability to meet their needs. Staff practice showed people mattered, staff were patient, and they demonstrated empathy in their conversations with people and in how they spoke about them. Visitors said they were confident their relatives received kind and compassionate care from a staff group who knew people’s needs well.

Staff developed positive caring and compassionate relationships with people. People were treated with dignity and respect and their human rights were upheld. We have recommended the service ensures that mental capacity assessments and best interest decisions are fully documented. We saw this working in every day practice, but care plans did not always fully document this. Following feedback on the first day of the inspection, the registered manager immediately began working on this. She had obtained a decision specific mental capacity assessment and was working through each care file to see where this documentation may be needed.

People experienced effective care and support which promoted their health and wellbeing. Staff that had the knowledge and skills needed to carry out their role. People were supported by enough skilled staff so their care and support could be provided at a time and pace convenient for them. Each person’s needs were assessed and care records had personalised information about how to meet them.

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make decisions in their day to day lives. Staff were knowledgeable and had received training and support to do their job competently and effectively.

People said they felt safe living at the home. Staff were aware of signs of abuse and knew how to report concerns. Recruitment processes ensured people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns would be listened and responded to.

People, relatives and staff said the home was organised and well run. The culture was open and transparent. The registered manager had an ‘open door’ policy which staff and people confirmed. Staff worked well as a team and felt supported and valued for their work. The registered manager had worked hard to promote the wellbeing of people living with dementia, both within the home and in the wider community of Ilfracombe. She had been recognised for her work in promoting a dementia friendly town with local awards.

The service had a range of quality monitoring systems, which were well established. Following our feedback, the registered manager said they would update some of the monthly maintenance audits to include checking of window

A single inspector carried out this inspection and it was completed in one day. We saw all of the people who lived at the home and spoke with nine people and three relatives to gain their experiences of the service.

The focus of the inspection was 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.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Comments included "always polite and respectful" and "everyone (the staff) is kind and polite".

The registered manager sets the staff rotas. These take into account people's care needs when making decisions about the numbers, qualifications, skills and experience needed. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. People told us "you just press the buzzer if you need help" and "always enough staff". This helped to ensure that people's needs are always met.

The home had a homely and friendly atmosphere. People told us it was kept clean and tidy. However, we did find that some areas of the home which were unsafe and unsuitable. This was putting people at risk of unnecessary harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring the home is safe for people to live there.

Some systems were in place to make sure that learning from events such as accidents, incidents, complaints and investigations took place. This reduces the risks to people and helps the service to continually improve.

People's care records and risk assessments did not always contain all the information required. This puts people at unnecessary risk of harm. A compliance action has been set for this. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to keeping accurate care records and individual risk assessments.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit it was unclear whether some people required a DoLS referral due to their freedom and choice being restricted. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to this matter.

Is the service effective?

People told us they were happy with the care and support they received and felt their needs had been met. They told us "it's lovely - wonderful", "everything is lovely" and "you could not get a better place". Their health and care needs were assessed and, for those people that were able, they were involved in the reviewing their care or support plans.

Relatives we spoke with told us they were able to see people in private and always felt welcome by staff. This showed privacy was respected

Is the service caring?

People were supported by kind and attentive staff. We observed how relaxed and comfortable people were with the staff group. Comments included "good care X receives from fantastic staff", "cannot fault the carers at all" and "staff are very good - we all like living here".

People benefitted from a static staff group that were enthusiastic, motivated and enjoyed their work. Staff comments included "we all help each other out" and "we are like a family, it's like home and we love coming to work".

"Is the service responsive?

People's needs had been assessed before they moved into the home. Records showed that some people's preferences, choices and needs had been recorded and care/support plans had been provided which detailed their needs.

The service involved specialist professionals when necessary to make sure people received the appropriate care. One health professional commented "the standard of care good".

People knew how to make a complaint if they were unhappy. People, staff and relatives felt they could voice concerns and they would be listened to.

Is the service well-led?

The service had a quality assurance system in place. The management of the home was open and inclusive. People were regularly asked for their feedback on the service or treatment they received - this ensured that improvement was continually sought.

We completed this planned inspection by spending time observing care and support being delivered. We looked at three care plans and daily records in detail and we spoke with staff about their understanding of people's needs and preferences.

We spoke with ten people who lived at the home and with three visiting relatives. Most comments were very complimentary about the care and support received from staff. One person told us ''The staff are all very good. I am quite satisfied. The food is good, staff check we are okay, even at night they do their rounds.'' Another person told us ''I have been here a long time, I can't find fault. It is a very good home. The girls make sure we are all well looked after.'' One person was less satisfied, but when we checked with staff and their records we found they had received the care and support they said was not given.

We saw care and support was well planned and took into account risks. Staff had good training and support to do their job. We spoke with six staff members and they all confirmed they felt supported to do their job and could have their say about how the home was being run.

The home had systems in place to ensure their quality of care was reviewed and took into account the views of people living at the home. The environment was well maintained with health and safety checks, risk assessments and audits being completed to help demonstrate a clean and safe environment for people to live in.

We carried out this responsive inspection in response to some information of concern received via our website 'Have your say' feedback form. The concerns stated, people's needs were not being met, and in particular their continence needs. It also highlighted that hot water was not available in people's bedrooms and that new staff had not been given a proper induction to help them understand their job.

Prior to the inspection visit, we spoke with the local community nurse team who visit people at this home on a regular basis. We also spoke with the commissioning team, who fund placements for people at this home. Health and social care professionals were very complimentary about the care and support people received at this home. We heard that staff ''know their residents well, always call for advice and people always look well cared for, clean and happy.'' During this inspection, most people were out having a Christmas lunch at the local golf club. We were able to speak to two people, who were satisfied with their care and to two staff members. We also check the hot water in most of the bedrooms. We found there to be an issue in two bedrooms, which the provider was already addressing.

We found that people's needs were being met in a timely fashion. We saw that there was written information about their continence needs and support. Regular checks were made to ensure people were kept clean comfortable and their dignity upheld.

We carried out this unannounced inspection on 11 may 2012 as part of our planned inspection programme. We brought forward this inspection as a result of receiving some information of concern around staff issues. We did not find any information to support the concerns during this inspection.

We spent time at the home talking to seven people who lived there as well as four members of staff. At the time of this inspection there were 18 people living at the home with three care staff per shift.

We observed how care and support was delivered through different times of the day. Most people that lived at this service have dementia and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool allows us to spent time watching what is going on in a service and helps us record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us their views. We also spoke with two visiting relatives and two health care professionals.

We looked at some of the key records kept by the home. These included care plans, risk assessments and staff training records. This helps us to better understand how well the home is run.

People we spoke with who were able to share their experiences of living at the service were very positive. Comments included ‘‘I have been here about 12 months now and have settled in very well, the staff are all lovely and I feel very well cared for.’’ One visiting relative told us they visited at different times and different days of the week and were always made welcome. They said ‘’it’s a very happy atmosphere here, the girls work very hard, but are always welcoming.’’

We spoke with one visiting health care professional during the inspection and spoke to another following the visit. Both felt that the service met people’s needs in a timely way and referred onto health care teams for advice and support as needed. One professional commented ‘’People are always clean and tidy, we are very happy with the care and support here.’’

We looked at how well care and support was planned and reviewed. The plans contained good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. Risk assessments were in place to show how the home identify, manage and minimised any risks for people.

We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job, but that some staff were unhappy with changes to the staff rota and did not feel confident that their views had been listened to.

We observed people experiencing positive interactions with staff trying hard to engage people. There are good systems in place that ensured people’s views were listened to and acted upon. The quality assurance system could be enhanced by including a formal process of gaining staff views about the running of the home.

We spoke to nine people who live at Pinehurst during our visit. Most people were very positive about the care and support they receive. Comments included

• ‘I like it very much here, staff are very kind. I ask for various things and they supply it.’

• ‘Very nice here, we have nothing to grumble about.’

• ‘The girls are lovely, I am spoilt’

We also spoke to one visiting relative and was told that they were always made welcome and that they could discuss their relatives care and health needs with staff as they wished.

We observed care and support being given in a caring and respectful way. There were several people who were confused and needed guidance and support throughout the day. We observed staff ensuring they were comfortable and guided to communal areas, for meals and assisted to the bathrooms.

We saw that staff brought hot and cold drinks for people. One person told us they had not had a drink since 6.30am that morning, but we checked with staff and were told that they had been served with at least two drinks throughout the morning and after 6.30am.

People we spoke to said that overall they were happy with the meals provided, and that they could ask for something different to the menu if they so wished. One person told us that the week end meals were not as well cooked as the week day, but that overall they were of a good standard. We saw that the meal offered during our visit was well presented. We saw that people who needed assistance to eat were given this support at a pace that suited them.

Staff that we spoke to said that they were well supported and had good opportunities for training. They were able to tell us about the needs of the people living at the home and how they met those needs.

We saw that some of the records relating to peoples needs were not as well maintained as they should be. This could lead to inconsistent care being delivered.

We saw that medications were not always as secure as they should be. This was in relation to controlled drugs, however when we returned two days later to give feedback to the registered manager about the compliance visit, this issue had been rectified.