Priceholme is owned and managed by Methodist Homes and provides personal care and support for up to 33 people who are elderly and may be living with a dementia. There were 31 people living at the service when we visited. Priceholme is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

We inspected the service on 15 and 21 February 2018. The visit on day one was unannounced and the second day of inspection was announced.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People we spoke with told us they felt safe, respected and well cared for. Staff showed a good understanding of the processes required to safeguard adults who may be vulnerable from abuse and they were able to explain to us what they would do if they had concerns. We observed staff knew the people they supported well and were able to recognise any changes to people’s physical and emotional health.

People we spoke with were complimentary about the management and staff of the organisation. We found evidence of complaints being made to the service and we saw that these were dealt with in a proactive manner. The service received a number of compliments and commendations which praised the staff and the service delivery.

The registered manager and provider was responsive to people's needs and regularly sought their opinions. This helped ensure people’s rights and diverse circumstances were respected.

Risks to people's health and safety had been identified and risk assessments were in place to identify and evaluate risks which are then managed with guidance for staff through associated ‘support plans’. Regular servicing of equipment, environmental safety checks and checks of services such as gas took place. People's medicines were managed safely.

Robust recruitment practices were in place which included obtaining references and completing Disclosure and Barring checks. This ensured only suitable people were employed.

We observed sufficient staff were deployed throughout the service to meet people's needs. Staff received appropriate training and support to carry out their role Staff received regular supervisions and appraisals from senior staff or management and they told us the manager was approachable and supportive.

Staff worked within the principles of the Mental Capacity Act when providing support to people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Best interest decisions involved people’s representatives when required.

People told us they enjoyed the meals provided and were supported to eat a healthy balanced diet. Where needed, people's nutrition was monitored by staff. People had good access to healthcare professionals to support all of their health needs.

The environment supported people's needs and their personal space reflected their preferences and personalities. People's choices were taken account of when planning their care and they could choose how that care was delivered. Their end of life support needs were considered and planned for with the involvement of the person and their next of kin.

People’s needs were assessed and care plans reflected their care preferences and how they liked to spend their time. People were supported to engage in activities and where they had friends or family they were supported to maintain those relationships in a meaningful way.

Regular checks of all areas of the service were compl

This inspection took place on 26 January 2016 and was unannounced. There were no breaches of regulation at the last inspection on 15 September 2014.

Priceholme is situated in a residential area of Scarborough. The service is owned and managed by Methodist Homes. The home is on two levels and has accommodation for up to 33 people. On the day of our visit there were 32 people in residence. It provides residential care support and is fully accessible to people with mobility needs. Every room has an en-suite bathroom, and there are various communal and secure outside areas which people can access.

The home had a registered manager in place. 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 felt safe and secure at the home. People were supported to engage in a variety of activities and staff had safeguards in place to allow outings and activities to go ahead. For example, they made sure that people were accompanied by sufficient staff. Risk assessments were kept under review and the staff approach was very flexible to allow for changes in circumstances.

Staff were trained in safeguarding adults and understood how to recognise and report any abuse. They had regular updates and held discussions between training sessions so that they could apply their learning to individual people’s care needs.

Staffing ratios were responsive to people’s changing needs and overall dependency levels. This allowed for people to make full use of all of the facilities the home had to offer and to receive person centred care.

People received the right medicines at the right time and these were handled safely. The home was proactive in involving heath care professionals when required.

People told us they thought staff understood their individual care needs well. People were supported by staff who were well trained. All new staff received induction training which gave them details about their work and the expectations on them. Staff also received mandatory training in addition to specific training for people’s individual needs. During the inspection staff expressed an enthusiastic commitment to providing good standards of care.

People’s nutritional needs were met and monitored and they received the health care support they required. People were consulted about their food and drink choices and were supported to express their preferences for meals and snacks. The cook made sure these preferences were included when menu planning. When people needed specialist diets these were prepared and well presented. Meals were seen as a social event. Tables were set attractively and people sat in social groups they felt comfortable in. Special meals, themed meals and celebration meals featured regularly on the menu.

The registered manager and staff were clear about their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were proactive in their approach to supporting people to make informed decisions about their care and lifestyle.

Staff had developed positive relationships with people and were warm, kind and caring in their approach. People’s privacy and dignity were respected. People were supported to be as independent as possible in all aspects of their lives. Care plans reflected individual care needs and were sufficiently detailed for staff to understand how people wanted their care delivering.

People were supported to take part in activities which they found both meaningful and enjoyable.

Families and friends had made comments about the positive experiences people had at Priceholme, including end of life care. People were encouraged to complain or raise concerns. However, no complaints had been received in the last twelve months.

Systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement. Staff told us that overall the management team supported and listened to them and tried new ideas to improve the quality of service. Communication at all levels was clear and respectful.

At the time of the inspection there were twenty nine people living at the home. We talked with people who used the service and we observed their experiences to support our inspection. We spoke with the registered manager, five care staff, two district nurses and one relative.

We considered our inspection findings to answer questions we always ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

We saw the service was safe, clean and hygienic. The home had effective systems for the prevention and control of infection. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and how they would manage an outbreak at the home so the risk of infection spreading could be reduced.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. All the people we spoke with told us they felt safe. One person told us, “They are very good here and I feel safe.” Another person told us, “I know how to complain if I am not happy or worried. I do feel looked after and safe.”

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). They told us they had received training in making an application and showed us the policy and procedures they followed. They told us some staff had received relevant training and had access to the policy and procedures. Those staff told us they had received this training.

Is the service effective?

We saw how people were involved in their care and treatment. Care staff told us they worked closely with people. One staff member told us, “We treat everyone as an individual. Person centred care is about working to support each person in the way they would like, and everyone is different”. The staff told us they always try to respond to people in the service and gain an understanding of what they want and how they work very closely with people’s families.

All the people had a keyworker who supported them with their care and welfare needs. One person we spoke with told us, “I have a lovely keyworker. If I need anything I will just ask her.” Staff told us how they supported people and told us they needed to be flexible and responsive as people’s care and support needs can change.

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, “If I need any help, advice or support I can speak with the manager or a senior member of staff at any time. They are very supportive.” The staff told us they had regular staff meetings. They all told us they felt supported by the manager and could approach them at any time for support or to raise any issues or concerns.

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. People were not rushed when care was delivered and we saw staff interactions with people were caring. One relative we spoke with told us, “The care my mother has received is beyond compare. I can’t tell you how happy I am with the care and love she receives here.”

We saw staff treated people with respect and dignity. All the people we spoke with told us they were very happy with the care they received.

Is the service responsive?

We saw staff would respond to any requests for support. The two district nurses we spoke with told us the staff were very supportive. One of them told us, “The care in here is remarkable. They are always so helpful when we visit.

People’s care needs had been reviewed at least every month. We saw when people's requirements had changed the provider had responded appropriately and reviewed the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

The service had a registered manager in post who showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been taken into account.

We saw the home had systems in place which ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place.

When we spoke with people who used the service they told us they were very happy with the support they received. One person told us “They are ever so kind. I feel genuinely cared for”. Another person told us “I have been happy with the care so far. They have helped me in all the right areas. They are very obliging and work very hard, they answer the call bell quickly”.

Care plans were detailed, person centred and regularly updated. When people required assistance or input from other services staff were timely in seeking this and followed guidance and advice closely.

The environment was well maintained and provided a homely and comfortable place for people to spend their time.

Staff were recruited safely and were given a full induction before starting work on their own.

There were comprehensive and robust quality assurance systems in place and people who used the service and staff were given chances to feed back about their support and life in the home through meetings and questionnaires.

During our inspection we looked at records and documentation for people using the service. We saw that consent to care and treatment was regularly obtained both verbally and in written form. People we spoke with told us that staff always asked before carrying out any care.

We saw that there was a wide range of activities for people to take part in, and various opportunities for people to be involved in the development and changes in the home. We looked at care plan documentation for people which was detailed and up to date. The plans were regularly reviewed with the full involvement of the person.

The service was found to be clean and hygienic and infection control procedures were being followed by staff. People using the service were happy with the level of maintenance of the home.

Staff were given many opportunities to complete training, and there was a robust system in place for the supervision and support of staff.

There was a complaints procedure, as well as other monitoring processes in place to ensure that any issues were addressed quickly and appropriately. The service was maintaining up to date and accurate records for staff and resident’s and these were stored appropriately.

People liked living in the home, and were happy with the standard of care and support they received. One person who used the service told us “It’s a bit like a first class hotel”.

During the visit people who use the service said that they had made their own decision to be admitted to the home. They found that they are able to follow their own routines and that staff support them in a discreet manner. They have care plans and these documents are reviewed every month. People are able to influence what happens in the home through the residents meetings and by going to speak to the manager or deputy manager. They said that they are treated as individuals. People said 'it was alright living here' and 'the food is like what you would have at home’