We inspected Sotwell Hill House on 8 November 2016. This was an unannounced inspection.

Sotwell Hill House is a care home providing accommodation for people requiring personal care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 29 people living in the service.

We carried out an unannounced comprehensive inspection of this service on 4 and 6 November 2015. Breaches of legal requirements were found relating to the management of risks to people and the safe management of medicines. We also found that care and treatment was not always provided with the consent of the relevant person. The provider sent us an action plan stating the action they would take to improve the service to the required standard. We undertook this comprehensive inspection on 8 November 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. At this inspection we found actions had been completed and improvements made.

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.

We were greeted warmly by the registered manager and staff at the service. The atmosphere was open and friendly.

People told us they felt safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they understood how to recognise and report safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed.

There were sufficient staff to meet people’s needs. Staffing levels were consistently maintained. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act 2005 (MCA) and all staff applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed the food and had enough to eat and drink. Where people required support with their food and drink they were supported appropriately.

The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

People told they enjoyed activities in the home and the provider provided a range of activities for people to engage with. This included religious services and trips outside of the home.

Staff spoke positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People and their relatives told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positivel

During this visit we spoke with eight people who use the service, three relatives, a visiting professional and three relatives. There were 29 people residing at the home on the day of our visit. We looked at two outcomes that were previously non compliant and three additional outcomes.

We found assessments and care plans detailed people’s preferences and choices. One relative told us “they were wonderful here they discussed everything with us”. One person told us “I knew all about this place before I came, it is most acceptable the staff are very nice, very pleasing”.

We found improvement in the way staff were supported and trained to enable them to deliver good care. One care worker told us “we have supervision at least every six months but I can raise any issues when I need to and the management will always listen to any problems we may have”.

We found the service had quality assurance methods in place which involved people, to make sure they maintained and enhanced the quality of the service they were providing.

We saw good arrangements in place in relation to medication procedures. One care worker told us “we are all trained and medication is all very well checked”.

We found improvements in how the service monitors and improves its’ quality. People we spoke with were happy with the service and knew how to complain if they had a concern. One person we spoke with told us “I would go to the Manager if I had any complaints but I have never had any”.

We observed that staff were very attentive, talking to people and showing interest. Staff and the people who used the service were sharing stories and joking together. It was clear that relationships were very positive. One person told us ‘the thing that is so great is it’s so homely here, really comfortable. The staff are really lovely’.

Care plans detailed a person’s support needs in clear sections such as mobility, dressing, personal care, appetite. Risk assessments used a traffic light system, red amber, green to indicate the level of risk and enabled staff to understand the level of support required.

We heard that people were protected from abuse. Staff had done safeguarding training and were aware of how and when to raise an alert. People and their relatives felt they were safe. One person told us “I feel very safe here. I've never felt worried or uncomfortable about anything."

We found that supervision was not regular. This meant that staff may not have had proper guidance to provide good care to people. Although some staff we spoke with felt they could talk to the manager, a lack of formal supervision meant that these discussions were not recorded and action taken was not evident.

We saw that, although the home had a number of ways in which they gathered views about the quality of the service, there was no evidence that the information had any impact on the care provided. This was because no action was identified following collection of information.

People told us that they were very happy living in the home. We were told that they received the personal care and support that they needed. Comments included, ”I really like it here” and, “The home’s very nice and I get the help that I need.”

People also made comments about the activities that the home provided. These included;

“They take us out which is very nice,” and “I enjoy the meals and activities and being part of the ‘family’.”

People living in the home provided some very positive comments about the staff who supported them. These comments included, “Excellent,” “Couldn’t ask for better,” and “Staff couldn’t do anymore for you, they make it excellent.”

We carried out our inspection on 4 and 6 November 2015. This was an unannounced inspection.

The service had a registered manager who was responsible for overall management of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated regulations about how the service is run.

Sotwell Hill House is a care home providing accommodation for people requiring personal care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 32 people living in the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS enable restrictions to be used in a person’s support, where they are in the best interests of a person who lacks capacity to make the decision themselves. The registered manager had made appropriate referrals to the supervisory body. However where people lacked capacity to make decisions the registered manager was not always acting within the principles of the Mental Capacity Act (2005).

People were positive about living in the home and felt safe. People were complimentary about the staff and felt they were treated with dignity and respect. People enjoyed the activities organised in the home, which included trips out.

Throughout the inspection there was a calm, cheerful atmosphere. People laughed and chatted with staff and requests for support were responded to in a timely manner. The registered manager was visible about the home and took time to speak with people and staff.

People felt there was not always enough staff and had to wait to be supported. The registered manager was actively recruiting and employed agency staff when needed.

Medicines were not always managed safely and people were not always receiving topical medicines as prescribed. Risks to people, associated with swallowing difficulties were not always managed safely.

Staff were well supported by the registered manager through regular face to face meetings. Staff had access to training and development opportunities to ensure they had the skills to meet people’s needs. Staff felt valued and listened to and were involved in developing the service.

Systems in place to monitor the quality of the service were not always effective. Audits were carried out but had not identified the issues we found during our inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the end of the full version of the report.