South Hayes Care Home is registered to provide accommodation and personal care for up to 39 older people; the home does not provide nursing care. Accommodation is provided over two floors with lift access. At the time of the inspection 18 people were using the service.

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 ongoing 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.

At this inspection we found the service remained Good.

People told us they felt safe living at the home and were supported to have choice and control of their lives. Staff supported people in the least restrictive way possible, which we observed during the inspection; the policies and systems in the service supported this practice.

There were sufficient staff available to ensure people's wellbeing, safety and security was protected. An appropriate recruitment and selection process was in place which helped to ensure new staff had the right skills and were suitable to work with people living in the home.

Staff had a good understanding of systems in place to manage medicines and safeguarding matters.

Accidents and incidents were recorded and audited to identify any trends or reoccurrences. The home had been responsive in referring people to other services when there were concerns about their health. Staff had a good knowledge and understanding of people's health conditions.

The provider learned from comments received from people and their relatives and used them to improve the service.

Risk assessments were in place for a number of areas and were regularly updated.

The service worked in partnership with other professionals and agencies to meet people's care needs.

Feedback received from people who used the service and their relatives was positive and people were encouraged to contribute their views. People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration. Mealtimes were unrushed and calm and dining tables were nicely presented.

There was an open and transparent culture and people told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed. Staff told us they enjoyed working for the organisation and spoke positively about the culture and management of the service. They also told us that they were encouraged to openly discuss any issues.

There was a homely atmosphere and due consideration was given to the needs of people with dementia. Refurbishment of the building was being undertaken and new en-suite bedrooms were being created. Links to the local community had been made.

Audit and governance systems were in place and operated effectively and statutory notifications were sent to CQC appropriately.

There was an up to date certificate of registration with CQC and insurance certificates on display as required. We saw the last CQC report was also displayed in the premises as per legal requirements.

Further information is in the detailed findings below.

The inspection was unannounced and took place on 24 March 2016.

South Hayes is registered to provide accommodation and personal care for a maximum of 39 people. There were 21 people living at home on the day of the inspection.

There was a register manager in place. A 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 were supported by staff to be safe and protected from the risk of abuse. All staff knew each person which helped them to understand and reduced their risk of harm or abuse. All staff felt confident in recognised the potential signs of abuse and would report these through the senior staff or management at the home. Where needed the team took steps to prevent further harm and make referral to external agencies as required.

People had staff that were available when needed and to meet their care needs. Where people had risks identified as part of their daily living staff supported them to reduce those risks. People told us they received their medicines as prescribed and at the correct time. All relatives we spoke with told us there were enough staff to support their relative and did not have to wait for care to be provided.

People were cared for by staff the who told us their training reflected the needs of people who lived at the home. We saw that all staff provided care and support to people in a confident and caring way. People consent to their care and treatment had been sought where needed. The registered manager and staff had a clear understanding on what to do if they felt people were not able to make a decision on their own.

People had access to snacks and meals throughout the day and night. People told us they enjoyed the meals and were able to make suggestions to the chef about what they would like on the menu. People had accessed other healthcare professionals to support them and had visits from their GP when needed.

Staff developed positive and respectful relationships with people and were kind in their approach. People’s privacy and dignity were respected and were supported to be independent as possible in aspects of their lives. People’s care needs were met quickly and in an unhurried way.

People were involved in the planning of their care and this had been recorded in their care plans. All relatives we spoke with felt they were involved in their family members care and their view and opinions mattered. People’s care plans also reflected their preferences and life histories.

People were happy to raise any concerns or worries directly with the staff who were able to provide solutions or answers at that time. All relatives we spoke with knew how to make a complaint if needed. The registered manger told us they were happy to answer people’s concerns as they happened so they could respond immediately.

People were seen to approach and make request through the day with all staff, including the registered manager. The staff team felt it was important that they were approachable and visible which people and relatives liked.

We spoke with six people who lived at the home about their thoughts on the home. All felt the staff treated people living at the home with respect. One person told us: “They are very good and look after me”. We asked people if they were happy in the home. One person told us: “I am happy here and provided for very well".

People and their relatives were involved in making decisions about their care. We looked at the assessments of people’s care and support needs. We found that people’s choices and preferences had been discussed with them and included in the assessment. Care plans provided sufficient information to ensure staff had clear guidance and information on how to support people and keep them safe.

We looked at the medicines for three people who lived at the home. We found that people had received their medicines as prescribed by their doctors to meet their health needs. One person told us: “They (staff) always give me my medicine, this is important to me".

The provider had procedures in place to listen to people’s complaints so that these could be resolved to their satisfaction. People who lived at the home had no complaints about the suitability and cleanliness of the home. Without exception all people that we spoke with liked their rooms and the lounge, and told us the views were wonderful.

We spoke with people who lived at the home and a relative who was visiting. They said they felt that they were asked about the care that was provided and that their views were acted on.

One person said, “It’s really good. We have residents’ meetings. They sorted the problem out very well. When I say something’s not right, they do something. I like it here.”

Another person told us, “We had a meeting a few weeks ago. I can’t think of anything much that wants doing. There was also a questionnaire, but if there’s anything I wanted to say I’d just say it.”

The relative told us, “I’ve had a questionnaire to fill in. I put something on about drinks and they’ve done something about it. They’ve taken notice.”

People that we spoke with told us they were able to make choices about what time they went to bed and what time they got up. They also said they had a choice of what they would like to eat. One person said that they sometimes chose their lunch the night before but if they changed their mind the next day staff would make any changes without a problem. A relative that we spoke with told us, “Staff have been really patient. They try to involve her in little jobs and make her feel valued and special.” This meant that the service was supporting people in promoting their independence and their right to make choices for themselves.

A visitor we spoke with told us they had been involved in reviews of their relative’s care plan. They told us, “We had a meeting when her needs changed. They involved the psychiatric team to look at the options.” In this way people were involved in making choices about the care and treatment provided by the service.

People told us that they liked living at the home. One person said, “I like it very much. I feel at home”. Another person told us, “It’s smashing. I can’t grumble at anything.” A relative told us, “I’m very pleased with the care my mum and dad had.”

People that we spoke with told us that staff treated them well. One person said, “The staff are very nice, very helpful”. Another said, “The staff are alright once you get to know them.” Another said, “The staff are very, very good. I get full attention.” People told us that staff understood their needs and how to look after them. A relative that we spoke with told us, “The home meets mum’s needs as far as it can”.

People said they usually had enough to do during the day. One person said, “They organise things. You can do it if you want to and not do it if you don’t want to.”

Staff seemed to be busy throughout our inspection. A relative told us “I never see the staff having time to sit still. They’re always on the go.” However this person added, “The staff don’t have the time to sit and be companions to residents.”

People told us they felt safe living at the service and that they knew who to speak to if they were not happy about something. One person said,”I’d speak to the manager or a carer. I’ve never had to make a complaint. I think they’d do something about it.”

A relative we spoke with also told us they knew how to raise concerns. They said, “I feel if I’ve got an issue I can raise it.”

A relative we spoke with told us, “They are always very prompt with medicines. Also, everything is very carefully locked away. Staff will generally stay in the room until they’re sure the tablet hasn’t gone down the side of the chair.”

We found issues relating to the provider’s quality assurance system. The provider did not have an effective system in place to regularly assess and monitor the quality of service that people received.

We spoke with people who use the service as well as some people visiting the home and asked them for their views about the service provided. People were generally positive about their experience at South Hayes. One person told us that the staff are ‘exceptional’ while someone else said ‘they’re very kind to me’ and ‘they are very good.’ Staff were seen to be very busy and this appeared to have an effect on the support provided, including some lack of dignity when communicating with people living at South Hayes. People were having to wait to be taken to the toilet including one person who was calling out for assistance.

Care plans were not always an accurate reflection of people’s current needs. We received differing accounts for where one person needed to have creams applied and records showed inconsistence regarding frequency.

Most areas of the home were clean and tidy with some exceptions. One person told us that they were happy with their bedroom. Due to a problem with the passenger lift the service is currently not using the second floor of the building to accommodate anybody.

Staff had an awareness of their responsibilities regarding the safeguarding of vulnerable people despite the lack of training and outdated procedures.

The storage and recording of administration of medication needs to be improved to reduce the risk of medicines deteriorating and errors occurring.

Procedures need to be reviewed and improved to ensure that all suitable checks and follow ups take place prior to new employees starting work at South Hayes to ensure that people are not placed at risk.