This inspection took place on 8 and 10 November 2017 and was unannounced. The home provides accommodation for up to 25 older people with personal care needs. There were 21 people living at the home when we visited. All areas of the home were accessible via stairs equipped with electric stair lifts and there were lounges/dining rooms on the ground floor of the home. There was accessible outdoor space from the ground floor.

There was a registered manager at the home. 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 registered manager was dedicated and passionate in their role. They knew people’s needs well and were prominently involved in the day to day running of the service. Staff were friendly and patient in their approach with people and understood about their preferences, routines and the support they needed to maintain important relationships.

Staff were aware of their responsibilities in keeping people safe from harm and treated people with dignity and respect. People were encouraged to be as independent as possible and the service provided a range of activities to keep people stimulated and active.

The service was accessible and comfortable for people. There was access to a range of communal and garden spaces which people were free to use. There was a friendly, warm atmosphere at the service which encouraged people to make friends and participate in events and activities run by staff

Staff understood the need to gain consent and followed legislation designed to protect people’s rights and freedoms. Staffs understood people’s individual needs and were able to make adjustments to ensure these needs were met. Where people received care at the end of their life, they were fully consulted and given choices about the care that was provided.

There were sufficient staff to meet people’s needs and senior staff were available to provide extra support in the event that people required additional help. The provider had recruitment processes in place to help ensure suitable staff were employed and there was a training, induction and programme of supervision in place once in their role, which helped staff remain effective.

Risks to individuals were assessed and monitored. When incidents took place, the registered manager reflected on the events to ensure learning was embedded for future practice. People were supported to access healthcare services when required. The service had a good track record of working with different stakeholders in order to ensure people’s needs were met.

People told us they enjoyed the meal time experience at the service. There was a chef on site, who took the time to engage people in suggesting menu options to provide a varied and nutritious provision of food. People were monitored and encouraged with their eating and drinking where required and concerns about their health were quickly followed up with referrals to relevant professionals.

The registered manager sought feedback about the service in order to make improvements. There were examples were suggestions from people, relatives and staff had resulted in the implementation of changes to improve the service. There was a complaints policy in place which people felt comfortable using if they had concern.

The registered manager monitored the quality and safety of the service through a series of audits about key areas.

This inspection took place on 29 May and 04 June and was an unannounced inspection. At our last inspection in January 2014 no concerns were identified.

Stoke Knoll is a care home which provides accommodation and care for 25 older people, some of whom were living with dementia. At the time of our inspection they were fully occupied and held a waiting list for people who had requested to move into the home.

There is 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.

The provider had policies in place to provide guidance for staff in most topics. Whilst these had been reviewed recently, we found not all of the policies were amended to reflect legislation and care Practices. For example the provider’s safeguarding policy did not refer to the local authority’s latest safeguarding policy. There were no updates to the policies on the Mental Capacity Act or Deprivation of Liberties Safeguards.

People and their relatives felt safe with the support provided by staff in Stoke Knoll. Staff were aware of the local authority and provider’s safeguarding policies and guidance. They knew how to identify concerns and were aware of who they should report these to within the home and to external agencies. Recruitment processes helped ensure staff were suitable to work with older persons. There were sufficient numbers of staff to meet the needs of the people in the home.

People were supported to take their medicines safely by staff who had been trained to administer them appropriately. Staff were tested on their knowledge of the medicines they were giving and were observed by the registered manager for their competency in administering medicines. Storage and security of medicines was as stated in the provider’s policy. Appropriate actions and learning had occurred from a medicine error.

Staff received appropriate training to support the care they provided. There was an induction process in place for new staff which provided them with the necessary knowledge to support people in the home. Supervisions for staff occurred regularly and identified good practice and development needs for staff.

People’s needs were assessed and their care plans reflected the needs identified in the assessment. Where there were risks associated with care required, these had been assessed and measures were put in place to remove or minimise the potential risk of harm to people.

Staff and the registered manager worked in a personalised way and were aware of people’s individual likes, dislikes, histories and personal preferences. They found time to engage people in conversations and joined in activities with them. Staff treated people with dignity and respect and we heard terms such as ‘treated like one of the family’ and ‘this is their home.’

People were happy with the quality of the food and were able to request changes to the menu and options for their meals. Where people required it, food and fluid intakes were monitored and they were weighed regularly. Health support from GPs and other health care professionals was available and the registered manager worked closely with the local doctor’s surgeries to ensure people’s health needs were met.

People and their relatives had a good relationship with staff. There was a relaxed and friendly atmosphere in the home and people. People were happy with the care they received from staff. They were supported to express their views regularly by talking with staff and regular reviews of their care plans. People’s privacy and dignity was respected by staff who knew how people liked to be spoken to and were informed of how care was to be given.

The provider had a complaints policy which was accessible for people in the home. Complaints and concerns had been recorded and there were actions identified to alter aspects of care and the service following these. The provider acted within their policy in responding to a complaint and ensured a resolution to the complaint was to the person’s satisfaction.

The registered manager and provider were known to all people, relatives and staff. They were approachable and engaged in aspects of care which maintained their knowledge and understanding of people’s needs. They were aware of current trends and legislation changes within older person’s care and had taken action to adapt the environment to support people’s needs.

At the time of our inspection there were 23 people using the service. The manager told us 18 of them were living with dementia. We spoke with five people using the service, two visitors, seven members of staff and the manager. Comment cards were returned by five relatives of people using the service and one visiting healthcare professional.

All the people we spoke with were satisfied with the care and support they received. Comments on returned comment cards included “always impressed by care and compassion and respect for dignity” and “my mother has had really good care since arriving at Stoke Knoll”. A relative commented that staff were responsive to people’s needs, “The staff are very caring and relate to [the person] well.”

We found people were supported to access a range of services to ensure their health and welfare needs were met. Staff were responsive and caring, and committed to providing care that met people’s needs. Systems were in place to monitor and assess the quality of service provided.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The deputy manager was managing the regulated activity and they are referred to as “the manager” in this report.

There were twenty people living at the home at the time of the inspection. Throughout the day we saw that staff were communicating with people at a suitable pace, were relaxed and unhurried during their interactions.

The manager and staff were aware of people's likes, dislikes and abilities and through observation, discussion and review of individual records we saw how these were appropriately supported.

During previous visits to the service gaps had been identified in the care records. We looked at six care records. We found minor inconsistencies in person identifiable information and missing dates but saw that the records were person centred, they provided basic personal information on the persons assessment of needs, preference's, likes and dislikes and daily activities. They also provided structured information on care needs and what actions staff needed to take in order to meet people’s needs with regards to their health and welfare.

Everyone we spoke with at the home confirmed that the staff were caring and kind; three people added that they "felt safe and happy.” A visiting professional told us that “staff are very welcoming and open.”

People we spoke to told us that they were regularly asked if they were happy with their care and said “I wouldn’t hesitate to tell them if it wasn’t.” One person spoke at length about their life in the home and said “I could not ask for anything better.”

People told us they were happy living at Stoke Knoll Rest Home and they enjoyed the activities provided.

They told us staff provide the support and care they need including arranging for them to see their GP when they are not well.

People told us they were happy living at Stoke Knoll Rest Home and they enjoyed the activities provided. But some told us there is sometimes not a lot to do at the home and they get bored.

They told us staff provide the support and care they need including arranging for them to see their GP when they are not well.