We carried out an unannounced inspection of Stuart House on 9 January 2017.

Stuart House is situated in Weston-super-mare, Somerset and one of the 11 services provided by N. Notaro Homes Limited. Stuart House is located within walking distance of the town and seafront in a quiet residential area. The home is registered to provide residential care for twenty one older people living with dementia, however the provider uses the double bedrooms as singles for a maximum of 19 people. The home also cared for older people living with mental health issues such as Korsakoff’s syndrome (alcohol related brain damage). At the time of the inspection 17 people were living at Stuart House with another person receiving temporary respite care. People were also able to book in for day care.

The last inspection was carried out in July 2014 and we found the service to be compliant with the standards we inspected and meeting all the legal requirements in relation to the regulations.

At this inspection we found the service was still meeting all regulatory requirements and did not identify any concerns with the care provided to people living at the home.

There was 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.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. People were encouraged and supported to maintain their independence.

There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went out. The majority of people were living with dementia and were independently mobile. Staff engaged with them in ways which reflected people’s individual needs and understanding.

People said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. People said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance.

Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said “I don’t have any problems, the manager and all the staff are lovely. “

People were well cared for and were involved in planning and reviewing their care as much as they could, for example in deciding smaller choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on. Staff were present with family when the care planning was discussed, for example some people living with dementia were able to say if they would like a key to their room or not and have input into activities they liked to do. For example, one person liked to go for a swim and told us about how they enjoyed doing that to alleviate their aches and pains.

There were regular reviews of people’s health, and staff responded promptly to changes in need. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their spec

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with five members of staff, nine people who used the service and three relatives. We also reviewed four people’s care records.

If you wish to look at our findings in detail please see the full report.

Is the service safe?

People told us that they felt safe. The environment was clean. There were sufficient numbers of staff on duty to meet the needs of the people in the service. Staff were confident to raise safeguarding concerns to the manager and were able to describe the steps to take if they were concerned that abuse had taken place. The premises were secure from anyone entering unannounced, and care records were retained in secure areas and only accessed by authorised staff.

Is the service effective?

People can be reassured that their needs will be met at this service. Each person had a detailed care plan that described their support needs. Staff had a good understanding of people’s needs and they knew people in the service well. One relative told us, "They’re all very lovely here.”

Is the service caring?

People were supported by kind and attentive staff. We saw that the staff demonstrated a great deal of patience when supporting people. One staff member told us, “We always try to do our best.” We saw that people were not rushed to make their own decisions. A relative told us "We have no concerns at all, because it’s a lovely home.” We saw a survey that had been sent to families was complimentary and positive.

Is the service responsive?

People’s support needs were assessed before they were admitted. The service worked with other agencies to ensure people were supported in the best possible way. Care records reflected people’s individual needs and described staff interventions. People and their relatives were invited to meet with their keyworkers each month to review their care plans where necessary. People had access to activities that were important to them.

Is the service well-led?

The provider had systems in place to monitor the quality of the service being provided. These included feedback by the use of monthly audits, complaints received and surveys issued. All findings were evaluated and actioned. Staff had a good understanding of the aims of the service. All care records we viewed were current. All risks had been assessed, and safeguards put in place where necessary.

We were unable to speak with people in the home due to limited verbal communication. We, therefore, gathered evidence from speaking with staff, relatives and observing care. Relatives we spoke to told us that people who use the service were well looked after and were happy with the service. One relative told us, "It's a small home, so it's able to give individual care."

Meals were well-presented and nutritionally balanced. People ate independently but staff were available to provide support when necessary.

Staff were suitably qualified, skilled and experienced. All the staff we spoke to were happy in their work. One staff member told us "I am happy here, it's nice and really friendly". Staff told us about the training they had received. They were able to demonstrate how they would recognise signs of abuse and assured us they were confident to report any abuse.

The provider had systems in place to assess and monitor the quality of the service provision. Regular audits and patient surveys were carried out to continually monitor the service provision. Any findings were evaluated and actioned upon, in order to improve and develop the provision of services.

During this inspection we spoke with six people who lived in the home and four members of staff.

Some people who lived at Stuart House were unable to comment on the care and support they received. However those people spoken with who were able to comment all told us they were very happy living at Stuart House. One person said, “They are very efficient here, it is run just how I like it”. Another person told us, “I really do like it here and I had a good Christmas”.

We observed staff organised meaningful activities and treated people who lived in the home with respect and dignity.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual.

We found that the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager. The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.