The Close Care Home is a care home providing personal and nursing care for up to 90 people with a range of conditions. At the time of our inspection there were 84 people using the service. The accommodation is divided over four units. Two registered managers were jointly responsible for the management of the service. There were extensive, attractive grounds that were easily accessible for people to enjoy. There was a Bistro that formed a central social space which was enjoyed by people and their relatives.

The management team promoted an extremely caring, person-centred culture through their interactions with people, relatives and staff. The management team and staff put people at the centre of everything the service did. The provider was clearly passionate about providing a high quality service. The management team were visible throughout the inspection, talking with people, relatives and staff. It was clear they took time to develop trusting, positive relationships with everyone they spoke with.

Staff supported people in a caring way, showing kindness and compassion at all times. People were treated with dignity and respect and staff understood the importance of promoting people's independence. People were supported to maintain and improve their health and well-being.

The management team ensured people felt cared for. Feedback from people was sought to ensure they were able to influence improvements to the service.

Staff felt valued and supported. Staff were confident to approach any of the management team and were certain they would be listened to and any concerns addressed. There was a positive atmosphere throughout the home that demonstrated the open and transparent culture staff spoke about.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Food was appetising and well presented. Where people had specific dietary needs these were met. People were supported to access a range of health professionals when needed.

People felt safe and were supported by staff who understood their responsibilities to identify and report any concerns relating to safeguarding. Risks to people were assessed and there were plans in place to manage the risks.

We inspected The Close Care Home on 6 January 2016. The Close Care Home provides residential and nursing care for people with a range of conditions, this includes people with dementia. The home offers a service for up to 90 people. At the time of our visit 72 people were using the service. This was an unannounced inspection.

At our inspection on 14 May 2015 we found the service did not always support people in line with the principles of the Mental Capacity Act 2005 (MCA). We also found medicines were not always managed safely. Following our inspection we asked the provider to send us an action plan telling us how they would meet the regulations.

At this inspection we found improvements had been made and the provider had taken steps to meet the required standard. However we found another area where improvements were required.

Since our last inspection the provider had completely restructured the management team in the home. Three home managers had been appointed; this consisted of two clinical home managers and a non-clinical manager. One of the clinical managers had applied to CQC to become a registered manager. The second clinical manager was in the process of submitting their application. 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, relatives and staff were complimentary about the new management team. There was a calm, relaxed atmosphere throughout the day. The management team were approachable and promoted an open culture that put people at the centre of everything that happened in the home.

Health and social care professionals were positive about the changes made at the home and care provided. They were complimentary about the skills and knowledge of the care team.

Care records contained information relating to people’s preferences and people were given choices about all aspects of their care. However care records were not always up to date and fully completed.

There was a range of activities available to people throughout the day, these included both individual and group activities. People enjoyed the activities and individual interests were identified to ensure people had access to activities that interested them.

People were extremely complimentary about the food and were given choices at each meal. Pictorial menus were available to support people to make choices. Food looked appetising and people were supported to eat and drink in a respectful, dignified manner.

Staff felt well supported and were positive about changes made to one to one meetings with their managers. The changes meant staff were encouraged to identify their own development needs. Staff were knowledgeable about the people they supported and had a caring attitude.

The provider was committed to improving the quality of care at The Close. A comprehensive audit had been carried out by an independent consultant to identify areas where improvements could be made.

We inspected The Close Care Home on 14 and 15 May 2015. The Close Care Home provides residential and nursing care for people with a range of conditions.

, this incudes people with dementia. The home offers a service for up to 90 people. At the time of our visit 63 people were using the service. This was an unannounced inspection.

At previous inspections of this service on 30 May 2014 and 22  November 2014 we found there were not always sufficient staff to meet people's needs. In addition we found people were not always treated with dignity and respect and the provider and registered manager did not have effective systems in place to monitor and improve the quality of the service.

Following our inspection on 11 November 2014 we issued a warning notice to the provider and registered manager to tell them they must take action around staffing levels to ensure there were enough staff to meet people's needs. Additionally we asked the provider to send us an action plan telling us how they would meet the standards relating to the other areas of concern.

At this inspection, in May 2015, we found the provider had taken action to address the areas of concern and bring the service up to the required standards. However, there were still some further areas where improvements were required.

Since our inspection on 11 November the registered manager had left. 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. At this inspection a new manager was in post. The manager was in the process of applying to be the registered manager with CQC.

People's needs had been assessed and where risks were identified risk assessments were in place. Staff were knowledgeable about people's needs and provided care in line with risk assessments. However, people's medicines were not always managed safely.

People were supported by staff who were kind and caring. The atmosphere during our inspection was calm. People were supported in a respectful manner and requests for assistance responded to promptly. However, the provider was not always adhering to the principles of the Mental Capacity Act 2005 Code of Practice. The Mental Capacity Act 2005 ensures that where people lack the capacity to make decisions, any decisions made on the person's behalf are made in their best interest.

The manager had made applications where people were being deprived of their liberty, these had been completed in accordance with the Deprivation of Liberty Safeguards. A Deprivation of Liberty Safeguard allows a person to be legally deprived of their liberty where it is considered to be in their best interests. The manager had identified there were further applications needed.

People had access to a range of activities. We saw people enjoying activities in the home. People were positive about the activities and there was an enthusiastic atmosphere when activities were taking place.  

People told us they enjoyed the food. There was a choice of food and people could make individual requests if they did not like the menu. Pureed food looked appetising and people's individual dietary needs were met.

People, their representatives and staff spoke positively about the improvements that had been made and the new manager. The management had introduced a number of changes to improve systems monitoring the quality of care people received. These systems had identified most of the issues we found during our inspection and action was being taken.

Staff felt well supported and had regular supervision. Staff had attended training and were being supported by the manager to attain social and health care qualifications.

The provider was not always sending notifications to CQC as required by the conditions of their registration. We have made a recommendation regarding their responsibility to send notifications. 

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

This inspection took place on 11 November 2014 and was unannounced.

The Close Care Home is situated in Burcot, near Abingdon in Oxfordshire. The home is registered to provide accommodation, nursing and personal care for up to 90 people. The home is divided in to four units. River View unit supports 20 people living with dementia, Willow unit supports 33 people with nursing and care needs, Dorchester unit supports 29 people with nursing and care needs and Clifton unit supports eight people with acquired brain injuries. On the day of our visit there were 74 people using the service.

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 and associated Regulations about how the service is run.

At our inspection on 30 May 2014 we found breaches of regulations relating to how people’s care and welfare needs were met. We also found breaches relating to staffing and systems relating to assessing and monitoring the quality of service. Following that inspection the provider sent us an action plan to tell us what improvements they were going to make. They told us these improvements would be made by 16 July 2014.

During our inspection on 11 November 2014 we looked to see if improvements had been made. We could see that some action had been taken but further improvement was needed in the level of staffing, the way care was delivered to people to promote their welfare and the quality assurance systems. We also found additional areas of concern in relation to the services ability to safeguard people from harm, how staff were supported in their roles and how people were respected and involved in their care. We have also made a recommendation in relation to The Mental Capacity Act 2005.

Although people told us they felt safe we found staff did not always report concerns and the provider did not always respond appropriately to concerns when they were raised. We found that staffing levels were not always sufficient to meet people’s needs. Staff did not have time to spend with people which put them at risk of social isolation.

We observed some interactions where staff showed kindness and understanding; however some people were not supported in a way that respected them. People were not always given choices. When people were given choices, staff did not always respect their choice.

Although the home had taken steps to provide social interaction, people told us they were not always able to take part in activities that interested them. Some people wanted to go out into the grounds of the home but told us this did not often happen.

Staff told us they were not supported through a system of regular supervision and appraisal. Several staff had not had training in dementia care.

The service had systems in place to monitor the quality of the service but did not use the results to look for trends and to improve the quality of care.

People, relatives and staff reported concerns over the management and leadership within the home. The culture did not promote openness and transparency. Staff described morale as low and relatives told us this was impacting on care the provided.

You can see what action we told the provider to take at the back of the full version of the report.

On the day of our visit 89 people were using the service. They were supported by a combination of 17 care workers and nurses, waitresses, house keepers, the deputy manager, the registered manager and the operations manager. The home had four units that provided residential and nursing care, support for people living with dementia and support for eight people with acquired brain injury. We spoke with seven people who used the service, three relatives and eight care workers. We also spoke with the deputy manager, the registered manager and the operations manager. Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The service was not always safe. There was not always sufficient numbers of care workers on duty to support people. People told us they did not think there was always enough care staff on duty. One said “there’s not enough staff all the time, especially weekends." A relative said "staff are brilliant, under a lot of pressure, working long hours. There are a lot of elderly residents sat in the lounge and no one is around." We saw that actual care staff levels often fell short of planned care staff levels.

The provider checked, as far as possible, that care workers were of good character. At least two references were sought, one being from the last employer, before care workers started work. Disclosure barring Service (DBS) and criminal Records Bureau (CRB) checks were also conducted.

People were safe from the risk of abuse. People told us they felt safe and care workers demonstrated a good knowledge of the risks of abuse and what to do if they suspected abuse was happening. The provider had a safeguarding policy that gave clear guidance to care workers on what steps to take if they suspected abuse. We also saw evidence that, where appropriate, the provider informed and worked with Oxfordshire County Council (OCC) regarding alerts.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. During our visit we saw two DoLS applications that were complete, correct and up to date. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the service effective. People told us they enjoyed being at the home and felt well cared for. One said "the rooms and facilities are excellent and the food has improved of late". Another said "I like it here. I have no complaints". However one relative said "it can be the small things like having the wrong glasses on, dirty washing found in the wardrobe”.

Care workers had been appropriately trained to carry out their roles. All care workers undertook a period of induction training before starting work. This included food hygiene, safeguarding vulnerable adults and infection control. All the care workers we spoke with had a good understanding of the people they cared for and their needs. We observed care workers working throughout out visit and saw they were committed, professional and effective.

Is the service caring?

We found the service was caring. People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. For example, we observed the lunchtime meal. Care workers assisted people to eat their meals in a caring and patient fashion. They sat next to the person and worked at the person's pace. They offered choices and gave praise and encouragement that engaged people. Drinks were regularly offered and people clearly enjoyed the experience. Care workers spoke to people in a respectful manner and took time to listen to what they had to say. This showed us that people were treated with dignity and respect.

Is the service responsive?

We found that the service was not always responsive. For example, complaints were recorded and dealt with in line with the provider’s policy on complaints. However some complaints had not been recorded. The manager told us they were dealt with verbally as they were of a minor nature. We asked if there was a system in place to allow oversight of complaints to enable them to investigate them collectively and look for patterns and trends. We were told there was not. This meant that patterns and trends within complaints could not be readily identified and addressed and could not be used to inform the delivery of service. This could have a negative impact on people who used the service.

We saw there was very little in the way of activities for people. We looked at the activities programme for the previous week and saw that on two days there were no published activities. Two days had limited activity in the afternoon and two evenings had planned games or bingo. The operations manager told us that the activities co-ordinator had left and they were recruiting four "life skills support workers." This could have a negative impact on people's daily lives.

Is the service well led?

We found that the service was not always well led. There was a registered manager in post and a new operations manager who was applying to become the nominated individual for the service. They told us that the management team was implementing a series of changes to improve the service. However, at the time of our visit not all the changes were in place.

Accidents and incidents were recorded. We asked the registered manager if there was a system in place to collectively review and investigate accidents and incidents as we could not find one. They said there was no such system in place. This meant that learning from such events could not be acted upon or shared.

There was no system in place that consistently allowed the manager to check that care plan reviews had been carried out. We could not find a system that identified actions or issues within the reviews. This meant that the manager could not check that people’s care plans were up to date.

People were involved and their choices listened to. We conducted a Short Observational Framework for Inspectors (SOFI) exercise within the home's dementia care unit. People living on this floor had a diagnosis of dementia and required nursing care. We noted that people experienced care and genuine respect from care workers.

Relatives that we spoke with told us they were happy with the care provided to their relatives and had no complaints.

One relative told us "my mother seems genuinely happy here. The carers spend a lot of quality time with the residents". Another relative told us "we can't fault the care that people receive here, all the staff are marvellous".

We spoke with nurses and care workers on each of the four unit. All expressed their satisfaction of working in the home and all felt there were sufficient numbers of staff on duty. One care worker told us "if we are short of staff then the manager will bring in agency staff, this doesn't happen much".

People we spoke with said the manager visited each day to ask if they were alright. People told us the manager was approachable and would listen to their concerns or worries.

People told us they were confident that their records were accurate, remained confidential and were stored securely. We looked at a sample of daily records on each unit. Daily records were comprehensive and completed daily or more frequently if needed, clearly detailing the care provided to people on a daily basis.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practicing professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person we spoke with said they liked being at The Close Care Home. They said ''there are very high standards here.'' A visitor told us a priest visits the service, which was very important to her relative.

People spoken with said they had enjoyed their lunch. One person said it was ''a nice meal'' and they were able to manage to cut and chew the food without any problem. They said that was important because they had suffered a stroke. Another person told us ''lunch was very nice.'' One person commented ''the meals are really delicious and I always finish my plate.''

Three relatives and two people using the service that we spoke with said they knew how to raise any concerns.

People we spoke with said they were satisfied with the support they received from staff in meeting their personal care needs.

One person told us that they came into the home for respite care and support and they liked it so much they had decided to stay.

People said they liked living in the home and they thought that their needs were being met. Other comments were that they had no worries; staff anticipated their needs and communicated well with them.

People stated that they were, “Quite impressed with the home,” “Often have lunch in the new bistro” and that the garden had been revamped and was lovely.