We inspected the service on 13 December 2016. The inspection was unannounced. The Herons is a care home without nursing for up to 39 people and is located in Toton in Nottinghamshire. On the day of our inspection 37 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

Some people felt they had to wait longer for staff at peak times of day. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to minimise the risk of them coming to harm.

Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions and staff knew how to act if people did not have the capacity to make decisions.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where staff listened to them. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

The systems in place to monitor the quality of the service were not always effective in identifying issues and bringing about improvements. People were involved in giving their views on how the service was run.

We inspected the service on 2 December 2014. This was an unannounced inspection. The Herons is registered to provide accommodation for up to 39 older people. The home is situated on two floors with a passenger lift for access to the upper floor. On the day of our inspection 38 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

When we last inspected the service on 13 May 2014 we found there were improvements needed in relation to how people gave consent to their care, how they received care and support which met their needs and the manager’s failure to notify us of events in the service. The provider sent us an action plan telling us they would make these improvements by August 2014. We found at this inspection that this had been completed and the provider had made improvements in line with the action plan.

People felt safe in the service and the manager shared information with the local authority when needed. Staff knew how to respond to incidents if the manager was not in the service. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people received their medicines as prescribed. Staffing levels were matched to the needs of people who used the service to ensure they received care and support when they needed it.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. The manager told us that all of the people using the service had the capacity to make their own decisions but there were systems in place to ensure the appropriate assessments would take place if the need arose.

People were supported to maintain their nutrition and health needs. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people.

People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in the manager implementing action plans to improve the service.

We spoke with five people using the service and two members of staff. There were varying views in respect of people’s experiences of living at the home. Although they were all settled three out of five people did express concerns in respect of how the staffing affected the care they received. Nevertheless they all told us that staff were kind and caring and they supported them with their needs.

People we spoke with told us they received their medicines when they needed them and they had no problems. Two people told us they self administered their medicines and they felt this improved their independence.

Two people told us they had been looked after well during their recent illness. One person said, “I am happy and settled, I am looked after very well and when I was unwell recently all my needs were met and I am feeling much better.” Another person said, “I am looked after very well, I have been unwell but I am feeling much better now.”

We spoke with two people about the recruitment processes. Both said they were not involved in this and neither of them wished to be. They told us they trusted the manager to recruit suitable staff and that when new staff started working at the home they were introduced to them.

We found the provider did take account of concerns or complaints raised and people were aware how they may make these known. However two out of five people spoken with told us they were unsure if concerns they raised would be listened to and acted upon.

We visited the location to carry out a planned review. We spoke with one relative, four people using the service and two members of staff.

One person told us their family had made all of the arrangements for them to come and live at the home and they had got all of the information they needed. Another person said they used to visit the home before they moved in, so they knew everything they needed to know to make a decision.

All of the people spoken with said staff were respectful to them and they respected their privacy. They also said they could make their own choices about what they did and how they spent their time.

One relative said they were involved in important decisions about their relative’s care.

All of the people we spoke with spoke highly of the staff and the care they received. One person said, “My needs are met and I am helped as needed.” Another person said, “I am very happy, I am looked after well, the staff are nice and helpful.”

One relative said, “The staff are amazing and discreet with their care. All of my [relatives] needs are met. I have been involved in the care planning and have signed them. Everything was explained.”

All of the people we spoke with said they felt safe living at the home.

One relative said they thought their relative was very safe living at the home.

We spoke with two people about the recruitment processes. Both said they were not involved in this and one suggested that they may like to be. Although they were not involved, both had an understanding of the checks that the employer made to make sure that staff were recruited safely.

Three of the people we spoke with were aware of the meetings that took place in the home and two also said they had completed questionnaires in the past.

All of the people we spoke with said they were happy with the service they received and that if they were unhappy they could approach the staff to talk about this.

During the inspection we spoke with three people using the service and asked them about their experiences of living at the care home. We also spoke with two relatives. We observed the care that was given to people. We also spoke with three care staff, a maintenance staff member, the registered manager and the service manager for the provider. We looked at some of the records held in the service including the care records for four people.

During the inspection we gathered information 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 we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People using the service told us they felt safe. They told us they received good care. One person said, “There’s always somebody [staff] there.”

Relatives told us they felt their family members were safe. One relative said, “I’ve never seen anything negative in the way they [staff] treat anybody.”

Staff told us they felt people using the service were safe. One staff member said, “I think we’ve got a good care team.” Staff also told us they felt there were enough staff to meet people's needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw a DoLS policy was in place. The manager also had an appropriate understanding of DoLS. However, two care staff we spoke with did not have an understanding of DoLS.

Is the service effective?

People using the service told us their needs were met. They told us staff provided them with choices and respected their decisions. We saw staff asked people whether they wanted assistance and did not act against their wishes.

Relatives told us they felt their family members received good care that met their needs. One relative said, “I feel [family member’s] needs are met here.”

We saw assessments had been completed and people had many care plans which set out their care needs. However, we found some care records regarding pressure area care did not contain appropriate information. Staff had not always acted in accordance with people’s identified needs regarding pressure area care.

We saw that some people had not signed to record their agreement to information in their care records.

People using the service and relatives told us they felt staff were well trained and good at their jobs. One relative said, “There’s constantly training going on.”

Staff also told us they received enough training and could ask for more if needed. We found staff received training to provide appropriate and safe care.

Is the service caring?

People were supported by kind and attentive staff. A person using the service said staff were, “Very nice. They’re most kind.”

Relatives told us staff were caring. One relative said, “They’re brilliant. The staff are excellent.”

We saw staff interacting with people. We saw they were very caring and very kind. We saw they communicated warmly with people as they supported them.

Is the service responsive?

Staff had a good understanding of people's care and support needs. They told us how they supported people to maintain their health and wellbeing and involved other agencies when appropriate. We found that the service arranged for people to access other services such as a community falls team and district nursing services.

Is the service well led?

People using the service told us they felt the service was good. They told us they felt listened to and could contribute their views. One person said, "She’s [the manager is] very approachable.”

Staff told us they felt the service was well led.

We saw that residents and staff meetings took place.

We found that the provider had effective processes in place to regularly monitor the quality of the service. We saw audits were completed.

However, we found that the provider had not notified the Care Quality Commission about two incidents that affected people using the service which they were required to do by law.