Townend Close is a care home without nursing for up to 39 older people, some of whom maybe living with dementia. The home is arranged over two floors which can be accessed via a lift. Each person had an individual flat which consisted of a private bathroom and open plan bedroom, lounge and kitchen area. The home has a garden which people can access and it is close to local amenities. At the time of our inspection 35 people lived at the service.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

We identified some areas for improvement to further develop systems which keep people safe from avoidable harm. This included the development of health care plans for people, so staff know how to support people better, also the development of guidance to help staff understand when to administer ‘as and when required’ medicines.

We saw that on some occasions people’s care plans did not always reflect their current care needs, the registered manager explained how they would improve systems to ensure care plans were up to date. The registered provider updated their recruitment policy following our inspection to ensure the process gathered a full work history from candidates.

People received support from staff who had received training, were regularly supported by their managers and who had the skills to perform their roles effectively. We saw good practice around supporting people with dementia in relation to the environment and the development of activities.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. We recommended that the registered provider review their policy with regards to the Mental Capacity Act 2005 to make clear when formal assessments and best interest decisions were required for people who lacked capacity.

People were happy with the choice of food they received and we observed a positive mealtime experience. People were supported to have access to healthcare support and their health needs were monitored well by staff.

People and their relatives told us they found staff to be caring and compassionate. We observed positive and warm interactions between staff and the people who used the service. People were offered choices and were supported to maintain their independence.

People told us the service was responsive to their needs and we saw this was the case. People’s preferences were recorded in their care plans and staff were aware of them when delivering support. People had access to a wide range of activities, which included maintaining contact with groups in the community and pursuing their own hobbies and interests.

Quality assurance systems were effective in assessing the quality and safety of the service. Where areas for improvement were identified we saw actions plans were in place to ensure improvements were made. People, their families and members of staff had opportunities to provide feedback on the service and their views were listened to and acted upon. This meant the service was run in the best interests of the people who lived there.

People and their families were positive about the leadership of the service and told us it was well run.

We inspected the home on the 2 December 2014 and the visit was unannounced. Our last inspection took place on 14 October 2013 and at that time we found the service was meeting the regulations.

During the visit, we spoke with 12 people living at the home, a relative, six members of staff, the registered manager and the care manager. We also spoke with a district nurse who was in the service giving treatment to people via the local doctor’s surgery.

The home had a registered manager, who had been registered at Townend Close since 2006. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the registered provider.

Townend Close is registered to provide personal care and accommodation for up to 39 adults and has a designated respite room which is regularly used by people who need a short stay. Some people using the respite facility use it as a ‘phased’ introduction to the service. Townend Close is owned and managed by Anchor Trust. The purpose built detached property is close to local amenities, and the towns of Skipton and Keighley. The home's accommodation is arranged over two floors. All the rooms have a bedroom/living area, a kitchenette and bathroom. Each room has an individual front door with letterbox, which leads off a communal corridor. There is a passenger lift available to reach the first floor and parking for visitors. On the day of the inspection 29 people were living in the home, all were permanent residents.

Some people living in the home had complex needs and had difficulties with verbal communication. The staff had developed different communication methods in accordance with people’s needs and preferences. This approach reduced people’s levels of anxiety and stress.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The registered provider had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The registered manager had been trained to understand when an application should be made, and in how to submit one. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show that staff employed were safe to work with vulnerable people.

Suitable arrangements were in place to provide people with a choice of a varied diet with healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored. This included the monitoring of people’s health conditions and symptoms, so that appropriate referrals to health professionals were made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Care and support was tailored to meet people’s individual needs and we could tell that staff knew people well. The support plans included detailed risk assessments. Staff had good relationships with the people living at the home and the atmosphere was relaxed and had a homely feel to it.

Medicines were administered, stored and disposed of safely and people using the service received their medication as prescribed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting and assisting them. Staff knew how to respect people’s privacy and dignity. People were supported to attend meetings, where they could express their views about the home. Relatives also attended meetings to make sure they had a ‘voice’ in the running of the service.

A range of activities were provided both in-house and in the community. People were able to choose where they spent their time. For example, in the communal lounge, small seating areas throughout the building or in their own rooms. We saw people were involved and consulted about all aspects of the service including what improvements they would like to see and suggestions for activities. Staff told us people were encouraged to maintain contact with friends and family.

The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the registered provider. Staff told us they were always looking at ways to improve the home, the service they provide and the quality of people’s care. This meant people were benefiting from a service that was continually looking how it could provide better care for people. Staff told us they were supported to challenge and make suggestions, through their staff meetings and with discussions at handover, when they felt there could be improvements. There was an open and honest culture in the home.

We spoke with five visitors, fourteen people who used the service and some of the staff on duty. Before people received any care or treatment they were routinely asked for their consent. People told us they were involved in decisions about their daily lives and that staff were polite and obliging.

We used a number of methods to help us understand the experiences of people using the service. This included talking to visitors, staff and observing the care provided. People told us they were treated well by the staff. One person told us, “The care is very good here.” We observed staff being friendly and respectful towards people.

We saw from people's care records that they were supported to retain their independence as much as possible. The records we reviewed were person centred and included essential risk assessments. The information used was kept under review, to enable appropriate treatment, care and support to be given.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage the administration of medicines safely.

There were robust recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were described as ‘very kind and thoughtful.’ People told us they felt that they were well looked after. People gave us the impression that their experiences at the service were positive and that they received a good standard of care.

There was an effective complaints system available. At the time of our inspection there were no outstanding complaints.

People told us that they were involved in planning their care. They told us they were supported to take part in activities of their choosing and that their comments were listened to and acted upon. People told us they felt safe. One person told us: “They listen to what I tell them and they make sure things get done.” Another person said: “Staff are committed and connected to their work.” This person went on to say, “The staff are brilliant, we are very well looked after.” One person told us, “Its not like being at home but it’s the next best thing.”

We spoke with four visitors. They all said positive things about Townend Close. They said the staff ‘had time’ for people; they respond to buzzers quickly and the care was ‘excellent’ and of a ‘high standard.’ One relative had written in a thank you letter that they ‘provided a caring and happy environment’ and that staff know people on an ‘individual’ basis and provide for their ‘different needs.’

People using the service told us that they were involved in decisions about their care and day to day living. For example, people said they were asked about where they wanted to go; what they wanted to do; what they wanted to eat, they also said they were free to decide when they wished to get up and go to bed. People told us they felt 'well looked after' and 'liked' living at Townend Close. One person said, "This home is second to none. It isn't my own home but it is the closest it can be. I am very well looked after by kind and considerate staff." People told us they felt 'safe' and that they had 'confidence' that if they needed to report anything, then it would be taken seriously and dealt with in a confidential way. People said they received the care they needed and did not feel 'rushed'. They said staff were 'kind and patient' and gave them enough time to receive the care they needed. Most people said that they didn’t need to wait long when they called for assistance; however one person said that it sometimes seemed to take a while particularly if it was a busy time of day, but that it was probably only about ten minutes. People told us that they were often asked about the service they were receiving and felt able to raise issues with the staff if they wanted something changing.