This inspection was carried out on 22 February 2018 and was unannounced.

Walmer Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Walmer Care Centre provides care for up to 37 older people with dementia. The service is arranged over two adjacent houses on the seafront near Deal. There are two residential floors in each building, with communal lounges and dining areas. There were 29 people living at the service when we inspected.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good

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. Potential risks to people’s health and safety were assessed and there was detailed guidance for staff to mitigate risk and keep people as independent as possible. People were able to follow their hobbies and interests and were supported to maintain relationships with people who were important to them.

People were supported by enough staff who knew how to recognise abuse and discrimination. Staff had been recruited safely and received the training they needed to support people safely. Staff received supervision and appraisals to discuss their training and development needs. Staff knew people well and the support they needed.

There was a mutual trust between people and staff. People’s privacy and dignity was respected. People, relatives and staff told us that there was an open and transparent culture within the service. The registered manager completed checks and audits on the quality of the service. Where shortfalls had been identified action plans had been implemented to ensure improvements. Accidents and incidents were analysed and used as learning experiences to reduce the risk of them happening again. People, relatives and staff attended regular meetings to discuss the service and raise any concerns they may have. People and relatives knew how to complain; any complaints had been investigated and used to drive improvements.

People’s care had been assessed before they came to live at the service in line with current guidance. Care plans gave staff clear guidance about how to support people in the way they preferred. Care plans were reviewed regularly to ensure people received the right support. People were asked how they would like to be supported at the end of their life, staff supported people and their family to ensure that their wishes were met. People’s care plans and other records were held securely.

The premises suited people’s needs and was clean. People were protected from the risk of infection. People received their medicines safely and when they needed them. People were supported to stay as healthy as possible including attending appointments with healthcare professionals and taking part in appropriate exercise. People had a choice of meals and these were prepared to people’s specific health needs.

The registered manager was experienced and skilled in supporting people living with dementia and continued to enhance their knowledge and skills. The registered manager had a clear vision for the service and this was shared by the staff. The registered manager worked with other professionals to ensure people had the support they needed and encouraged links with the local community.

The registered manager h

Care service description

Walmer Care Centre is a care home for up to 37 people who may be living with dementia. The service is provided in two houses that are next door to each other, Carlton Lodge and Carlton Mead. Bedrooms are on the ground and first floors and there are communal areas including lounges overlooking the sea. There were 15 people living in each of the houses when we inspected.

Rating at last inspection

At the last inspection on 23 November 2015, the service was rated ‘good’ overall with a rating of ‘requires improvement’ in the safe domain as there was a breach of a regulation. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that the service remained rated ‘good’ overall and the breach of the regulation had been met.

This report covers only the safe domain; please see the previous reports for further information.

Why the service is rated good

Staff were aware of potential risks to people and any risks had been assessed to reduce them as much as possible. Previously, there was a lack of guidance for staff about how to reduce risks including how to move people safely. There was now step by step guidance for staff to follow.

Changes had been made to make sure that all medicine was now administered safely. There were enough staff to meet people’s needs. Staff had been checked before they started to work with people.

Staff had been trained to recognise abuse and knew about different types of abuse and who to report to.

Further information is in the detailed findings below

We spoke with four people and relatives at the home. We also observed care given to people at the service, as well as interactions between staff and people, to determine how care was provided. People told us that the home was very good. A relative told us “The care has been handled very sensitively here; they are great”. Another person said “I enjoy living here, and have no concerns”. We noted that staff spoke clearly to people when providing care. We observed that staff asked people if they wanted the care which was offered, for example, when offering to help a person walk to the bathroom. We spoke with staff who told us that they always asked before attempting personal care, and waited for a response.

We found that care plans were comprehensive, personalised and took into account the needs and abilities of the people who used the service. We saw evidence of monitoring and regular evaluations of the support that was provided, together with involvement and liaison with relatives and various health professionals, to ensure they were kept informed of changes in people's conditions when necessary.

We toured the premises and found that the equipment used at the home, including hoists, motorised wheelchairs, and adapted furniture, was in working order and maintained regularly. Staff told us that they received the training required to carry out their roles well, and that they felt well supported by the management team and other staff. We noted that the manager had implemented regular discussions of the service with staff, as well as a program of appraisal and supervision, to ensure that any issues of concern could be quickly addressed. We found that the provider had implemented ways to gather feedback on the service from people and their relatives.

People who use the service said that staff treated them with respect and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “The staff are kindness itself and I can do what I like. There’s no set routine as such, you can go to bed when you want and get up when you want.”

A carer (relative) said, “The staff are very attentive and always make sure that my relative gets the care they need. I always find them well cared for, comfortable and well presented.”

The inspection took place on 23 and 24 November 2015, and was an unannounced inspection. The previous inspection on 4 December 2013 found no breaches in the legal requirements.

The service is registered to provide accommodation and personal care for up to 37 older people who are living with dementia. At the time of this inspection there were 29 people receiving the service. The service is called Walmer Care Centre and consists of two detached properties that share the same driveway. The premises are known as Carleton Lodge and Carleton Mead. Each person has a single room and there are communal lounges with a separate dining room in each of the premises. The service is situated on the seafront of Walmer with unrestricted views over the coast. At the time of the inspection in Carleton Lodge there were fifteen people receiving a service and fourteen people at Carleton Mead.

The service has an established registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Potential risks to people were identified regarding moving and handling, but full guidance on how to safely manage the associated risks were not always available. In some cases there were no risk assessments in place, for example when people were receiving support to be moved with a hoist, or taking a bath. There was also no guidance in place for staff to follow when using equipment, such as handling belts and slide sheets.

Medicines were stored and administered safely. However, people did not always receive their medicines in line with safe infection control procedures because of the way some staff handled the medicines.

People felt safe in the service. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe. They were aware of the actions to

take in the event of abuse and policies and procedures were in place to give guidance on what actions to take.

Records of accident and incidents showed that action was promptly taken to prevent further re-occurrence. Appropriate servicing and safety checks had been undertaken to ensure the premises were safe. Fire drills were held and environmental risk assessments were in place. Plans were in place in the event of an emergency.

Some refurbishment of the premises had been carried out and plans were in place to improve the environment. A maintenance plan was in place to address areas that still required attention.

People’s rooms were personalised to their individual preferences.

We observed that people were comfortable in the presence of staff. Staff were compassionate, patient and caring, and ensured that people received the care they needed. The registered manager used an assessment tool to ensure there was enough staff on duty at all times. Staff were recruited safely and there was a structured training programme to ensure that staff had the skills and competencies to carry out their roles.

People were supported to make their own decisions and choices, and these were respected by staff. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which apply to care homes. The manager understood when an application should be made and some people had authorised restrictions in place to ensure that the decision about the restriction had been made in their best interests and was lawful.

People had choices of food, and specialist diets were catered for. Staff understood people’s likes and dislikes, dietary requirements and promoted people to eat a healthy diet.

People were supported to maintain good health and received medical attention when they needed to. Appropriate referrals to health care professionals were made when required.

Staff treated people with kindness, encouraged their independence and responded to their needs. People and relatives told us that staff were respectful and their privacy and dignity was maintained.

People and relatives had been involved in the care planning process. Care plans had been regularly updated and relatives told us that they were invited to the care plan reviews when required. The registered manager had recognised that the care plans needed to be more personalised and there was an action plan in place to achieve this.

People had a varied programme of suitable leisure activities as each person had their own personalised activity plans, which were detailed about their life and interests. Visitors were made welcome in the service and were able to visit at any time.

There was a complaints procedure in place, which was on display so that people were aware how to complain. There had been no formal complaints received about the service.

The service sought feedback from people their relatives, staff and health care professionals about the overall quality of the service. Audits and health and safety checks were regularly carried out to ensure the service was safe.

We made a recommendation about medicines administration.

We found one breach 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.