Priceholme

We inspected the service on 15 and 21 February 2018. The visit on day one was unannounced and the second day of inspection was announced.

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 on-going 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.

People we spoke with told us they felt safe, respected and well cared for. Staff showed a good understanding of the processes required to safeguard adults who may be vulnerable from abuse and they were able to explain to us what they would do if they had concerns. We observed staff knew the people they supported well and were able to recognise any changes to people’s physical and emotional health.

People we spoke with were complimentary about the management and staff of the organisation. We found evidence of complaints being made to the service and we saw that these were dealt with in a proactive manner. The service received a number of compliments and commendations which praised the staff and the service delivery.

The registered manager and provider was responsive to people's needs and regularly sought their opinions. This helped ensure people’s rights and diverse circumstances were respected.

Risks to people's health and safety had been identified and risk assessments were in place to identify and evaluate risks which are then managed with guidance for staff through associated ‘support plans’. Regular servicing of equipment, environmental safety checks and checks of services such as gas took place. People's medicines were managed safely.

Robust recruitment practices were in place which included obtaining references and completing Disclosure and Barring checks. This ensured only suitable people were employed.

We observed sufficient staff were deployed throughout the service to meet people's needs. Staff received appropriate training and support to carry out their role Staff received regular supervisions and appraisals from senior staff or management and they told us the manager was approachable and supportive.

Staff worked within the principles of the Mental Capacity Act when providing support to people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Best interest decisions involved people’s representatives when required.

People told us they enjoyed the meals provided and were supported to eat a healthy balanced diet. Where needed, people's nutrition was monitored by staff. People had good access to healthcare professionals to support all of their health needs.

The environment supported people's needs and their personal space reflected their preferences and personalities. People's choices were taken account of when planning their care and they could choose how that care was delivered. Their end of life support needs were considered and planned for with the involvement of the person and their next of kin.

People’s needs were assessed and care plans reflected their care preferences and how they liked to spend their time. People were supported to engage in activities and where they had friends or family they were supported to maintain those relationships in a meaningful way.

Regular checks of all areas of the service were completed by the registered manager. There was good oversight from the provider who completed unannounced quality assurance checks to ensure the safe running and quality of the service.

We received consistently positive feedback from people who used the service, their relatives and friends, and visiting professionals.

We considered our inspection findings to answer questions we always ask.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

We saw the service was safe, clean and hygienic. The home had effective systems for the prevention and control of infection. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and how they would manage an outbreak at the home so the risk of infection spreading could be reduced.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. All the people we spoke with told us they felt safe. One person told us, 'They are very good here and I feel safe.' Another person told us, 'I know how to complain if I am not happy or worried. I do feel looked after and safe.'

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). They told us they had received training in making an application and showed us the policy and procedures they followed. They told us some staff had received relevant training and had access to the policy and procedures. Those staff told us they had received this training.

Is the service effective?

We saw how people were involved in their care and treatment. Care staff told us they worked closely with people. One staff member told us, 'We treat everyone as an individual. Person centred care is about working to support each person in the way they would like, and everyone is different'. The staff told us they always try to respond to people in the service and gain an understanding of what they want and how they work very closely with people's families.

All the people had a keyworker who supported them with their care and welfare needs. One person we spoke with told us, 'I have a lovely keyworker. If I need anything I will just ask her.' Staff told us how they supported people and told us they needed to be flexible and responsive as people's care and support needs can change.

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, 'If I need any help, advice or support I can speak with the manager or a senior member of staff at any time. They are very supportive.' The staff told us they had regular staff meetings. They all told us they felt supported by the manager and could approach them at any time for support or to raise any issues or concerns.

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way which could be easily understood. People were not rushed when care was delivered and we saw staff interactions with people were caring. One relative we spoke with told us, 'The care my mother has received is beyond compare. I can't tell you how happy I am with the care and love she receives here.'

We saw staff treated people with respect and dignity. All the people we spoke with told us they were very happy with the care they received.

Is the service responsive?

We saw staff would respond to any requests for support. The two district nurses we spoke with told us the staff were very supportive. One of them told us, 'The care in here is remarkable. They are always so helpful when we visit.

People's care needs had been reviewed at least every month. We saw when people's requirements had changed the provider had responded appropriately and reviewed the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The service had a registered manager in post who showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been taken into account.

We saw the home had systems in place which ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place.

Care plans were detailed, person centred and regularly updated. When people required assistance or input from other services staff were timely in seeking this and followed guidance and advice closely.

The environment was well maintained and provided a homely and comfortable place for people to spend their time.

Staff were recruited safely and were given a full induction before starting work on their own.

There were comprehensive and robust quality assurance systems in place and people who used the service and staff were given chances to feed back about their support and life in the home through meetings and questionnaires.

We saw that there was a wide range of activities for people to take part in, and various opportunities for people to be involved in the development and changes in the home. We looked at care plan documentation for people which was detailed and up to date. The plans were regularly reviewed with the full involvement of the person.

The service was found to be clean and hygienic and infection control procedures were being followed by staff. People using the service were happy with the level of maintenance of the home.

Staff were given many opportunities to complete training, and there was a robust system in place for the supervision and support of staff.

There was a complaints procedure, as well as other monitoring processes in place to ensure that any issues were addressed quickly and appropriately. The service was maintaining up to date and accurate records for staff and resident's and these were stored appropriately.

People liked living in the home, and were happy with the standard of care and support they received. One person who used the service told us 'It's a bit like a first class hotel'.