We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well led?
This is a summary of what we found:
Is the service caring?
Our observations of the care provided by staff and our discussions with people who lived in the home showed the service was caring.
We observed staff treated each individual with dignity and respect. They spoke to people in a caring, polite and friendly manner. One person said 'I like it here very much. Everyone is so nice'. Another person said 'They do everything they can to make you happy'.
People who lived in the home were complimentary about the staff. One person said 'The staff are very good. They do their best to take care of us'. Another person said 'The staff are lovely and kind. I'm looked after very well thank you'.
Is the service responsive?
The service was responsive to people's preferences and choices. People told us they were asked about their likes and dislikes prior to moving to the home. We saw care plans detailed people's preferences regarding personal care routines, food, hobbies and interests.
One person said 'I've got everything here I want. If I need anything I just have to ask'. Another person said 'The food is lovely and we always get a choice'. A third person said 'It's a wonderful place here, I'm very happy'.
We observed people could decide where and how they spent their time. They were free to move around the home and the scenic gardens as they wanted. One person said 'I go for walks in the garden most days' another person with mobility difficulties said 'Staff will push me outside if it's a fine day'. People told us they could decide to have their meals in their rooms, in the dining room or on a tray in the TV lounge.
People were able to express their views at quarterly 'Residents and Relatives meetings'. Records of the meetings showed they were well attended by people and their friends or relatives. We saw a wide range of topics were covered and ideas for improving the quality of people's experiences in the home were taken on board.
An annual customer care questionnaire was sent to people and their relatives. We looked at a sample of the returned questionnaires and they predominantly showed people were 'very satisfied' with all aspects of the service.
Is the service safe?
People who lived in the home told us they felt safe and they were well treated by staff. When asked if they had ever been treated badly or witnessed anyone else being treated badly, one person said 'Not at all, they are all extremely nice and willing to help you. Matron wouldn't stand for anything like that'. Another person said 'The staff treat me very well. They are all very nice. If I didn't like anything I would tell the matron but I haven't had any problems'.
We spoke with the manager (also known as matron) and six other members of staff. They all knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns.
The manager told us they always carried out relevant employment and criminal record checks when new staff were recruited. This helped protect people from the risk of abuse.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Deprivation of Liberty Safeguards is in place to protect people's freedom and human rights. The manager said they had not needed to submit a Deprivation of Liberty Safeguards application to-date. However, the manager was aware when an application should be made and knew who to go to if an application was required.
There were arrangements in place to deal with foreseeable emergencies such as utility failures. People had individual evacuation plans to follow in the event of a fire. Staff received fire safety and first aid training. They knew to call the emergency services or the GP practice if they had any worries.
Environmental risk assessments were in place for fire safety, buildings and equipment. These were carried out by the home's maintenance staff or specialist external contractors as appropriate. We observed the environment throughout the home looked in good condition.
Is the service effective?
The service was effective in meeting people's care and treatment needs. People told us they were very happy with the care and treatment they received. One person said 'I'm very well. I'm happy with the care I've had up to now'. Another person said 'It's lovely here, we're well looked after'.
We observed people had call bells in their rooms to call for staff assistance whenever needed. People said they did not have to wait long for assistance. One person said 'They don't take very long to come, usually a few minutes'.
We saw care plans included a range of individual risk assessments and actions for managing these risks. These included assessment of people's risk of developing pressure ulcers, risk of malnutrition and risk of falls. The GP or a dietician was consulted if there were any concerns. The nurses who worked in the home said external advice was available whenever needed from specialist health care professionals.
Staff told us they were provided with the skills and knowledge to provide a safe and appropriate standard of care. We saw training and development records to confirm this.
People were supported to engage in social activities and interests. They went out for trips to places of interest with their family members or with support from the staff. Within the home people could participate in group activities like singing, films and reminiscence sessions. Staff regularly organised afternoon teas in the home's scenic gardens.
Individual activities such as aromatherapy and hand massage were offered to people who were being nursed in bed. The activities organiser said they spent as much one to one time as they could with people who were restricted to their rooms.
Is the service well led?
People who lived in the home and the staff we spoke with all said the manager of the home was very good.
The home was managed by a person who was registered with the Care Quality Commission as the registered manager for the service. People who lived in the home told us they could talk to the manager (also known as matron) or the other staff about any issues and they always did their best to meet their needs. A typical comment was 'I can have a chat with matron anytime, she is lovely. She always sorts things out'.
Staff told us the manager was very fair and approachable. One member of staff said 'If you have any problems or concerns you can discuss them with matron. She is very approachable and always gives good advice and support'. Another staff member said 'Matron is very fair and is good at resolving any disputes'. One of the nurses said 'The manager is in uniform for some shifts. She has her finger on the pulse and keeps a close eye on the care provided. When needed she reminds staff what is expected'.
Decisions about people's care and treatment were made by the appropriate staff at the appropriate level. There was a clear staffing structure in place with clear lines of reporting and accountability. The manager supervised the nurses and the nurses supervised the care staff. Care staff we spoke with said everyone worked well together as a team and supported each other. They were able to seek advice from the nurses and report issues directly to the manager whenever needed.
The manager told us they received excellent support from both the owner and the area support manager. The manager said 'The owner is brilliant. She visits most weeks and wants high end care provision for the residents'.