101 Royal Hill

At our last inspection of this service on 22 February 2016 the service was rated Good. At this inspection we found the service remained Good. The home demonstrated they continued to meet the regulations and fundamental standards.

At the time of our inspection the home did not have a registered manager in post. However there was a manager in post and they were in the process of applying to the CQC to become the registered manager for the home. They were knowledgeable about the requirements of a registered manager and their responsibilities with regard to the Health and Social Care Act 2014.

There were safeguarding and whistle blowing procedures in place and staff had a clear understanding of these procedures. We observed and staff told us there was enough staff on duty to meet people’s needs. Appropriate recruitment checks were carried out before staff started working at the home. Action was taken to assess any risks to people. People were receiving their medicines as prescribed by health care professionals.

Staff had the knowledge and skills required to meet people needs. The manager had a good understanding of the Mental Capacity Act 2005 and staff acted according to this legislation. People were encouraged to eat healthy meals and to cook for themselves. Staff monitored people’s health and welfare and where there were concerns people were referred to appropriate health professionals.

People’s needs were assessed and care plans included detailed information and guidance for staff about how their needs should be met. People’s care records included individual communication profiles that recorded their methods of communicating with staff. People were supported to practice their religion and attend places of worship. The home had a complaints procedure in place and this was available in a format that met their needs.

The provider recognised the importance of regularly monitoring the quality of the service they provided to people. Regular health and safety, medicines, fire safety and incidents and accidents audits were being carried out at the home. The home took into account people’s views of the service through residents meetings. Staff said they enjoyed working at the home and they received good support from the registered manager.

There was a registered manager in post at the time of our inspection. 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. The registered manager informed us they would be taking a 12 months secondment opportunity away from the home. They told us they were in the process of submitting an application to cancel their registration as a manager with CQC. An acting manager had been appointed by the provider to run the home in their absence. The provider told us the acting manager was in the process of applying to CQC to become the new registered manager.

Most of the people using the service could not communicate their views to us verbally. We contacted some of their family members for their views about the care provided to their relative. They told us their relatives were safe and that staff treated them well. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work. Risks to people were assessed and care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed training specific to the needs of the people they supported and they received regular supervision and annual appraisals of their work performance. People were provided with sufficient amounts of nutritional food and drink to meet their needs and staff knew how to support people with eating and drinking. They had access to a GP and other health care professionals when they needed them. The acting manager and staff had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards and acted according to this legislation.

People and their relatives were provided with appropriate information about the home. This ensured they were aware of the standard of care they should expect. People and their relatives, where appropriate, had been involved in planning for their care needs. Relatives were aware of the complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider recognised the importance of regularly monitoring the quality of the service provided to people. They sought the views of people using the service and their relatives through annual satisfaction surveys. Staff said they enjoyed working at the home and they received good support from the acting manager. There was an out of hours on call system in operation that ensured management support and advice was always available when staff needed it.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

During our inspection we spoke to the manager, assistant manager, staff, a speech and language therapist, two relatives and three people who used the service. We were unable to consult with people who used the service about consenting to their care. This was because we were unable to effectively communicate with the people who used the service. However, a relative confirmed they were always involved with consenting to their family member's care. We observed staff assisting people to make decisions relating to their care and well-being during our inspection. We saw evidence of mental capacity assessments which had been completed and involved external healthcare professionals, the staff team and relatives.

We found staff were trained in safeguarding. Staff told us and we saw evidence that they followed safeguarding procedures when incidents took place and knew who to contact in the event of a safeguarding issue.

We saw evidence that recruitment procedures were followed by the provider.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We looked at four people's personal folders and found people's care needs were assessed by a multi-disciplinary team. We found that people had risk assessments and action plans in place which were reviewed regularly by the home's manager.

We spoke to two relatives and one told us, "The staff care for people well here." We also spoke to a speech and language therapist during our inspection who confirmed the staff were open and willing to learn new methods of communicating with people who used the service.

Is the service caring?

A relative we spoke with told us, "The staff are caring and people are treated with kindness and respect." We observed people being cared for and spoken to in a gentle and understanding manner. One person who used the service referred to their 1:1 worker as, "my friend."

Previous responses from people, advocates and relatives on satisfaction surveys indicated the care being provided was good. We spoke with a speech and language therapist who confirmed the staff team were willing to learn new methods of communication in order to communicate effectively with people who used the service. We saw evidence of this training in the staff room during our inspection. For example, the staff were learning Makaton (a form of sign language to support the spoken word) and the staff notice board had a picture of 'the word of the week' for the staff to learn.

Is the service responsive?

Two relatives we spoke with knew how to make a complaint. We noted there was a compliments and complaints poster in the reception area for people to refer to if they needed it. We saw the complaints log and noted that no complaints had been received since our last inspection in May 2013.

There was evidence that learning from incidents took place and appropriate changes were implemented. Incidents had been properly documented and acted upon. We saw action was taken to prevent a recurrence of an incident and this had been documented for staff to learn from.

Is the service well led?

The service had quality assurance audits and systems in place. The manager told us and we saw evidence of monthly staff meetings which covered areas that affected both people who used the service and staff. The manager also held 1:1 supervisory meetings every six weeks with the staff to encourage good practice.

Care planning and reviews took place regularly with involvement from people who used the service. We found that people's ability to consent to their care was being assessed, and care plans were agreed by people who used the service or their representatives. We found that the staff understood people's care needs and how to protect them from risk and harm, and that there were enough experienced staff present to provide for peoples care needs. Documentation and records held at the home was well organised and up to date.

Staff were respectful in providing support for people and regularly interacted with them, helping people to go out for activities. Increased staff time was available to provide more one to one activities for some people, and to in the community. Staff sensitively intervened when people were upset in any way and ensured that people were safe.

People waited in for a nurse to call to offer all of the people who lived at the home an inoculation against the flu virus, the flu jab, which we were told had not been formally agreed by each individual or their representatives.

We found that people's care needs were being planned for. We found that the staff understood people's care needs and how to protect them from risk and harm. However care plans and risk assessments were not being reviewed annually.

Staff had adequate training and supervision and were supported by the management to do their job.