We found the following examples of good practice.
The provider had a system in place so visitors could access the service safely and inline with current government guidance.
Protocols were in place for both staff and people should they need to self-isolate due to COVID-19.
The registered manager followed the most recent government guidance on testing both people and staff.
Four Seasons is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 22 people with different health and care needs, including those living with dementia, in one adapted building.
People’s experience of using this service and what we found
People’s experience of using the service was positive. This was confirmed by the consistently good feedback we received. Some aspects of meeting regulatory requirements and ensuring robust record-keeping needed to be improved. We made a recommendation regarding this.
People felt safe with the care from staff and enjoyed the close, family-like and personalised support this relatively small service provided. People, relatives and staff were involved in the development of the service and felt listened to. One person told us, “[Managers] meet with us at least weekly to see how things are going and involve us in decisions. I like that it is a small home, it means for example the chef knows us well, what we like and do not like.”
Staff enjoyed working at the service and people were cared for by an established team, who knew them well and supported them with sensitive encouragement and respect. The service was overseen by a well-respected manager, who was praised for their ‘hands-on’ approach in their support to people and staff.
The service worked effectively with a variety of professionals to achieve good outcomes for people and promote their health and wellbeing. This included supporting people to maintain or regain their independence.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk .
Rating at last inspection
The last rating for this service was good (published 17 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 18 January 2017 and was unannounced.
The provider of Four Seasons Care Home is registered to provide accommodation and personal care for up to 22 people. At the time of this inspection 19 people lived at the home.
There was a registered manager in post who was present for our inspection. A registered manager is a person who has registered with the Care Quality Commission 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 service was last inspected on 2 November 2015 and required improvement in safe, responsive and well-led areas. We saw that improvements had been made to all these areas.
People were kept safe by staff who understood how to identify and report potential harm and abuse. Staff were aware of any risks to people and what they needed to do to help reduce those risks, such as helping people to move safely around the home. People were supported by sufficient numbers of staff who had the skills and knowledge to meet their needs. People were supported to take their medicine when they needed it.
Staff respected and supported people's right to make their own decisions and choices about their care and treatment. People's permission was sought by staff before they helped them with anything. Staff had received training relevant to their roles and felt supported by the registered manager.
People were supported to eat and drink enough to maintain good health. People had access to other healthcare professionals as required to make sure their health needs were met. People felt staff treated them with kindness and compassion and they felt involved in their own care. Staff respected people's dignity and privacy and supported them to keep their independence. People received care that was personal to them because staff knew them well. People received their care when they needed it and were not kept waiting by staff when they asked for assistance.
People knew how to make a complaint and felt able to discuss any concerns with the registered manager. The registered provider encouraged people and their relatives to give their opinions of the home through feedback forms and at meetings.
The registered manager was supported by an established staff team. The registered manager and staff had created an environment that was homely and welcoming. The provider enabled staff to value people and support them in a dignified and compassionate way. Staff were clear on their roles and spoke about the people they supported with fondness and respect.
We saw that systems were in place to monitor and check the quality of care and to make sure people were safe. The provider and registered manager used the information to drive continuous improvement of the service they provided.
We inspected this service on 2 November 2015. This was an unannounced inspection. Our last inspection took place in August 2013 and at that time we found the home was meeting the regulations that we checked them against.
The service was registered to provide accommodation and personal care for up to 22 people. At the time of our inspection 21 people were using the service. People who used the service had physical health needs and/or were living with dementia.
The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.
We found that improvements were needed to ensure people’s care records contained accurate and up to date information detailing how risks to their health and wellbeing should be managed. A record of people’s individual care preferences was also needed to ensure this information was readily available and accessible to the staff. This would reduce the risk of people receiving inconsistent care.
Improvements were also needed to ensure the quality of the information contained in people’s care records was assessed and monitored to ensure it was accurate and up to date.
We found that staff understood how to keep people safe, but they were unsure of the agreed local procedures in place to report safety concerns to the local authority.
There were sufficient numbers of staff to meet people’s needs and keep people safe. Staff received regular training and support to enable them to provide safe and effective care.
Staff sought people’s consent before they provided care and support. When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.
People were supported to access suitable amounts of food and drink of their choice and their health and wellbeing needs were monitored. Advice from health and social care professionals was sought and followed when required.
Staff treated people with kindness and compassion and people’s dignity and privacy was promoted. People were encouraged to make choices about their care and the staff respected the choices people made.
People and their relatives were involved in the planning of the care and care was delivered in accordance with people’s care preferences. People could also participate in leisure and social based activities that met their individual preferences.
People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.
There was a positive atmosphere within the home and staff were supported by the registered manager. Some systems were in place to enable the registered manager and provider to assess, monitor and improve the quality of care.
On this inspection we found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. We saw recruitment records demonstrated there were systems in place to ensure the staff were suitable to work with vulnerable people. This meant there were effective systems to ensure people using the service were protected and safe.
We found that people were treated with dignity and respect. Their individuality was recognised and they were supported to make their own choices.
Care records were written with people and reflected their wishes. People using the service and their relatives confirmed they felt involved in their formulation.
People were happy with the food and drink provided. We saw that choices of food and drink were offered and a healthy diet was promoted.
During our last inspection in December 2012 we found medication management needed improvement. We saw that suitable systems were now in place.
We found disclosure and barring service checks had been carried out. However, the recruitment policy was outdated and we found that the provider had not always acted appropriately to ensure that people using the service were protected.
We checked the records were stored safely and correctly and systems were as required. This was to ensure people's confidential information was stored appropriately.
We looked at how people were involved in decisions about their care and treatment and found that staff knew when they needed to seek consent. We saw records to confirm people's wishes were sought and complied with. There were systems in place for people who did not have the capacity to consent.
We saw that care records contained individuals' personal preferences. We found evidence of a variety of activities and people told us there was always something to get involved with if it suited them.
We looked at the way medication was managed and saw that improvements were needed to ensure medication systems and practices were safe and suitable.
There was evidence that staff were encouraged to attend training. The registered manager ensured staff had the time to attend training by changing their shift patterns. Staff told us they felt supported, and were knowledgeable and confident in their ability to carry out their work.
We found that complaints were dealt with quickly and appropriately. Details were being recorded in the complaints records, but were not being recorded in the complaints register.
There were 22 people living at Four Seasons Residential Care Home when we visited on 22 March 2012. The visit was unannounced which meant the provider and the staff did not know we were coming.
Before our visit we contacted other people who may have had an interest in the service such as fire safety officers, environmental health, and local involvement networks (LINks). LINks are groups of individual members of the public and local voluntary and community groups who work together to improve health and social care services. To do this they gather the views of local people. None of the other agencies identified any concerns.
People using the service told us, 'I like living here. I chose to move here and have been happy.'
During our visit we spoke with the manager and two of the support staff. The staff team was experienced and delivered a good standard of care and support to people. The manager and staff knew each person well and understood their needs, choices and preferences. Each person had an effective care plan in place which ensured that their specific needs were met. We spoke to a relative who confirmed that they were happy with the care and support their relative received.
We looked at medication arrangements in the home, but found that some practices potentially were unsafe. We have received information from the home that action has been taken to address the concerns we identified. We will undertake another visit to check the arrangements are satisfactory.
We saw that people using the service were usually involved in choosing the things that they did, but they were not always routinely involved in choosing the way their care and support was delivered.
We saw that the service recruited staff in a way that protected people using the service from harm and provided staff with the training they needed to ensure they had the skills to meet people's needs.
After our visit to the service we spoke with two professional people who visited the home regularly. They did not raise any concerns about the quality of the care provided.