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Inspection carried out on 12 April 2017

During a routine inspection

Care service description.

Walnut Close provides support and personal care to up to 35 people in total, with needs arising from old age. Up to eleven people living with dementia are supported in a separate specialist unit. The service does not provide nursing care.

Rating at last inspection.

At the last inspection in November 2014, the service was rated Good.

Rating at this inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

The service had continued to develop and improve, particularly in terms of the developments in the dementia unit, which had been prioritised recently. The improvements made and planned there had significantly enhanced the experience of those living with dementia, and a range of further developments were in process.

People felt safe and well cared for and said staff were kind and attentive to their needs. Feedback from the local authority was positive and the service had worked with them to improve some records and systems. A local authority representative commented, “The staff are very person centred and from my experience during my visits are very supportive and kind to the residents.” Regarding the management of the service they said, “Management are very proactive and transparent.”

People were kept as safe as possible by the systems, policies, procedures and the training provided to staff. Health and safety and other risks were well managed.

People’s safety and wellbeing were enhanced by the changes in staffing, including additional staff at key times, piloting qualified shift leaders on night shifts and increasing management cover at weekends. The appointment of ‘champions’ in key areas also helped to drive further developments in the service.

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.

Induction improvements and an effective ongoing training programme helped ensure staff had the up to date knowledge and skills to deliver person centred care. The registered manager had taken steps to improve the frequency of ongoing staff support through supervision and had ensured staff development was encouraged through annual appraisals.

People continued to receive effective healthcare support and the service worked well with external healthcare providers. Where issues had been identified with the quality of food provided, the registered manager had taken steps to address these with the external caterers and had achieved improvements.

Staff delivered support calmly and in a timely way. They respected people’s dignity, individuality and cultural or personal needs. There was a positive rapport between people and staff. The service continued to respond promptly to people’s changing needs, feedback and complaints. Ongoing improvements had been made in the variety and individualisation of activities.

The service was well led by a competent registered manager who sought to involve people and staff in plans for future developments. The view of people, staff and external professionals had been sought and identified issues acted upon.

Inspection carried out on 24 and 25 November 2014

During a routine inspection

We inspected Walnut Close on 24 and 25 November 2014. This was an unannounced inspection. The service provides personal care and support for up to 35 older people. The service has a unit specialising in the care of up to 11 people living with dementia and four smaller units providing care for up to 24 people with needs relating to old age.

Thirty two people were supported in the service at the time of this inspection. The service has a registered manager who had been in post since 2013. 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.

Staff understood how to keep people safe and how to report any concerns about care or safety. People in the service and their relatives felt people were safe and well cared for. The care staffing levels helped to ensure that people’s needs were met and their safety maintained. Potential risks to people were identified and assessed and appropriate steps taken to reduce the risk of harm. This included seeking advice from external health specialists where necessary. Risks from accidents were managed and monitored and steps taken to reduce their recurrence. People living in the dementia unit were assessed to identify whether they were at risk of pressure damage and provided with suitable equipment to minimise this risk.

Staff were subject to an appropriate recruitment process and required checks on their suitability were made. The required records of this process were maintained. Staff received training in aspects of their role relating to people’s safety and their knowledge and competency were also assessed.

People’s medicines were managed safely on their behalf where they could not manage these themselves. Appropriate procedures were in place around medicines management and administration, which reflected people’s rights around consent.

Where people’s behaviour could impact upon the safety of themselves or others, advice was sought from appropriate professionals in devising plans to manage the behaviour consistently to keep them safe. Staff had been trained on managing such behaviours effectively. The service was effective because staff received appropriate training and support. Staff were good at supporting people to maintain independence and seeking their consent to care. Appropriate decision making systems were in place where people were unable to consent for themselves.

Advice was sought from external health professionals when necessary to address health issues and staff communicated well as a team to maintain continuity of care. Although the service did not have a dedicated activities co-ordinator, care staff worked hard to provide a programme of activities for people which were supplemented by activities brought in from outside.

A new catering company had been contracted to provide meals in the service and feedback from people suggested the meals and the level of choice offered had improved. Nutritional risk assessments were used to identify those at risk with regard to food or fluid intake. Appropriate care plans and intake monitoring were in place.

People told us that the staff usually worked in a very caring way and respected their dignity. Staff offered people choices and supported them to make decisions and treated them with respect. Staff and the registered manager gave people time to express their views and people had a relaxed relationship with the staff. People were supported or encouraged where necessary to eat their lunch and their preferences were provided for.

Advice had been sought from recognised experts regarding the design of the dementia unit in order to meet people’s needs. The building had other adaptations and equipment provided to meet people’s needs.The environment supported people’s dignity with all individual bedrooms and people could choose from a range of communal areas. A bedroom was prepared in advance of admission with familiar items to try to make the person’s transition less stressful. People or their representatives were involved in decision making and care planning.

 People’s needs around identity and spirituality were provided for and staff promoted a positive self-image and identity. Relatives told us and records showed, that end of life planning and care was good. The staff provided care according to people’s individual needs, which they knew well. They engaged with people effectively so they were able to recognise when someone was not themselves. People’s social and emotional needs were met through a range of social activities and some outings within the limitations of staff availability. Some activities were led by external providers to broaden the range available. Staff had supported some activities in their own time to enable them to take place. The registered manager had applied to the provider to fund a dedicated activities co-ordinator post to take the lead on activities provision. A series of dementia focused reminiscence activities had been obtained to help address the needs of people living with dementia.

Although comprehensive surveys of people’s views had not been carried out recently, a food satisfaction survey had been done. People also had opportunities to give feedback and raise any concerns through resident’s meetings, the complaints procedure and informal contact with management. Any issues raised by people or their relatives had been responded to and addressed by management. The service was well led by an established management team who sought the views of people, staff and relatives in various ways to inform their management. People were positive about the management of the service, felt they had opportunities to give their views and were listened to. People’s records were kept securely but were made available to staff to inform their care.

Staff were managed and supported effectively through regular supervision, appraisals and meetings as well as on a daily basis by a visible and accessible management team. With one exception, appropriate and timely notifications of events were made to the Care Quality Commission as required. The registered manager used a variety of systems to monitor the day-to-day operation of the service and people’s health, safety and welfare. The registered manager and provider took appropriate action in response where any concerns were raised. The provider also monitored the effective operation of the service through regular audit visits and reporting systems.

Inspection carried out on 20 December 2013

During an inspection to make sure that the improvements required had been made

We looked at 10 plans of care which included comprehensive overall assessments, specific individual plans of care and detailed risk assessments. These showed that staff had enough information to provide safe and appropriate care. A family member told us that the home met their relative’s needs.

Inspection carried out on 23 September 2013

During an inspection to make sure that the improvements required had been made

We found that the home did not always show that they had properly assessed peoples’ needs. They did not have written plans for everyone who lived in the home to instruct care staff how to provide safe care to people.

Some people told us that they were ‘’very well looked after’’.

The service had made amendments to completed plans of care to show that people had agreed with them and what date any changes were made.

Inspection carried out on 11 June 2013

During a routine inspection

We spoke with 11 people who lived in the home, three of their relatives and three visitors to the home.

We found that people were well cared for in the way they preferred. People told us that they were ''very happy with their care'' and ''staff always care for me in the way I like best''. One person said, ''I am very happy living here and feel so safe and cared for''. People told us they were treated with the greatest respect and that staff always seemed to know what they needed.

We found that the home was clean and hygiene and staff knew all about infection control. People told us that that their home was always ''comfortable and clean''.

We found that the home had safe ways of giving people medication which had been prescribed for them by their doctors.

We found that staff were appropriately trained and supported to give the best possible care to the people who lived in the home. People described staff as ''absolutely brilliant'' and ''very respectful''.

The home had ways of making sure that they checked the quality of care being given to people. They listened to the views of the people who lived in the home. People said, ''the girls always ask me if things are alright and put them right if they’re not''.

We found that some people’s personal records were not completed properly and were not detailed enough to support good care and did not reflect the good practice we saw.

Inspection carried out on 26 June 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at Walnut Close and described how they were

treated by staff and their involvement in making choices about their care. They also told us

about the quality and choice of food and drink available. This was because this inspection

was part of an inspection programme to assess whether older people living in care homes

are treated with dignity and respect and whether their nutritional needs are met.

We spent time observing care to help us understand the experience of people who could not talk with us.

The inspection team was led by a CQC inspector joined by a professional advisor.

During the visit, of the 24 people accommodated at the home, we spoke with ten people in their bedrooms. People told us that they were well looked after and their needs were met. People said that they were “happy living in the home” and that staff were “helpful and they never felt hurried”.

People said that they made decisions about where they wanted to spend their time. They

said that they had a varied menu choice and were happy with the food served.

Reports under our old system of regulation (including those from before CQC was created)