Archived: Strand House Residential Care Home

People’s experience of using this service and what we found

People’s experience of using this service:

People were extremely positive about their experience of living at the home. For example, one person described Strand House as “a very comfortable, pleasant home living up to its good name."

People said they felt safe because of the quality of care and the small size of the home. Staffing levels delivered responsive support to people. People received their medicines on time and staff were quick to respond to changes in their health and well-being. People were protected from abuse because staff understood their safeguarding responsibilities. Care staff were recruited to suit the caring values of the service. They recognised the importance of team work to provide consistent and safe care. The home was well maintained, clean, and staff had access to protective equipment to protect people from the risk of infections.

There was a stable and attentive staff group; a person said, “I can’t fault them.” People were supported by staff who respected their privacy and dignity. Staff relationships with the people they assisted was caring and reassuring.

Staff received training throughout their employment to ensure they had the skills to provide effective care. People’s care needs were regularly reviewed. Referrals were appropriately made to health care services when people’s needs changed. Risk assessments identified when people could be at risk. They covered people's physical and mental health needs and the environment they lived in. People's nutritional needs were met, and people socialised as they ate their meal in a relaxed atmosphere.

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. Information was in place to ensure people’s legal rights were protected.

There were systems in place which enabled the registered manager to monitor the quality of care. For example, through reviews and surveys. Feedback from people using and visiting the service showed this approach had been effective. For example, a relative said, "Just keep doing, what you are doing. It's the best."

Rating at last inspection (and update):

The last rating for this service was Good (published March 2017). At this inspection, the rating remained the same.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Strand House is a very small residential care home which is registered to provide personal care for up to eight people over the age of 65 years. It does not provide nursing care. The home has been run as a family business for the last 28 years. The provider, who was also the registered manager, lived at the premises with her husband, who was also the maintenance person.

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.

At the time of the inspection, there were four people using the service and three vacancies.

Strand House was warm, clean and welcoming and had a very calm, peaceful atmosphere. People living there said they were content and felt safe and happy. The service is located in a small village and was actively involved with village activities such as the local schools’ Harvest Festivals. Many relatives visited daily. They spoke highly of the care and support their relatives received at the service. ne person said, "Strand House is a lovely home. The staff are lovely … very caring and nothing is too much trouble.”

Strand House was decorated and maintained to a very high standard. The open plan kitchen dining room had the feel of a home kitchen, where people were able to see the food being prepared and talk to the cook when eating. This was also the registered manager’s own kitchen and she ate meals with people living there most days. This meant people could communicate directly with the registered manager and develop close relationships. People were also enabled to take part in activities such as cooking, baking and jam making.

Staff understood people's needs and supported people in a way which respected their wishes and preferred routine. People were protected because staff understood how to identify potential abuse and how to report this. Care and support was well planned to ensure every aspect of people's needs was met and any risks were identified. People's medicines were safely managed and people were supported to eat and drink a good range of healthy homemade food.

Staff recruitment processes ensured only staff who were suitable to work with vulnerable people were employed. New staff went through an induction programme. Staff felt valued and that they had sufficient training and support to do their job effectively. All staff were supported by having one to one supervisions and appraisals with the registered manager to help identify good practice and areas of learning.

The registered manager had a good understanding of the Mental Capacity Act 2005 and had systems in place to monitor capacity. All four residents had full capacity. She felt the staff could benefit from some refresher training in this legislation.

Staff were kind and compassionate towards people and had developed warm and caring relationships with them. Healthcare professionals supported people living at the service and the staff by regular visits. Staff supported and involved people and their families to express their views and make their own decisions, which staff acted on.

The registered manager operated well-established systems of quality assurance, including an effective complaints system, which ensured the home was well maintained. Records were kept up to date and people using the service and their families were fully involved in the care being delivered.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were six people living at Strand House. The summary is based on conversations with five people using the service, two staff supporting them and the registered manager, observation and records.

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

Is the service safe?

We found the home environment was under regular review and kept in good order. Care workers were trained and supported to care for people safely. People's needs were assessed and their care planned, which took into account hazards to their safety. A health care professional said they had no concerns about the service at Strand House. The provider improved the safety of medicines management and record keeping, as indicated in their action plan following our last inspection.

Is the service caring?

We saw attentive, individual care provided. People were treated with respect, their independence promoted and their privacy protected. Our observations indicated a caring staff group and a nurturing environment.

Is the service effective?

We found people received a good standard of personal care. One person told us how their health had improved since they moved to Strand House. They said that their needs had been discussed with them and were being met. They said "I like it here."

Is the service responsive?

We found that people's health was promoted and issues responded to promptly, such as pain relief. Care workers were seen to respond to people's individual needs, such as assistance with eating and responding to people's preferences. There was effective communication with the people using the service and their families.

A person's request to replace a vanity unit in a bedroom had been met. Another request, to move to a ground floor room was being arranged following decorating.

Is the service well led?

The owner/manager was in clear overall control of the home and led care workers by example. People said they were pleased with the standard of care provided. Care workers said they felt supported and their opinion was sought and listened to. Care workers said there was a very low staff turnover and staff morale was good. We found that care workers were enthusiastic about the service they provided.

All the people, but one, praised the home and the care workers. One person said 'Wonderful, my family couldn't have put me anywhere better'. Another person told us that the care workers 'just can't do enough for you'. A visitor said 'the best place they can be, there's nowhere better. Fantastic place'.

We found that people's consent had been obtained for care and treatment provided to them by the service.

People we spoke with were happy with the care provided at the home.

People had not been protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were cared for by staff who had been employed following the home's robust recruitment procedure.

People told us that they felt safe and knew what to do if they had concerns. One person said "I would feel very comfortable making a complaint if I ever had any concerns, but I've never had any". People told us that they would not hesitate to report any issues to any member of staff. One person said, "I am sure that if I did complain it wouldn't be ignored".

The home had not maintained accurate records which related to the care and treatment provided to each person who lived at the home.

We looked at the care records for three of the people who lived in the home to find out how their health and personal care needs had been assessed, and how the home planned to meet those needs. We saw evidence that care plans were regularly reviewed and updated as people's needs changed. We saw that when people's short term needs changed this was recorded so that staff knew what they needed to do to meet these needs.

One person we spoke with told us "I've got everything I need". Another person told us "I don't need much help, but they are there if I need them". One person told us staff "always teat me nicely, very good in all aspects". Another told us "only have to ring the bell and they (staff) come". We were also told the manager was "so kind and gentle, do anything for you".

We saw that medication was being stored safely. Medication was supplied to the home in a series of blister packs and stored in a locked metal cabinet. We saw that the medication storage areas were clean and free from a build up of excess stock.