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Inspection carried out on 19 December 2019

During a routine inspection

Home Close is a care home that was providing personal and nursing care to 57 people aged 65 and over at the time of the inspection.

The service can accommodate up to 72 people across eight separate wings, over two floors, each of which has separate adapted facilities.

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

Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

Sufficient numbers of staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet the specific needs of people using the service.

Staff continued to treat people they supported with kindness and compassion. People liked the staff that cared for them. People's privacy and dignity was maintained. People enjoyed the activities that went on at the service. Links were established with the local community.

People were supported to eat and drink enough, they were positive about the food and choices on offer. People were involved in making decisions about their care. Staff gave and respected people's choices.

Peoples preferences on how care was to be delivered was recorded in their care records for staff to follow. This included people's end of life wishes.

The service was being managed by an operational manager in the absence of a registered manager. Staff were passionate about providing people with a good-quality service. Robust systems were in place to monitor the quality of care being delivered to people.

Complaints and concerns were investigated, and complainants responded to. People, their relatives and staff were given opportunities to give their view of the service and from this feedback action was taken to make any improvements.

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 11 July 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.

Inspection carried out on 6 June 2017

During a routine inspection

Home Close provides accommodation, nursing care and personal care for up to 72 older people. The home is over two floors with various communal areas for people to sit and meet with visitors. There were 65 people living at the home at the time of our inspection.

This unannounced inspection took place on 6 June 2017. At the last inspection on 15 July 2015 the service was rated as ‘good’. At this inspection we found overall the service remained ‘good’.

A registered manager was in post at the time of the 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.

Staff were only employed after the provider had obtained satisfactory pre-employment checks.

Staff were clear about the procedure to follow to protect people from being harmed.

People had health, care, and support plans in place which took account of their needs. These recorded people’s individual choices, their likes and dislikes and any assistance they required. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise these risks and enable people to live as independent and safe life as possible.

Medicines were well managed and people received their medicines as prescribed.

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.

People and visitors said staff were always very kind and caring. People’s dignity, respect and choices were not always protected.

Staff understood their roles and responsibilities and were supported by the registered manager to maintain and develop their skills and knowledge by way of supervision, observations, and appraisals. Staff were trained to provide safe and effective care which met people’s individual needs and knew people’s care requirements well.

People and their visitors were able to raise any suggestions or concerns they might have with the registered manager and team of staff. They said that they felt listened to as communication with the registered manager and staff team was good.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their visitors were encouraged to share their views and feedback about the quality of the care and support provided.

Further information is in the detailed findings below.

Inspection carried out on 15 July 2015

During a routine inspection

Home Close is registered to provide accommodation, nursing care and personal care for up to 72 older people. The home is over two floors with various communal areas for people to sit and meet with relatives. There were 68 people living at the home at the time of our inspection.

This unannounced inspection took place on 15 July 2015. At our previous inspection on 30 September 2014 we found that the provider was not meeting one of the regulations that we looked at. This was because some records were not accurate and well maintained. The provider sent us an action plan informing us of the actions that they would take in respect of this. During this inspection we found that improvements had been made.

At the time of this inspection the home had a registered manager. 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 and associated Regulations about how the service is run.

Staff treated people in a way that people preferred. Staff received appropriate training and support to carry out their roles. There were sufficient numbers of staff to safely meet people’s needs. People received care which had maintained their health and well-being. Relatives were very happy with the care provided

Staff supported each person according to their needs. This included people at risk of malnutrition or dehydration who were being supported to receive sufficient quantities to eat and drink.

Medicines were stored correctly and records showed that people had received their medication as prescribed. Staff had received appropriate training for their role in medicine administration and management.

Staff respected people’s privacy and dignity.

People’s needs were clearly recorded in their plans of care so that staff had the information they needed to provide care in a consistent way.

People confirmed they were offered a variety of hobbies and interests to take part in and people were able to change their minds if they did not wish to take part in these

Effective quality assurance systems were in place to monitor the service and people’s views were sought and used to improve it.

Inspection carried out on 30 September 2014

During an inspection looking at part of the service

During our last inspection in June 2014 we found that although people�s health was monitored, not all care plans we looked at had the required information available or they were difficult to navigate to provide people with consistent care. This unannounced inspection, which we carried out on 30 September 2014, was to assess if improvements had been made since our last inspection.

At the time of our inspection on 30 September 2014, the provider was not carrying out the regulated activity �Diagnostics and screening' at this service. This regulated activity was therefore not assessed on this occasion.

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer the five key questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary describes what people using the service, their relatives, and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people using the service had complex needs which meant they were not all able to tell us about their experiences. During this inspection we observed care being provided to people. We spoke with six people who received care at the home, one person�s relative and five staff members. We also viewed six people�s care records.

Is the service safe?

The risks associated with providing care to each person were assessed and action taken to minimise any identified risks. This ensured that care was provided safely. However, we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Is the service effective?

People�s needs were assessed prior to care being offered. This ensured the service was able to meet the person�s needs. People�s care was delivered in the way they preferred and people told us that the care they received met their needs.

Is the service caring?

People were complimentary about the care provided at the home. One person told us, �If you need looking after, this is a good place to be.� Another person told us, �The care is very good and the nurses are lovely.� During our inspection we saw that staff interactions with people were respectful and caring in their approach. People told us this was always the case.

Is the service responsive?

We saw that staff referred people appropriately where they required specialist treatment or healthcare, and followed the guidance provided by other healthcare professionals. This meant that people�s needs were met.

Is the service well led?

The provider had notified us that a new manager had taken up post since our last inspection. The manager advised us that they were in the process of applying to register with us. Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and of the standards of care and support expected of them. A relative told us that staff acted had identified their family member�s preferences very quickly and acted upon their wishes, ensuring that care was provided in the way people wanted. However, we found that people�s care records were not always complete or fit for purpose. This meant there was a risk that care may not be delivered in a way that met people�s needs.

We found that the provider was compliant with one of the two regulations that we assessed. We have asked the provider to tell us how they will make improvements and meet the requirements of the law. If you wish to see the evidence supporting our summary please read the full report.

Inspection carried out on 5 June 2014

During a routine inspection

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 safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with ten people who use the service, four visitors, six staff, the quality manager, the nominated individual, the clinical manager and the training manager.

The registered manager had recently resigned. The Care Quality Commission have received the application to cancel their registration at Home Close. We were informed by the area manager that a manager is due to commence employment at Home Close in July 2014.

Is the service safe?

People we spoke with told us the staff were kind and helpful and that they were very happy living at Home Close.

Potential risks to people had been identified and recorded clearly in their care records. We saw that these risks had been reviewed on a regular basis to ensure that people were kept safe.

Staff were knowledgeable about the care and support people required. Although we found that the information on people�s care needs were not all easy to find. This could potentially put people at risk of not receiving care in a consistent way.

Regular gas, electrical and fire safety checks had been undertaken. This ensured the safety of people who lived within the scheme their visitors and staff.

Is the service effective?

People said they were happy and felt well looked after at Home Close, they told us the staff always ask them what help they need. People�s health was regularly monitored to identify changes to their needs and they were supported to see a range of health care professionals to maintain their wellbeing.

Is the service caring?

We saw that people got on well with the staff and were comfortable with them. Staff were patient, kind and showed that they respected the people who lived at Home Close. People told us that staff helped them to maintain their privacy and independence.

Is the service responsive?

People�s needs were assessed before they were admitted to the home, and a care plan developed to meet those individual needs. People told us that staff responded to their needs in a timely way.

Staff were being provided with training that enabled them to do their job effectively. A new internal training framework was being introduced. This would enable staff to update their skills in a more timely way as training was being provided by internal trainers.

Is the service well-led?

People told us they would be happy to speak with the manager or any of the staff if anything was not right. They felt that any issues would be dealt with.

The provider had a quality assurance system in place to make sure that the service provided by the staff was of a high standard. A range of audits and action plans ensured that all aspects of the service were closely monitored.

Staff we spoke with told us they felt well supported by the leadership team and enjoyed working at Home Close.

We found that the provider was non compliant with one of the regulations out of the five areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

Inspection carried out on 7 August 2013

During a routine inspection

Record keeping had improved since our last inspection. Records were now maintained well. Those we looked at were accurate, relevant and up to date.

We observed the care that was being provided and staff were attentive and spoke to people in a respectful manner.

People we spoke with couldn�t speak more highly of the staff and told us they were wonderful and looked after them well. One person said: �They are quick to come when we need help�.

Inspection carried out on 18 April 2013

During a routine inspection

During our inspection on 18 April 2013, the people we spoke with told us they were very happy with the care and support they received. We saw that staff encouraged and supported people to be independent. One person told us, "I love it here, the staff are great".

We observed staff supporting people in a kind and calm manner. Overall, staff communicated with people in a positive and respectful manner. Although the provider might like to note that when we observed during the lunchtime period, we noted on two occasions a person was moved in their chair without the member of staff explaining to them what was happening.

We saw that care plans provided brief details of how people�s needs were to be met, although not all of the plans had been updated. Information had not been cross-referenced onto care plans from the reviews and this made it more difficult to get a complete picture of peoples needs.

Staffing levels in the home were adequate to met peoples needs. The recruitment procedures were robust and the files we looked at contained all the required information.

Inspection carried out on 20 June and 11 July 2012

During a routine inspection

People we spoke with during our visit told us they were happy living at Home Close, that staff treated them in a way that they liked and the care they received was good. One person reported, �I know I�m in the right place should anything happen to me�. Another commented, �The staff are good and they all become friends in time�. However one person told us that staff got her up far too early each day, routinely between 5.30 and 5.45 a.m., even though her care plan explicitly stated she liked to be woken at 7 a.m. She told us that staff sometimes woke her from a deep sleep and this made her feel tired for the rest of the day. She also told us that she was only offered a weekly shower, and would like more, given that she used to have a daily shower before she moved in. Despite this however, she described the home and its staff as, �Fantastic� and that she would recommend it to anyone.

There was a good range of daily activities at the home and one person told us she really enjoyed playing the home�s piano everyday and another that he enjoyed the home�s quizzes as they, �Keep my old brain moving�. However one family member had concerns that people were not encouraged into the home�s grounds enough and that their relative had not once been in the gardens since she was admitted.

One relative told us, �We would happily bow down before the staff, they are amazing people�. This relative went on to report, �You hear terrible things about care homes these days, but when I visit Home Close, I think to myself, well I wouldn�t mind being here at all, it�s really lovely and there�s lots to do�. Another relative told us, �You get a good feeling when you walk in, and the place is always clean�.

A visiting hairdresser told us, �All the residents here are very happy, I know them well and I�m not aware of anything bad at all. They would soon tell me if something was wrong�.

Inspection carried out on 21 September 2011

During a routine inspection

We spoke with people living at the home and they made several positive comments about the support they received. People were generally satisfied with the care provided. One person was looking forward to a planned �pamper session� in the afternoon, when someone was coming to their room to do give them a manicure. Another person told us, �The girl that runs them (the activities) is second to none�.

However two people we spoke with told us they wished they could get outside more, one commented: �When I see a lovely morning like this I would love to go out for a walk but staff don�t seem to have the time�. Another person said "I have not been out for two months or more". We spoke to another person who said they enjoyed the activities provided, but spent a lot of time on their own, because they said other people were too frail to come out of their bedrooms.

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