Pilgrims View

The service provides care and support for up to 44 older people who do not have nursing needs, but some of whom are living with mild to moderate dementia. At the time of our inspection there were 36 people using the service. Two of these people were cared for in bed. The accommodation was situated over four units; each had its own dining room and lounge areas and small kitchenette.

At the last Care Quality Commission (CQC) inspection on 30 September 2015, the service was rated Good in Safe, Effective, Caring and Well Led domains with an overall Good rating. However, the Responsive domain Required Improvement. We recommended to the provider to seek advice and guidance from a reputable source and to carry out research on published guidance about the benefits of and types of activities recommended for people living with dementia.

At this inspection we found the service remained good.

The service has a registered manager. The registered manager was not available on the day of our inspection as they were on holiday. 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 provided good leadership. They checked staff were focussed on people experiencing good quality care and support.

There were activities located around the home for people to engage with independently and each dining room table was set up for people to be engaged in different activity. All staff took the time to sit and engage with people and take an interest in what people were doing. Staff made time for people.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

People and staff were encouraged to provide feedback about how the home could be improved. This was used to make changes and improvements that people wanted. Records were consistent and robust.

People continued to be safe at Pilgrims View. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

There were enough staff to keep people safe. The registered manager continued to have appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed they were caring and they treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

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 home supported this practice.

The registered manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the home continued to be made to ensure people experienced good quality safe care and support.

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

Is the service safe?

The staff that we spoke with understood the procedures they needed to follow to ensure that people were safe. During our inspection we saw that staff delivered the care outlined in people's care plans. For example we observed that staff ensured people were safe from falls because they encouraged people to use their walking aids.

Procedures for dealing with emergencies were in place and staff were able to describe these to us. Staff had access to support and advice at all times from a senior member of staff.

The registered manager ensured that staff underwent checks before starting work at the home. For example they checked a person's character by carrying out Disclosure and Barring Service checks (DBS). This was formally known as a criminal records check.

Staff were trained in safeguarding people from abuse and they understood their responsibilities to protect vulnerable people.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We saw that people's rights were protected because the manager understood how to support people to make decisions in their best interest.

There were systems in place for making regular checks on the safety of the premises and for ensuring that the staff had the required skills and knowledge to care for people in a safe way.

Is the service effective?

People had an individual care plan which set out their care needs. We saw that people had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. People's care plans were reviewed regularly to check they were still effective. During our inspection we saw staff delivering the care outlined in people's plans. People who used the service talked positively about the care they had received. One person said 'I am aware of my care plan and staff treat me with respect'. Staff were able to explain to us about how they reviewed people's care plans. They told us that they keep people's care plans under review. One said 'We go through people's care plans with them'. We found that all of the care plan files we looked at had been reviewed recently by the person's key worker. The records showed that the reviews had included the person who used the service.

Is the service caring?

We found that people were treated with respect and their dignity was maintained. People appeared relaxed and comfortable with the staff that supported them. We observed that people had a positive relationship with staff. Staff took time to chat with people about day to day matters. People we talked with were positive about their experiences of the service. During our inspection we talked with four people who used the service or their relatives. All of the people we talked with were happy with the care they had received. People told us that the staff were caring. One person said 'The staff are friendly and caring.' Another person said 'I am very happy with the care here, in my experience this is as good as it gets'. A relative said 'The staff are very caring they meet X's needs very well.' Another relative said 'The staff are very friendly, they are very good'.

Is the service responsive?

The service reviewed people's care plans regularly. There was a nominated person in charge of the service with the required training and authority to manage how the service was delivered. The registered manager or their deputies were available via telephone for further advice when needed.

We found that the manager asked people about what they experienced from the care and treatment they had received. The manager had consulted people who used the service, listened to their comments and acted on them.

Is the service well-led?

The provider continually monitored areas of risk in the service and made regular checks on quality. There was evidence that the provider learnt from incidents that occurred to prevent them from occurring again.

We noted that at the time of our inspection that there was no registered manager for the service. However, the manager told us that they were applying for registration. We saw that the provider was auditing this process to ensure that they supported the manager's registration application.

The manager ensured that daily checks of the quality and safety of the service were carried out. Regular reviews of people's care plans took place which ensured their needs were being met.

Staff were trained, appraised and supervised to ensure they could care for people effectively.

Staff understood the importance about asking people for their consent before any care and treatment was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People were generally supported appropriately with regards to their medication needs.

There were safe recruitment procedures in place to safeguard the people who lived in the home. Staff were given the training and support they needed to meet the needs of the people who lived in the home.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Overall we found that Pilgrims View had achieved compliance but have made some comments that the provider may find useful to note.

We found that staffing levels had increased, which meant that there were enough staff to meet the needs of the people who lived in the home.

Staff knew about peoples individual likes, dislikes and preferences and we observed positive interactions between staff and the people who lived in the home.

We saw that care plans and risk assessments contained more information and gave clearer guidance to staff. Risk assessments did not always give staff enough information on how to support the person to reduce any potential risks.

The quality monitoring of the service and the systems in place had been developed so that ongoing improvements could be made.

Not all records were maintained appropriately so that the delivery of care could be monitored and reviewed.