This unannounced inspection was carried out on 10 and 11 April 2018.

At the last Care Quality Commission (CQC) comprehensive inspection on 20 and 22 May 2015, this service had an overall rating of Outstanding.

At this inspection, we found the evidence continued to support the rating of Outstanding. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. You can read the report from our last comprehensive inspection and subsequent focused inspection, by selecting the 'all reports' link for Amherst Court on our website at www.cqc.org.uk

This service is a care home. People in care services receive accommodation and nursing or personal care as single package under one contractual agreement. The service was not providing nursing care at the time of this inspection. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 62 older people living in the service with moderate to high care needs, some of whom were living with short term memory loss or cognitive impairment associated with dementia. The accommodation was provided in four care suites spread over two floors, a lift was available to take people between floors.

There was a registered manager in post. 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.

Feedback provided by people and their relatives about their experiences of the service included, “The staff come in and help with washing and dressing, they are careful with my shoulder because it hurts when I move it sometimes, but they are gentle when it comes to that side; I think they are great," “Mum seems so much happier here compared to the other place [care home]; she always wanted to go home and was always complaining," “I love it here, this is my new home," “I believe mum is safe, the staff are kind and respectful and very patient with mum” and “I think staff are quite good and I enjoy the atmosphere, if it’s someone’s birthday they always have a celebration."

The service continued to exceed relevant fundamental standards. The service provider and staff had built on their previous successes and sustained the outstanding model of care and support in the responsive and well led domains. The directors of the company, management team and staff continued to find ways to improve the service and remain driven by their passion for caring for people, including those with dementia. There remained a heavy emphasis on community involvement. The ground floor coffee shop was open to the public. The vision and the value of the service to 'enable people to live as they choose' remained embedded in the service.

Staff had an excellent understanding of people's needs and were imaginative in the way they provided person centred care which put people at the heart of the service. They continue to find creative ways of supporting people to have an exceptional quality of life. Leaders in the service promoted person centred values. Team leaders and care staff were well informed about their roles and they described in detail how they provided support to new staff so that they understood the core values and how to care for people.

The learning from taking part in research projects had been embedded into the delivery of the service since our last inspection. Partnership working with key stakeholders in the local community such as the police, the NHS, universities and private businesses had continued.

People continued to be 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 support this practice. We observe

Some people using the service had dementia. This meant they were not always able to tell us their experiences. We spoke to some people who lived in the home and observed how people interacted with the staff and management of the service.

We saw that staff were cheerful and friendly with the people who lived in the home. We found that people were happy to talk to staff and that staff listened to what people had to say.

Staff understood the needs of the people who lived in the home and supported them in line with the guidance in their care plans.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment. We found that staff understood how to support people with making choices about how they spent their day.

People were provided with appropriate care and support that met their needs and promoted their wellbeing. There were a range of activities available that suited people's individual needs and preferences.

People received the medicines they needed, when they needed them.

Staff were supported with appropriate training that helped them obtain the necessary skills to meet the needs of the people who lived in the home.

There was an effective system to regularly assess and monitor the quality of service that people received.

The inspection was carried out by one inspector and lasted seven hours. During this time we visited all three floors of the home and spent time in the six different suites. We were able to speak with staff and managers of the suites. We were also able to speak with five relatives, who were visiting family, and chatted to some of the people with dementia who live in the home.

Families spoke positively about the care and support provided to their relatives. They told us "I think it is great here. They give 101% care". "Everybody who works here is very happy and this gives the home a happy atmosphere and it is a good combination". "Staff always treat people with dignity and respect" and "From the domestic staff to the people at the top – there is a good atmosphere in the home and everybody is caring".

We found that staff treated people with dignity and respect and supported people to make sure that their health, care and welfare needs were met.

People who used the service told us that they liked living in the home and that they liked the staff.

One person said, 'The staff are very good and always about if I need them'. Another person told us 'I like the food here and I can do what I want'. One person said 'I can't walk very well, but staff will always answer my buzzer'.

People told us that they could choose how they wanted to spend their time. One person said, 'I do little jobs around the home to help the staff out'. Other people told us that they could go out and had been out for walks. People told us that they liked visiting the café in the reception area.

People also told us that they could spend their time where they liked. They told us they could stay in their rooms if they preferred or spend time in one of the communal areas.

The inspection was carried out on 20 and 22 May 2015 and was unannounced. There were 105 people living in the home when we inspected.

Amherst Court provides high quality accommodation and personal care for older people some of whom may be living with dementia. The provider had built the home to an exceptionally good modern standard, specifically adapted for people living with dementia. The home provided accommodation over three floors arranged in six suites. All the rooms had en-suite shower and toilet facilities which promoted independence and facilitated individual personalised care. There was a sensory garden for people and their relatives to enjoy that stimulated the senses of smell and hearing. Recent donations from the community meant a ‘crazy golf course’ and herbs and vegetables were being grown by people, with the assistance of volunteers and staff for use in the kitchen.

People benefited from a fully accessible, well equipped and designed community café where they could meet relatives and friends. There was a truly open atmosphere on entering the premises. Direct dial telephones were available to people in their own bedrooms and people could access the internet if they wanted to. All areas within the home had been designed for the needs of people with dementia. Plenty of communal space, lounges, breakaway areas and dining areas were available to people, as were quiet areas where people could sit in peace. We observed that this was a very safe home with a well-designed system allowing staff and visitors to move freely within the home. All the corridors were flat and have hand rails. A relative said, “Although my mother is partially sighted she is able to negotiate her way with the help of the hand rails”.

There was a registered manager employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. People told us and we found the home to be extremely well led.

Peoples comments about the home and staff were very positive. Health and social care professionals were very enthusiastic about Amherst Court, and had many positive things to say. Relatives were very happy with the home and the care people received. A visitor to the café area noted, ‘The place is kept spotless and the gardener is very good too.’

Peoples needs were assessed and reviewed by a dedicated Admiral dementia nurse, an expert in dementia care assisted by an experienced head of care. The Admiral nurse also supported relatives and staff in their understanding of dementia.

The registered manager involved people in planning their care by assessing their needs both before and when they first moved in. Assessments were underpinned by information about the challenges people faced living with dementia. The risk in the home was assessed and the steps to be taken to minimise them were understood by staff.

People and their relatives described a home that was welcoming and friendly. One relatives said, “My children think this is a wonderful home for their grandmother and said they are putting my name down in advance,” and “My mother is very well cared for, she has her hair done and they even colour it for her which makes her very happy”.

People told us they felt safe. The safety culture included people having regular private and confidential access to the visiting Police and Community Support Officers, (PCSO).Staff had received training in protecting people from abuse and showed a good understanding of their responsibilities in preventing abuse and how to spot the signs of abuse in people living with dementia.

The home had an exceptionally full activities programme for people which included a ‘wishing well’ to enable people to visit past experiences that were important to them. This was supported by the local community and fundraising events. People were encouraged and supported to remain involved in community life. The registered manager promoted partnership working with key stakeholders in the local community such as the police, the NHS, universities and private businesses to enhance the care being delivered to people.

Staff understood the ethos of the provider by providing care which was friendly and compassionate and people were encouraged to get involved in how their care was planned and delivered. One person said, “This is the first time I have visited my friend here. I am really impressed. I have been here about an hour and I have been made welcome, offered refreshments and have seen nothing but care, love and kindness from the staff”.

People had access to GPs and other health and social care professionals with specialisms in dementia and mental ill health.

Staff received in depth training about dementia or other conditions people faced. Peoples needs were very well understood by staff who worked in partnership with the community nursing teams to deliver high quality care. Staff were very complimentary about their training and the opportunities they had to develop in their roles. Staff received regular supervision and annual appraisals. Staff embraced new concepts of care and were motivated for continuous improvement.

Staff followed robust medicines policies and had been trained extensively over twelve weeks to administer medicines safely. The management team worked innovatively with peoples' GPs to minimise the use of anti-psychotic drugs.

The senior management team were working towards further enhancing the quality of home they provided by taking part in research projects. This included individual work around memory loss in dementia and activities that were designed to help improve this. Additional guidance and research was used to promote peoples' cognitive and physical health who were living with dementia through activity and engagement. This had a direct and positive impact on peoples lives in the home. Feedback included, “It is hard for some people (with dementia) to verbalise what they are experiencing but actually when they are engaged in the activity you could see that they were enjoying what they were doing, there was so much fun and laughter involved”.

All of the comments about the food were good. Staff supported people with dementia exceptionally well to maintain their health by ensuring people had enough to eat and drink. Innovative ways were used to encourage people to eat and drink who walked with purpose and who became distressed if they could not do this.

There was a robust complaints policy. There were numerous forums and discussion meetings people could attend to express their views on the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

Robust recruitment policies were in place and followed by staff. Safe recruitment practices had been followed before staff started working at the home. The registered manager ensured that they employed enough staff to meet peoples' assessed needs. Staffing levels were kept under constant review as peoples' needs changed. Additional staff time was given to people if they became unwell. We found that staff treated people with dignity and respect, kindness and compassion.

The provider had outstanding quality audit systems that were independently verified. Health and safety risks were audited and actions were taken to minimise risk. An organisation not connected with the provider carried out annual surveys of peoples experiences of the home and the results were used to develop comprehensive business development plans. Peoples satisfaction with the home had improved to 93% compared to 88% last year.

The registered manager was experienced and well qualified to lead the home. They were supported by a very well organised and experienced management team who led from the front, working alongside staff to deliver care and monitor performance.

The local community and national and local business were heavily involved in assisting the registered manager with fund raising and through volunteering. The inspection team noted the openness within the home with the coffee shop open to members of the public. People in the home shared their experiences of dementia with the police. This promoted a very positive response for the police to encourage a better understanding of the challenges people living with dementia faced, both in the home and in the wider community.