This inspection took place on 15, 16 and 21 November 2018. It was an unannounced visit to the service.

Bartletts Residential Home is a care home. It is registered to support older people, some who are living with dementia. The original building is a Victorian country house built in 1856, over the years it has been added to and now provides care and support for 50 people. At the time of our inspection 43 people were being supported. Accommodation was spread over three floors in the original building and two floors in the newer build areas. People had access to a wide range of communal seating areas, dinning spaces and sociable area. The home benefitted from extensive well-maintained grounds with stunning views across the Chilterns.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The care home had a warm a welcoming feel, staff were keen to talk to us, relatives told us they liked that care staff smiled and engaged with their family member in a positive way.

We received positive comments from people and their relatives about their experience of Bartletts Residential Home, these included “Excellent. I went to quite a few care homes before this. I won’t say they were horrible, but just not somewhere I would like to spend the rest of my life. I had the feeling the day I came here, this is for me. They are all so welcoming,” “It is the best thing that happened to me to come to live here” and “The carers are absolutely wonderful.”

At our last inspection we made a recommendation about the management of risks. People had been exposed to risk of burning from an iron press and strangulation from unsecured blind cords. At this inspection we found improvements had been made in these areas. However, we found staff had not always been trained to use equipment used to support people in the event of a fire. Fire drills were carried out, however, no learning or evaluation was recorded about them. We have made a recommendation about this in the report. Other environmental risks were managed well.

Risks posed to people as a result of their medical condition had been assessed, however, risk assessments and care plans did not always reflect the same level of risk. We found records relating to people’s care was not always representative of the care and support delivered. We have made a recommendation about this in the report.

People were routinely protected from abuse and staff had good knowledge on how to recognise potential signs of abuse. Staff had been recruited safely to ensure they had the corrects skills and attributes to work with people.

The home was maintained to a high level of hygiene, however, the décor could be confusing to people with memory loss or a diagnosed dementia. We spoke with the registered manager about this. They were aware of the issue and had discussed this with the provider.

Staff had been supported to maintain their skills and learn new skills. Staff told us they felt supported.

People were supported by staff who treated them with dignity and respect. Comments from people included, “Everyone was so kind when I came here, not fussy kind, but treated me like a human being. They are very good at the job. Though sometimes they are very busy. But they do give you time to talk. I know I keep saying it’s all good, all good, but it really is good” and “Oh yes of course, as I said, they treat you like a human being. I have privacy in my room, and you can do anything you want to do. My son visits regularly. They do treat you with dignity and respect. I get treated very well.”

People were supported to have maximum c

This inspection took place on 31 March and 1 April 2016. It was an unannounced visit to the service.

Bartletts Residential Home is a care home for older adults who may be physically frail or be living with a dementia illness. Nursing services are provided by the community nursing team from local GP practices. Bartletts is registered to provide accommodation for 38 people. At the time of our inspection 36 people lived at the service.

We previously inspected the service on 09 January 2014. The service was meeting the requirements of the regulations at that time.

Bartletts is situated in a large open greenfield area on the outskirts of Aylesbury market town. The building is made up from a converted Victorian country home and a new purpose build extension. Rooms were of varied size all have en suite facilities.

The service had 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.

We found a number of potential risks to people; We found blind cords were not secured and people who had memory loss had access to a hot iron. However these were quickly rectified by the provider, after we pointed them out.

We received many positive comments about the service. Comments from people included “The staff are really nice, it’s a very nice home,” “It’s very friendly, warm and relaxed, the staff are very kind and compassionate, I am very pleased I came to live here.”

Relatives told us the service was managed really well. Comments included “The manager has always responded to my concerns” and “They [manager] could not be more helpful”. Another relative told us “The manager is excellent, they are open and transparent. I just have reassurance.”

People were supported by staff who were knowledgeable about their needs. Staff got to know people and understood their likes and dislikes.

People were offered a range on activities within the home and in the local community. People’s interests and hobbies were supported. For instance the service purchased a greenhouse for a keen gardener.

Relatives told us they chose Bartlett’s as it was “Warm”, “Welcoming” and for the standard of “Quality of accommodation” and “It’s got the right amount of activities and also space to have privacy.”

People had support from staff who had been selected by management following robust pre-employment checks. Once in post, staff were offered training and support for them to develop in their role.

The providers were supportive of the registered manager and invested in providing a continued programme of improvement to provide a high quality service.

We have made a recommendation about environmental risk assessments and reviewing the quality of them.

We spoke with six people and three relatives. People told us they were happy with their care. They said that their health and care needs were met. They told us staff were kind, caring and they could not fault the care they received. One person commented "It is fabulous here, staff are amazing, thoughtful and gentle". Another person commented "It is home from home". A relative told us they were kept informed of any changes in their relative's care and felt confident and reassured that their relative was well looked after.

We saw improvements had been made to people's care plans. Care plans addressed people's identified needs and they were detailed and informative as to the level of support people required. Risk assessments were in place to manage potential risks. This meant people's needs were met and risks were identified and managed to safeguard people from harm and injury.

We spoke with the manager and two staff. They were positive about the changes that had been made and the benefits to the people who used the service. We saw staff were aware and responsive to people's needs. This meant people's needs were met.

We spoke to four people using the service, one relative and four staff as part of this inspection. People who used the service said they were happy with their care and felt well looked after. They told us staff were kind, caring and good at their job. They felt there was sufficient staff to meet their needs and call bells were answered in a reasonable time frame.

One person told us they were generally happy with their care but indicated their choices in relation to getting up and meal choices were not promoted. They also told us they would like more activities out of the home. The registered manager was made aware of this during feedback and agreed to address it.

People's care and welfare needs were assessed. However, care plans and risks assessments were not comprehensive in addressing identified needs and risks. This had the potential to put people at risk of not receiving consistent and safe care.

The home was clean, well maintained and effective systems were in place to reduce the risk of cross infection for people.

Medication was appropriately managed which meant people received their medication in a safe way.

Staff told us they were suitably inducted, trained, supported and supervised in their roles. This ensured people were supported by staff who were suitably trained and supervised.

An effective complaints system was in place. This meant people’s concerns and complaints were addressed appropriately.

We spoke with six people who used the service and with two relatives. They told us they had all the information they needed to help them decide about moving into Bartletts. People told us they were satisfied with the way their views about how they wanted their care and support provided were respected and listened to.

When we had conversations with people who lived in Bartletts, they told us they were very satisfied with the care they received. "I am very happy here" one person said, whilst another told us the care staff were "absolutely wonderful". We spoke with two relatives who were both very positive about the standard of care they observed. "The staff are very caring and keep me informed about how things are going" one told us. People told us they felt safe. Those relatives we spoke with indicated they had no concerns about the safety of their relatives.

Throughout our visit we did not see any evidence of delays in answering call bells or of people having to wait for attention in the home's communal areas. When we spoke with relatives and people who live in Bartletts, none of them raised any concerns with us about the level of staffing in the home.

We saw a copy of the home's newsletter which included a feedback questionnaire analysis. This showed a very high level of satisfaction with all areas of the home's operation.

We spoke with four people using the service during our visit to the home.

People said they liked the home and its location. The registered manager was described by one person as ‘very open minded and concerned for people’s welfare.’ People said that carers had been kind and supportive.

People said carers had involved them when planning their care which they had then agreed.

People said their ongoing health needs had been met by attending health related appointments.

People said they liked the food and the chef was approachable. People said they had a choice of meal options per meal and if necessary could request an alternative meal option from those planned. People said meals were of a good quality and portions sufficient. People said they could access drinks at any time; one person said ‘they are very liberal with drinks’.

People said the home offered a range of activities which they were able to choose from. Some people said they would like to access a wider variety of activities and go out more.

Some people said they were not aware of residents meetings taking place. Others said they were aware of the meetings as a family member had attended them. People said they felt comfortable airing their views and should they have concerns they would approach staff at the home.