Beaufort House is registered to provide care and accommodation for up to 37 older people. The registered provider for the service is the Royal Agricultural Benevolent Institution, which is a charity that supports people who have worked in the farming community. The service was last inspected on 10 September 2013. At that time we found the service was meeting the requirements of the regulations we inspected at that time.

This inspection took place on 21 and 23 September 2016 and was unannounced. There were 32 people living at the service at the time of this inspection.

There was an experienced manager at the service who was registered with CQC. 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.

People consistently told us about the excellent care and support they received. People using the service, their relatives and visiting professionals said the service was “fantastic”; “one of the very best”; and “truly marvellous…” They said the service was safe. Comments included, “I feel very safe here. There are always people around to help me…” and “Mum was definitely safe here. There was never a shortage of staff, staff gave her the time she needed”. A visiting health professional said, “People thrive here…they are the best service…It is a pleasure to come here.” Another said, “This place is fantastic. Beyond fault. I’ve had no problems or faults in 13 years... It is outstanding…”

End of life care was provided by staff who were skilled and competent and ensured effective pain and symptom management. A palliative care specialist said, “This service is brilliant. They are excellent with family members…” Relatives were very appreciative of the care and support they received during their family member’s last days. One said, “They do whatever it takes to make people comfortable. The support we received was absolutely wonderful.”

People’s wellbeing and happiness was central to this service. Staff had developed a positive rapport with people and they were gentle, attentive, kind and respectful in their approach. One person said, “The staff are really lovely…I see how nice they are with all the other people too.” A relative commented, “There is a welcoming ethos here. It’s a family.” Another said, “This was the only home in the area I wanted (person’s name) to come to. Staff are wonderful…” People’s independence was encouraged and people were supported to do as much as possible for themselves.

The culture within the service was open, friendly and welcoming. People, staff and professionals expressed confidence in the registered manager and provider. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service and promoted links with the community, which benefitted people using the service.

People were protected from harm by staff who had a good understanding of the actions to take if they suspected someone was being abused or neglected. Risks to people had been assessed and measures were in place to prevent avoidable harm and to help ensure their independence was supported and respected. Accidents and incidents were monitored to identify themes and to help prevent any reoccurrence. There were sufficient numbers of experienced and caring staff to support people. People’s medicines were managed safely. The service had safe recruitment systems in place to ensure staff were suitable to work at the service.

People were protected by good practice in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); ensuring people’s rights were protected.

People were promptly referred

33 people were living at the home at the time of the inspection. We spoke with nine people and made observations throughout the visit.

People told us they were very happy with the care at the home. One person said "Everything is so good and nothing is ever too much trouble for the staff".

We observed people's care plans were individualised to ensure they met each person's care and support needs and contained detailed risk assessments. We saw that care plans were up to date, reviewed monthly and re assessed every six months.

People told us they enjoyed the food and said there was always plenty of choice. One person said "The food is so good my weight keeps going up". We observed a person who was intolerant to gluten, was able to enjoy the same food as other people as their food was made with gluten free ingredients.

People commented on the high standard of maintenance in the home and surrounding grounds. One person told us how grateful they were that their room had been decorated to their taste which had made them feel at home. We observed that new door closures ensured that people had the choice of leaving their room doors open but would close in the event of fire.

We observed throughout the visit that staff treated people with respect, kindness and dignity which supported people to live full and happy lives in the home.

We saw evidence that the quality of care and services were continually monitored and changes were made dependent on the outcome.

There were 30 people living at the home at the time of the inspection. During our visit we spoke with eight people and also made observations throughout the visit. We also spoke with visitors to the home, including a relative and a district nurse.

We observed staff gaining people's consent in a skilled way. We saw staff using risk assessments practically by picking up on people's health issues and escalating them. We saw people being given choices in relation to food, how they chose to spend their day and their daily routines.

People who used the service were positive about the care they received. People told us "I think we are very fortunate here" and "you won’t find a better home". We observed interactions between staff and people who were unable to give their opinion due to confusion or illness. Staff treated these people with dignity, sensitivity and respect without exception.

We observed that staff were knowledgeable, skilled and able to spend time with people. People told us they are "very caring", "wonderful" and worked hard to meet the needs of each individual through care plans and service delivery.

We observed procedures were in place to prevent infections. One person told us "everything is wonderfully clean" and "it's like a five star hotel here".

We saw evidence that the quality of care was being continually monitored and learning implemented by staff who took on board people's comments and the outcomes of various audits.

People living in the home told us they felt their privacy and dignity was maintained by staff. One person said; “You get your own privacy and can lock your own door.” Another person said; “Staff always knock on the door” before entering their bedroom.

People told us that they were involved with their daily care and were encouraged to keep their independence. One person said; “You are allowed to be independent but if you can’t do anything they will help.” Another person told us they helped with the gardening and said they were encouraged to be independent.

People received appropriate care and staff were considerate to people’s needs. One person told us; “The care is excellent, they are wonderful with everyone”. Another person said; “There is not a home in Burnham that can beat it”, “they couldn’t look after you better, the care is wonderful, so are the staff.”

People said they feel safe in the home. People told us that staff were patient and kind when delivering care. One person said; “I feel safe here staff are never impatient or rush me”.

People we spoke with told us that they were comfortable in speaking to staff if they had a concern about any aspect of their care. One person said; “I would be happy to complain if needed”. Another person said; “I am comfortable to make a complaint”.

During our visit we observed staff to be competent in delivering care to people. They were patient, approachable and knowledgeable of peoples needs in the home. Some of the comments people told us during our visit were; “Staff are kind and nothing is too much trouble”, “Staff go the extra mile”, “I can’t praise the staff enough” and “You couldn’t have better staff than you have here”.