Bucklesham Grange is a residential care home with nursing that provides accommodation and personal care for up to 57 people, some living with dementia. There were 54 people living in the service when we inspected on 7 June 2017. This was an unannounced inspection.

At our last inspection 9 February 2015 we rated the service good. At this inspection we found that the service had continued to develop and improve and was outstanding in Caring and Well Led. People received exceptional care that was personalised to them, taking account of their individual needs and wishes. They were at the heart of the service and told us how compassionate and dedicated staff went the extra mile to ensure they were extremely satisfied with all aspects of their care.

A registered manager was in post at the time of our inspection. 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. They were supported by a general manager with a clinical governance background who had day to day oversight of the service working closely with the managers from the different areas of the service such as administration, lifestyle, maintenance and hospitality.

Bucklesham Grange was exceptionally well led. There was visible and effective leadership within the service. The service was effectively organised and well run with an open and transparent culture. The registered manager was supported by a dynamic management team that demonstrated a holistic approach and had clear oversight of how the service was meeting people’s physical, emotional and social needs. They were able to effectively demonstrate how their robust quality assurance systems had sustained continual development and improvement at the service. They were clear about their expectations relating to how the service should be provided and led by example. Morale in the service was extremely high, at all levels within the service. Staff were proud to work at Bucklesham Grange and were remarkably motivated and passionate about delivering high quality care.

Staff were extremely compassionate, attentive and caring in their interactions with people. Staff understood the importance of obtaining consent when providing care. 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.

Ensuring people received care tailored to meet their needs which enhanced their quality of life was fundamental to the running of the service. An enabling and supportive culture focused on meeting the individual needs of people had been established and was reflected in people’s care records. Staff respected people’s privacy and dignity and promoted their independence. They demonstrated an enhanced understanding about people’s choices, views and preferences and acted on what they said.

The service provided outstanding end of life care. Effective systems and processes including working in partnership with the local hospice were in place to ensure people experienced a comfortable, dignified death in line with their wishes.

People and or their representatives, where appropriate, were actively involved in making decisions about their care arrangements. This led to people experiencing an excellent service which was distinctive to their individual needs

People were encouraged to maintain relationships that mattered to them such as family, community and other social links. They were supported to pursue their hobbies and to participate in activities of their choice. This protected people from the risks of social isolation and loneliness.

Staff were highly motivated, enjoyed their jobs and understood their roles and respon

We inspected this service on the 13 November 2014 and this inspection was unannounced. Bucklesham Grange is a care home with nursing. It provides care for 56 older people who may be elderly and or have a physical disability. Some people are living with dementia. There were 54 people living in the service when we inspected.

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.

People were positive about the care they received. They told us their care was personalised to them and met their needs and aspirations. The atmosphere in the service was warm and welcoming. People were proud to show visitors round the service they called home and said they felt part of an extended family.

People told us staff listened to them and acted on what they said. They told us they felt safe, were treated with kindness, compassion and respect by the staff. People were supported and encouraged to attend appointments with other healthcare professionals to maintain their health and well-being.

Staff knew how to recognise and respond to abuse correctly. People were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Any risks associated with people’s care needs were assessed and plans were in place to minimise the risk as far as possible to keep people safe. Appropriate arrangements were in place to provide people with their medication safely.

People were supported by sufficient numbers of staff with the knowledge and skills to meet their needs. Staff respected people’s privacy and dignity and interacted with people in a caring and respectful manner.

There was clear guidance for staff on how to meet people’s individual needs and aspirations, promote their independence and maintain their health and well-being. Where risks were identified to people’s health or well-being, action was taken to help minimise the risk as far as possible to keep people safe. Robust systems provided people with their medication in a safe manner.

People were supported by the managers and staff to make decisions about how they led their lives and wanted to be supported. They were able to voice their opinions and have their care needs provided for in the way they wanted. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they enjoyed the food and were provided with a variety of meals. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring and respectful manner.

People were encouraged and supported with their hobbies and interests and participated in a variety of personalised meaningful activities. People knew how to make a complaint and said that any concerns were acted on promptly and appropriately.

There was an open and transparent culture. Staff were motivated and morale was high. The management team planned, assessed and monitored the quality of care consistently. Systems were in place that encouraged feedback from people who used the service, relatives, and visiting professionals and this was used to make continual improvements to the service.

We talked with eight people who used the service to gain their views and experiences. People told us that they received good care and their views and choices were listened to and acted on. One person told us, “It’s very nice here. I am happy here.” Another person told us, “I have made lots of friends; we play bingo together and sit outside relaxing when it’s nice weather.”

All eight people told us that they were very satisfied with the service provided. One person said, “I have no complaints. I love it here. The staff help you with things and are pretty good. They always ask you if you need anything and are very kind and understanding.” Another person told us, “It is not an easy job to look after so many people; what pleases one doesn’t another but they ( staff) try ever so hard to be get it right and are flexible and accommodating.”

People confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, “They (staff) always get my permission before they start helping me. They make sure I am ready. I read somewhere about (different care home) staff getting people ready when they were still sleeping. They just started washing and dressing them without warning. I wouldn’t like that it must have been so frightening. They (staff) don’t do that here. They (staff) are kind and chatty and don’t rush you. They tell you what they are doing. It’s nice and reassuring and makes me feel safe.”

We looked at six people’s care records which provided information for staff on how to meet individual’s health and care needs. We saw that people’s choices and preferences were reflected in the care records and written in a way that promoted independence.

We saw that the service provided enough qualified, skilled and experienced staff to meet people’s needs. We looked at staff records and spoke with three members of staff who told us they were being appropriately supervised and supported. Staff we spoke with were knowledgeable about the people they supported and on to meet their needs.

We spoke with six people about the quality of the food. Feedback was positive. People said the food was appetising and there was a variety. We observed people as they were eating their lunch. Where a person required full assistance from staff to eat and drink, we observed positive staff interaction.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided. We also looked at the way that complaints were recorded and dealt with, and saw that they were handled in line with the provider's policy.

During our inspection we observed that the interaction between staff and people using the service was friendly, respectful and professional. Staff respected people’s privacy and dignity and sought their agreement before providing any support or assistance. One person told us how their choices and preferences were taken into account. They said, “I prefer not to join in the activities. It’s not for me. I like my own company and they (staff) know that. They don’t push me to join in but they do ask me to see if I have changed my mind. I won’t though but it’s nice they still check.”

We found that since our last inspection on 5 March 2013 care records had been revised. They contained risk assessments and care plans tailored to the requirements of the individual.

We saw that care records were regularly audited by the manager and action taken to ensure any areas of concern were addressed.

During our inspection we spoke with three people living at Bucklesham Grange. One told us, "They could not do better." Another said, "It is lovely here."

We found the service was clean and policies and procedures were in place to prevent infection.

We spoke with seven members of staff at different levels in the organisation. All said they were happy working at Buckelsham Grange and felt that they provided care to a good standard.

Prior to our inspection we received information of concern regarding the management of people’s care, insufficient staff to provide that care and the administration of medicines by untrained staff.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. However, there were shortfalls noted in all care records seen during our inspection. There was little evidence to show that any of the people who used the service had been involved with their care planning. During our inspection we saw that people appeared to be well looked after.

The medicines management and staff practices were in place and medicines were seen to be appropriately managed and administered. There were sufficient staff on duty to provide the care and attention that people who used the service needed.