Corner House is a privately owned and run care home. It provides accommodation and personal care and support for up to 57 older people, including people living with dementia and those needing support with a physical health condition. Corner House does not provide nursing care. There were 44 people living in the service when we inspected on 26 April 2018. This was an unannounced inspection.

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.

At our last inspection in August 2015, we found that people received personalised care, which was responsive to their needs, and the service was rated good. At this inspection, we found that people continued to receive good care and found the service was outstanding in the way it was led.

The management team were dynamic and innovative in their approach. They had a clear vision and set of values which they worked towards, and which were reflected throughout the staff team. Staff, people, relatives and healthcare professionals spoke highly of the management, and were confident in their ability.

There was a robust quality assurance system which meant the directors and management team had highly effective oversight of how the service was meeting people’s physical, emotional and social needs. The management team set a high standard for their staff and led by example. There was a strong emphasis on continually striving to improve.

People were at the heart of the service and the atmosphere was warm and welcoming. There was a positive, open and inclusive culture in the service.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

There were systems in place to minimise risks to people and to keep them safe. Staff were trained and supported to meet people’s needs effectively. There were sufficient numbers of staff to meet people’s needs. Recruitment processes checked the suitability of staff to work in the service.

People were provided with their medicines in a safe manner. They were prompted, encouraged and reassured as they took their medicines and given the time they needed.

Staff understood the importance of gaining people’s consent and were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them.

The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff supported people to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service supported this practice.

People were complimentary about the way staff interacted with them. Independence, privacy and dignity was promoted and respected. Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care.

People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support.

There was an open and transparent culture in the service. A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner. People, relatives, visitors and staff were confiden

Most of the people who lived at Corner House were able to speak with us. We spoke with 11 people who used the service, two relatives, one visiting professional and six staff on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who used the service and with staff. We also spoke with staff members. We looked at six people's care and social activity records. Other records viewed included staff rotas, training and supervision records, health and safety checks, medication records and records which related to the quality assurance of the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made and how to submit one.

We saw appropriate processes were in place with regard to medication and its administration. People could be confident they were protected from the unsafe use and management of medicines.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. We saw the service had processes in place which ensured that staff had the skills and knowledge to support people safely.

We saw that people's personal records including care files were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "They treat us very well here, I like being here it is a lovely place to be." People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who used the service in a caring and respectful manner. We saw that staff treated people with respect.

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns, appropriate action had been taken to address them. People could therefore be assured that complaints were investigated and action was taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, dietician and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We gathered evidence of people’s experiences of the service by speaking with them, observing how they spent their time and we noted how they interacted with other people living in the home and with staff.

We saw that Corner House provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner. During the course of our inspection we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

A visiting healthcare professional who attended the home on the day of our inspection said: “They are very good staff here, they are always very helpful and friendly.”

We noted that the environment at Corner House was spacious, with sufficient communal areas to meet the needs of people living there. We saw that people were comfortable in their surroundings.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.

People we spoke with said they were happy with the arrangements made for their medicines.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the storage and recording of medicines. There was insufficient guidance for staff on the use of some medicines.

Where people were unable to tell us their experiences, for example as a result of their limited verbal communication or poor cognitive ability, we noted their non verbal cues and these indicated that people were generally relaxed and comfortable and found their experience at Corner House to be positive.

Three people who used the service told us they could not remember being consulted about or being involved in developing their care plan or having been consulted when it was reviewed and updated.

Another person and their relative told us "Everything seemed to be ok and they were aware of what a care plan was, but had not been consulted about the same."

People told us they were satisfied with the level of care and support they received at Corner House. One person told us "I really like it here, I don't know anything else now."

People told us that they felt well looked after by the staff at Corner House. One person said "The staff are very kind and look after us well".

People told us they could choose whether or not to join in activities and could spend time alone in their room pursuing their own interests if they preferred.

People told us that they enjoyed their meals. One person said “The food is good” Another person said “We get a choice of meals”.

People using the service told us that staff helped them with their medication when they needed it.

People told us that they liked the service and that it provided a nice environment for them. They were happy with their rooms and found them comfortable.

Most people told us that they felt comfortable talking with the staff about any issues that they had and that the manager was also always available for them to talk to. One person said "I do feel safe here."

People told us that there were residents’ and relatives’ meetings held but these were not held often. One person told us they had never attended one but if they had any concerns they would make them known to the appropriate person.

We inspected this service on 18 and 26 August 2015 and the inspection was unannounced. At the time of our inspection Corner House was providing accommodation and personal care for up to 57 older people, some living with dementia. They were also offering home care to a small number of people living in their own home. It was the provider's intention to register the home care part of the service as a separate service. That registration process was in progress at the time of our inspection.

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.

There were enough staff to support people safely and they were clear about their roles. Recruitment practices were robust in contributing to protecting people from staff who were unsuitable to work in care in the home care section of the service. Although we did identify that one staff member had not followed their recruitment policy. The providers took immediate action to rectify the matter when we brought it to their attention.

Staff knew what to do if they suspected someone may be being abused or harmed and medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Where people were not able to give informed consent staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who were becoming unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s needs and preferences so that they could engage meaningfully with people. The manager had a commitment to offer people a chance to take part in activities and pastimes that were tailored to their individual preferences and wishes. Outings and outside entertainment was offered to people, and staff offered people activities and supported them on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that any complaints they made would be addressed by the manager.

The service had consistent leadership of a high standard; the manager is well organised and committed to supporting an open and positive culture that is person centred. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and asked people for their views so that improvements identified were made where possible. The providers also carried out quality assurance visits, set action plans and checked the actions had been undertaken.