The Inspection took place on 6 and 7 November 2017 and it was unannounced. At the last inspection, the service was rated good. At this inspection the service remains good in safe and effective and has improved in caring, responsive and well-led.

Crowstone House is a ‘care home’. People in care homes receive accommodation and or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to care for up to 54 older people, some of whom may be living with dementia, a physical disability and/or a sensory impairment. There were 48 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 consistently cared for by kind, caring, respectful and compassionate staff. They told us that they felt they mattered and that staff always listened to them and helped them in any way they could. Staff were passionate about their role and had an exceptionally good knowledge about the people they cared for. People and their relatives said that staff, ‘went the extra mile’ and, ‘go out of their way’ to ensure that people had the most pleasant experience of care. Staff were described as, ‘absolutely marvellous’ and, ‘kind and compassionate’. People and their relatives were kept actively involved in making decisions about their care. Advocacy services were available if people needed them. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People always received excellent personalised care that was tailored to their individual needs. Staff cared for each person as an individual and knew them really well. The service promoted the importance of engagement and linking people to their community, people were extremely positive about their lives and told us about their trips to the theatre, the seafront, the dementia awareness festival, local church groups and to local cafes. People told us they made good friends and one relative said their loved one had a better social life since moving into Crowstone House. Everyone we spoke with praised the service and staff. They could not speak highly enough of the care and support they received.

People were encouraged to maintain personal relationships. Their families were able to share meals with them if they wished. People had the use of technology such as mobile phones and email systems and one person had used a tablet computer. Where people had never used technology before the service supported them to learn and link with their families which increased their wellbeing exponentially. A satellite television service had been ordered to offer people a wider choice of TV programmes.

People and relatives spoke confidently about how the service listened to them and felt concerns and complaints, no matter how small, were acted upon and resolved to their satisfaction. The service learnt from complaints and made changes to ensure that people received an improved service. People had plans in place for their end of life care and staff knew how to support people’s families at these times.

There was a wonderful personal relationship between staff, people and their loved ones. People and their families had confidence in the registered manager and staff. People consistently told us they would recommend Crowstone House to others as the care was exceptionally good. People's relatives felt they could talk with any of the staff and that they all knew exactly how to care for their loved one.

Staff felt valued and supported by

The Inspection took place on 22 February 2016 was unannounced and carried out by one inspector.

Crowstone House is registered to provide accommodation and personal care without nursing for up to 54 persons who may be living with dementia. There were 48 people living in the service on the day 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.

At our last inspection in September 2015 we had concerns about staffing levels and medication storage. At this inspection we found that staffing levels and medication storage had improved and that people were cared for and supported by sufficient numbers of staff.

You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Crowstone House on our website at www.cqc.org.uk

People told us that they were happy with the care and support provided at Crowstone House. People felt that the service was responsive to their needs and caring. People said, "I am very content here and have no concerns," and, "The carers are lovely and always cheery."

We saw that people's care needs were assessed. Care plans were in place so that staff would know about people's care needs. Risks associated with people's care was minimised as far as possible through risk assessments being undertaken to keep people safe. The service was caring and responsive to people's changing needs. Staff sought support from other professionals or agencies when needed. Staff had a good knowledge of people's individual needs and offered them appropriate support. People had opportunities for activity and occupation.

People told us that they enjoyed the food provided at Crowstone House. We found that people's nutritional needs were assessed and monitored to ensure their on-going wellbeing.

People told us that they felt safe and secure living in Crowstone House. The home had a friendly, welcoming and caring atmosphere. We saw that staff had been trained to understand different types of abuse and to report and act upon any concerns they had about people's care and welfare.

People had access to sufficient levels of equipment to assist in meeting their needs. Equipment in use was kept in good condition and well maintained to ensure people's safety.

Staff were supported to be effective in their role through good levels of initial induction, training and on-going supervision.

Overall we found Crowstone House to be a caring, effective, responsive, safe and well led service.

We spoke with six relatives and three people that used the service. Everyone we spoke with was positive about their experience of this service. Relatives said, “You get a good initial reception every time you come in. They are very hospitable. The manager, everyone here is approachable”. Another relative said, “I can trust the staff when I leave”. A staff member told us it was a good place to work with good communication.

We found that people were treated with respect and dignity was promoted through dignity champions. Staff made pledges on the dignity tree for everyone to see how they individually would promote dignity within the service.

People told us that they experienced care, treatment and support that met their needs and protected their rights. Care plans were up to date and informative for staff to follow.

Staff were well trained in care and were aware of the needs of people living with dementia. Staff told us they were well supported by management and were happy to work at this establishment.

People told us that they were happy living in Crowstone House. They felt that the staff were caring and able to meet their needs. People said that staff were generally available when they needed them, but they might have to wait a while for help at busy times.

People said that they were given choice about how they spent their time and that activity and occupation were generally available to them.

People said that they liked their rooms and were happy with the food provided.

This inspection took place on 4 and 11 September 2015.

Crowstone House is registered to provide accommodation and care for up to 54 people some of whom may be living with dementia. There were 47 people living in the service on the day 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 insufficient staff on duty to meet people’s needs. Staffing levels had not been appropriately assessed to take into account people’s individual needs and staff and time required to support people safely and ensure their wellbeing. This is a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had been safely recruited and were well trained and supported to meet people’s assessed needs. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines. The manager had plans in place for improving the medication storage room.

The manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made applications appropriately when needed.

They knew how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely.

People were supported to have sufficient amounts of food and drink to meet their needs. However, the dining experience in the upstairs lounge was not as positive as in the downstairs dining room and lounges. People’s care needs had been assessed and catered for. The care plans provided staff with sufficient information about how to meet people’s individual needs and preferences and how to care for them safely. The service monitored people’s healthcare needs and sought advice and guidance from healthcare professionals when needed.

Staff were kind, caring and compassionate, they knew people well and ensured that their privacy and dignity was maintained at all times. Although people had mixed views about activities, it was an improving picture as a new activities co-ordinator had recently been appointed. People were able to express their views and opinions. Families and friends were made to feel welcome and people were able to receive their visitors at a time of their choosing.

People knew how to raise a concern or complaint and were confident that any concerns would be listened to and acted upon.

There was an effective system in place to assess and monitor the quality of the service and to drive improvements.