Culliford House is a residential care home for up to 25 older people aged 65 and above with a range of needs including dementia. At the time of our inspection the home was providing support to 20 people. People in care homes receive accommodation and nursing 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 home has three floors with the top floor available for relatives or friends who have travelled a long distance to see people or who are wishing to spend more time with them if they are receiving end of life care.

The home had a registered manager. 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.

Culliford House was last inspected on 14 October 2015 and the service was rated Good.

At this inspection we found the service remained Good overall.

The home had safe recruitment practices. Checks had taken place to ensure staff were suitable to support people at the home. Pre-employment and criminal records checks were undertaken. Records included photo identification, interview records and two references. 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.

People’s risks were assessed and staff knew how to manage these without being overly restrictive. For example, where people’s skin was at risk or they had problems swallowing; their care plans noted this and detailed how much support they required from staff and how much they were able to do themselves.

People’s mental capacity and ability to consent to living at the home had been checked as part of the pre-assessment process. Staff were able to tell us when and who they would involve if a person lacked capacity. Best interest meetings had taken place in cases where an assessment had determined that a person lacked capacity. These meetings had involved family members with the authority to make decisions on their relative’s behalf, staff who knew the person concerned and healthcare professionals. When necessary staff sought advice and input from the local mental capacity act team.

Staff received an induction programme which included being assigned a mentor and a probationary period involving shadow shifts with more experienced staff and regular competency checks. New starters were given a learning style questionnaire to help inform training sessions and development plans. Training included health and safety, mental capacity, and dementia care.

Interactions between staff and people were natural and warm and there was a relaxed and happy atmosphere in the home. Staff told us that the rotas gave them enough time to spend with people and help meet their needs in a compassionate and person-centred way. They said they had enough time to get to know people, to listen and to respond to any questions they had.

People’s need for privacy and dignity was respected and upheld. For example, we observed ‘please do not disturb’ signs on people’s doors when they were being supported with personal care.

People’s care plans were detailed and reviewed monthly with their involvement and input from family members and healthcare professionals when required. Care plans included what people had done in the past and what they enjoyed doing now.

People were encouraged to become involved in things affecting their quality of life at the home. For example one person had become the peoples’ health and safety representative and attended staff training sessions. Another person was due to join the health and safety committee. The home told u

Culliford House was last inspected on 22 August 2013 and found to be meeting the regulations. When we visited there a registered manager in post. A registered manager was in post that supported us at this 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.

Culliford House is registered to provide accommodation and personal care for up to 25 older people.

The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements were made. The care and support people received were regularly audited, areas for improvement were recognised. Staff knew people’s needs; the records relating to people’s care and support were kept up to date.

People told us that the staff met their care needs well. One person told us “The staff look after me well, I feel involved in what happens here and know that I am listened too”. Another person told us “I am too well looked after, nothing is too much trouble for them (staff) I can safely say I am spoilt living here”. We observed that people were treated with respect and kindness.

Staff knew people’s routines and respected them. One person told us “I like to stay in bed in the morning for a while before I get up, staff bring me tea and something to eat and come and ask if I am ready to get up”. Staff knew how to support people when they became anxious and had effective ways of addressing this.

The provider was meeting the requirements of the Mental Capacity Act 2005(MCA) and assessments of people’s capacity had consistently been made. The provider had appointed a senior member of staff to act as the homes MCA advisor to staff. This person had received appropriate training for this role. Other staff understood some of the concepts of the Act, such as allowing people to make decisions. Staff demonstrated that they could apply this to everyday life.

Staff demonstrated a caring and compassionate approach to people living at the home. People were offered choices at mealtimes such as where to sit and what to eat. The provider had a system to offer choice of what to eat during mealtimes that was effective.

People told us there was enough staff to meet their needs. The provider was able to demonstrate that extra staff were available to support people should their needs change or if extra support was required.

People told us they felt supported at the home and safe in the company of staff. The staff told us they enjoyed working at the home with many staff being in continuous employment at the home for 10 years and over. They told us they have enough time to sit and talk with people and to do things with them that they knew interested them. One staff member told us “the manager expects us to sit and talk with people”. We observed staff working discreetly and in an unhurried manner throughout the inspection.

People told us that they understood the care choices available to them, and could have their views taken into account in the way their care was delivered. A person told us, "They are very good, they explain things to you.” Another person told us, “They do listen to me.” Another person said, “We have alternatives. I go down for lunch and eat tea in my room.”

People's needs were assessed and care was planned and delivered to meet people's needs. A person told us, “I have a keyworker. She’s very helpful.” People’s care was regularly reviewed and their personal information was held securely. A visiting family member told us, "I’ve seen the care plan.”

We viewed a selection of staff records, and saw that relevant checks had been carried out when the home employed staff. Staff had opportunities to gain appropriate qualifications. A visiting family member told us, “They don’t seem to go through a lot of staff; the staff seem stable.”

We found that medicines were stored securely and were given at the correct time. The home’s activities co-ordinator told us that the home had implemented new medication management procedures in the past 12 months. The home also had procedures in place for the management and disposal of controlled drugs.

The home kept records of general maintenance of the building. Records were archived and destroyed in accordance with retention schedules.

We reviewed four sets of care notes and spoke to three who lived at the home. The notes were comprehensive and used on a day to day basis to plan and implement people's care.

Staff were keen to involve people in decisions about the home and held regular meetings. One person had asked to have the 'blinds in their room changed as they let too much sun in the room in the morning'. This had been done.

People could get up or go to bed at a time that suited them. One person chose to have tea at 6 a.m and then stayed in bed till their breakfast at 8 a.m as they wanted to maintain their established routine. The home was happy to respect this decision.

We observed staff chatting to people about the care they received and asked if there were any changes that they needed to make. One staff member said 'because people have the same condition it doesn't mean they are not individuals with their own specific needs'.

Staff reported that they were supervised on a regular basis and that 'they found it useful'. Comprehensive notes were kept of these sessions but the quality of some of them was lacking in any valuable information. The sessions were also used for keeping staff up to date with their appraisal which some reported as being confusing.

People told us they felt involved in the decisions made in the home. They commented on how nicely decorated and maintained the home was and their ability to 'come and go as they pleased'.