We carried out an inspection of Dalemead care home on 13 and 14 March 2017. The inspection was unannounced. At the previous inspection of 27 April 2015 the home had met all the standards.

Dalemead is a home for up to 49 older people, including people living with dementia. The home has 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.

At the time of the inspection the registered manager was on leave and the inspection was supported by the deputy manager and her team.

At this inspection we found the service remained Good.

The service demonstrated they continued to meet the regulations and fundamental standards.

People and their relatives using the service felt safe living at Dalemead and spoke positively about the support provided to them. They said staff treated them with kindness and respect. People were supported to lead active lives and maintain relationships with those who matter to them. People and their relatives also spoke highly about the care and support provided at the home.

People received care and support from a stable group of staff who knew them well and understood their needs and preferences. Each person had an individualised support plan to make sure they received the support they required. Assessments completed by the service identified any risks to each person and helped to safely promote their independence.

People were supported to have their health needs met. We saw that people’s prescribed medicines were being stored securely and managed safely.

The staff attended training which gave them the knowledge and skills to support people effectively. People were supported to have 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 and their relatives spoke highly about the range of activities offered in the home and the respectful and friendly manner with which staff supported and assisted them. People’s independence and privacy was respected and care was provided in a way that promoted people’s dignity. There was a choice of nutritious food which took into account people’s cultural and personal preferences.

Staff working at the home spoke positively about their philosophy of care and confirmed that they received regular support and training. People using the service felt able to speak to the registered manager or other staff to raise any issues or concerns. Records, policies and procedures were in place and were up to date.

An experienced registered manager was in post who knew the service and the people living there very well. There were systems in place to help ensure the safety and quality of the service provided.

Further information is in the detailed findings below.

We carried out an inspection of Dalemead care home on 27 April 2015. The inspection was unannounced. At the previous inspection of 6 May 2014 the home had met all the standards.

Dalemead is a home for up to 49 older people, including people living with dementia. The home has 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.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing.

Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

There were enough staff on duty to care for people, with between three and four care staff per floor, together with a team leader. Staff had been trained to use specialised equipment, such as hoists, safely. Specialist assessments had been completed in relation to complex moving and handling issues, for example, with the support of occupational therapists.

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us, “The staff are very attentive and the food is lovely”.

The provider had a clear Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

The provider ensured that people’s independence and choice was promoted. People told us that they had been involved in making decisions and there was good communication between staff and themselves. They also confirmed that their consent was asked for before doing anything, such as going somewhere, or receiving medicines.

We saw that people’s health, nutrition, fluids and weight were regularly monitored. There were well established links with GP services offering a single point of access for people. This included dieticians, occupational therapists, community mental health teams and other social and health services

People told us that the staff were kind and caring towards them. People’s comments included; “Staff are kind and caring and they listen to you”; “Staff are always really respectful”. One person told us, “nothing to complain about, I might as well be in a first class hotel’. Another said, ‘I am very well looked after and the staff are helpful’. One person said, ‘I couldn’t find anywhere better, the activity organiser is a lovely lady’.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, cultural and religious preferences. Care records included details such as personal achievements, places visited and family relationships.

We listened to how staff spoke with people and found this was professional and relaxed, and included friendly chit-chat between staff and people who used the service. We saw how people who used the service responded positively to the interaction. Staff responded promptly when asked a question and took time to explain their actions.

People said they were able to get up and go to bed at a time that suits them and were able to enjoy activities and interests that suited them. The home also supported people to maintain relationships with family, relatives and friends.

The home’s philosophy placed great importance on ensuring that people who live at the home continued to lead as normal a life as they were able. The activity co-coordinator and staff spent time getting to know the individual, their background and life history.

In order to listen to and learn from people’s experiences the home had monthly meetings with people, the latest meetings having been held in February and March 2015. There were also relatives meetings as well as holding a support group for family and friends. A relative confirmed they had attended a relatives meeting and the dates for future meetings were visible on the activity board.

The provider had an effective system to regularly assess and monitor the quality of service that people received. People were very positive about the culture and atmosphere in the home. One person said, “It’s like one big family. The staff are lovely”. Relatives were also complimentary about the accessibility of the manager and the atmosphere in the home.

The manager and staff maintained a focus on keeping up to date with best practice through participation with groups such as Skills for care and the National Care Homes Association and through programmes such as pilot schemes in care for people with dementia and at end of life.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People and relatives we spoke with told us that they felt very safe and happy at the home. One relative told us: “The fact we can visit anytime and can approach anyone with any worry is so reassuring”. Another person told us: “The staff here are nothing but kindness itself”.

During our visit we saw that people were protected from abuse and avoidable harm and that policies and procedures were in place to act on any concerns. We saw that staff had received training in Safeguarding, Moving and Handling and the safe administration of medicines. The provider had effective recruitment procedures which included checks made under the Disclosure and Barring Service (DBS).

We found that people were cared for in an environment that was safe, clean and hygienic. Equipment at the home was well maintained and serviced regularly. We saw that a recent fire report which had identified some areas for action had been promptly addressed.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst the manager informed us that no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The provider had been made aware of recent legal changes to decisions affecting people’s liberty and had plans in place to review and update current policies.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One relative told us. "They have taken the trouble to get to know him as a person and can talk about his past with him”. Another person told us: “The staff look after me really well. They help me when I need it and keep my room spotless and the food is always top notch”.

We found that the provider had a clear Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

We saw that the provider held comprehensive records on people which enabled staff to understand their health and social care needs. Records included care plans written from the individual’s perspective and in clear, plain English.

Staff were led by team leaders who provided support and supervision. In addition the service was supported by a team of domestic workers and a dedicated activities coordinator as well as administrative support.

There was good communication and contact between the provider and other services such as social services, pharmacy and community health services. One community nurse who was present during the inspection described the communication between her service and the home as “excellent”.

Residents meetings were held regularly as well as meetings for relatives. In addition to a flexible visiting-hours arrangement the provider also held several events per year to which relatives and friends were invited.

The provider had a complaints policy which was accessible to everyone as well as a comments and feedback process.

Is the service caring?

People we spoke with told us they were very happy with the level of care they received and the attitude of the staff team. One person told us: “I have all my needs met and the staff are very good”. A relative we spoke with said “We had visited several homes before choosing this one and as soon as we entered it just felt right. The staff are wonderful and I couldn’t fault their care”.

During our visit we saw that staff involved and treated people with compassion, kindness, dignity and respect. People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this to be the case.

We saw that the service had an ethos of placing the individual at the heart of everything they did. This was reflected in the way that people’s needs were assessed, their care plans and the choice of activities available in the home. We observed staff working at the home and spoke to staff. One carer described the home as a “family”. Another described their work positively by telling us that “there is always something new you can learn about people and how to make life better for them”.

Is the service responsive?

People we spoke with told us they were satisfied with how the staff responded to any queries or issues. One person told us: “I have never had any problems here, but if I needed anything I would just mention it to someone and they would sort me out”. A relative said: I have never had any trouble in being able to speak with the manager of anyone else”.

Services were organised so that they met people’s needs. People’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

The Service User Guide, which contained a copy of the complaints procedure and the latest CQC report was available in each of the different wings of the home. We also saw evidence of questionnaires and surveys sent to people as well as records of resident and relative meetings where plans for the service were discussed with people.

Is the service well-led?

People we spoke to were happy with the way the service was managed. One relative told us: “The manager and his team are fantastic. They are always available to speak to and really run this home well”. A resident of the home said: “Staff work so hard making sure this place is spotless and clean”. Staff we spoke with also told us they felt proud of the fact they did not need to use agency staff very often.

We saw that the leadership, management and governance of the organisation assured the delivery of high quality person centred care, supported learning and innovation and promoted an open and fair culture. Staff had a good understanding of the ethos of the home and quality assurance processes were in place.

We saw that the manager met regularly with his team and that team leaders provided supervision to care staff.

During our visit we spoke with relatives of people using the service, staff, the activity coordinator and the manager.

We saw that the staff treated people using the service and their relatives with dignity and respect. A relative we spoke with said "The staff are all very good, not just the care staff".

A relative we spoke with said "Staff are really down to earth and very thorough with the care", "You really feel the warmth of the staff, I feel very supported".

The staff we spoke with all felt there was enough staff to provide support and they had received a high level of training which helped them in their work. A member of staff said "It's a wonderful place; I want to work here for the rest of my life".

Relatives we spoke with said "The food looks and smells good and the menu is varied" and "The staff will go the extra mile to get the food people want".

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practising professional.

To help us to understand the experiences people have, we used our SOFI (Short

Observational Framework for Inspection) tool during this visit.

People told us that they were happy living at the home, saying "I made the right choice" and "I chose to come here". People told us that staff maintained their privacy and dignity and said they were involved in decisions of daily living and could choose the activities they participated in. They said "we have residents meetings and our views are taken into account". One person said “when the weather is fine we have our lunch or tea in the garden and this makes living here very enjoyable”.

Comments about the food were positive and included "pretty good", "good variety", "reasonable portions", "cooking is excellent", "top marks, I am a very fussy eater", "we can have an alternative if we do not like what is on the menu". People said they had enough to eat and drink.

People using the service said that they were happy with the care and support provided

to them, saying there were enough staff to meet their needs. Comments included "staff are very kind", "staff come when I call" and "staff listen and help".

Visitors told us that they were happy with the care and support provided. One person said "my relative always looks well cared for and wears their own clothes". Visitors said their relatives liked the home and were very happy with the food they were given.