Dauntsey House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dauntsey House accommodates 21 people in one adapted building, some of who are living with various degrees of dementia. At time of the inspection there were 21 people living there. Dauntsey House has 19 single and double bedrooms spread over two floors with access to a communal lounge, dining room and conservatory on the ground floor.

The inspection took place on 6 and 7 March 2018 and was unannounced.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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, relatives and visiting professionals spoke very highly of the care people received at Dauntsey House. People told us they felt safe and appeared comfortable around staff.

Staff knew the people they supported and were able to explain the risks relating to them and the action they would take to help reduce the risks from occurring.

People were supported by sufficient staff with the right skills and knowledge to meet their individual needs. At all times during the inspection, staffing levels meant people were well supported.

There were safe medicine administration systems in place and people received their medicines when required. Only senior staff who had received medicines administration training and had been assessed as competent, were able to administer medicines.

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.

Staff told us they were able to provide unrushed care and were able to spend time talking to people.

Staff showed concern for people’s wellbeing in a caring and meaningful way, and they responded to their needs quickly. People told us they were able to make choices about their daily routine.

Care, treatment and support plans were personalised. The examples seen were thorough and reflected people’s needs and choices. We saw care plans included background history and what was important to people, for example what careers people used to do and what hobbies and interests they had.

Complaints and concerns were taken seriously and used as an opportunity to improve the service. People and their relatives were given information on how to make a complaint, however relatives told us they had not needed to make any complaints.

There was an active programme of entertainment and activities daily. We observed people taking part in singing and dancing. Dauntsey House had a busy and happy atmosphere.

Staff spoke positively about management and told us they felt supported. The registered manager also told us they valued their staff team. Relatives said the manager’s door was always open.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home.

Dauntsey House is a care home, registered to provide accommodation and personal care for up to 20 older people, some of whom may have dementia. At time of the inspection there were 17 people living there. Dauntsey House has 19 bedrooms spread over two floors with access to a communal lounge, dining room and conservatory on the ground floor.

The service had a registered manager who was responsible for the day to day running of the home. 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 told us Dauntsey House had a homely feel to it. On the day of the inspection the home had a lively and busy atmosphere with people getting ready for the local school childrens’ carol singing. People’s rooms were decorated to their taste and were individual with their own furniture from home. People told us they felt safe living at the home. Staff understood their responsibilities and the actions they needed to take to keep people safe from harm and abuse. Risks to people’s health and safety were identified and plans were in place to minimise these risks.

Staff knew people well and supported them with maintaining their independence. People and their

relatives told us staff treated them or their relative with kindness, respected their privacy and dignity. People were supported to have sufficient food and drink to maintain good health. People told us they enjoyed the food and that there was always plenty available. They said they would be offered an alternative if they didn’t like the options available.

The home had a programme of activities in place for people, including meaningful activities for people living with dementia. We saw people were encouraged and supported to remain independent where they could. There was an in-room enrichment programme for people who preferred to stay in their rooms.

People’s medicines were managed safely and they had access to health care services when required.

Arrangements were in place for keeping the home clean and hygienic to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and free from odours.

Health and social care professionals spoke positively about the care and support people received and praised the management team. They said they found the staff and management team approachable and told us they sought advice and guidance where appropriate regarding people’s changes in care and support. The management team was proactive in advocating for people’s rights.

Staff acted in accordance with the requirements of the Mental Capacity Act (2005) where people were unable to consent to living in the home. Where people did not have the capacity to make the decisions themselves about their care and treatment, there was a lack of mental capacity assessments to support best interest decisions, for example with covert medication. Where required Deprivation of Liberty Safeguarding applications had been submitted by the registered manager.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person living at the home said “you don’t have to go out, it’s up to you”.

One person living at the home said “staff are so nice, there is never any difficulty, they are always willing to help”. One person’s relative said “it’s first class, they are good at encouraging people to interact with activities in the home and locally”.

There were effective systems in place to reduce the risk and spread of infection.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People told us they liked living in the home. One person said “It’s up to me what I do with my day.” Another person told us “I feel safe here”. A person informed us “they always get the doctor in if I’m ill.” A person described the staff as “very sympathetic” and another person said, “I like them all.” A person spoke about the manager and said “you can tell her about any matter you want” and “she sorts it.”

People had clear care plans, which staff followed. All people’s care plans had been agreed with them. Care plans were updated when people’s needs changed. Staff knew about people’s individual needs in detail.

Staff told us they were trained to carry out their roles, including safeguarding vulnerable people. Staff said they felt supported in their roles. A care worker told us the new manager “listens to what we say.”

The new manager was working through action plans to improve the home environment. These plans had started with the kitchen and would now move on to other areas, such as developments to the call bell system.

We had met with people who used the service during visits we made to Dauntsey House on 2 September 2011 and on 1 December 2011. Improvements had been needed following our first visit and the provider gave us their action plan for completing these. When we returned to the home in December 2011, we found that significant improvements had been made, but there were shortcomings in particular areas.

The provider confirmed that these shortcomings (concerning care plans and recording practice) would be addressed. We spoke to the provider on 14 March 2012 and they confirmed that action had been taken. They then provided us with evidence of the action taken and confirmed the arrangements being made to ensure that compliance was maintained.

We had received information about the early morning routines in the home. This had raised concerns about whether people were being supported safely and in a way which met their individual needs. There was a particular concern that some people were getting up early to fit in with staff routines.

We arrived at Dauntsey House at 5.30am. We went around the home and saw that some people were already up and dressed. Staff told us that a number of people needed a lot of support with getting up, and it was these people who were regularly up at that time. We were told this was an established practice which was linked to staff working periods. This was not a person centred way of working, and the practice did not reflect an individual approach to caring for people.

We also met people who told us they could get up in their own time and they managed some of their personal care. Other people were more dependent and needed regular support from staff to ensure that they were safe and their needs were met. We found that people’s care was not well monitored in particular areas. People were not always receiving the support that they needed with their drinks to ensure that they had the right amount of fluids.

A number of people needed support with continence. We found that there was odour in two bedrooms, although this was not a general problem within the home.