Dearnevale provides accommodation, personal care and nursing for up to 42 people, some of whom had a range of complex needs. The service specialises in care for people with neuro-disabilities, brain injury, stroke and enduring mental ill health. The home provides care over four units and in one adjacent ‘one-care’ service. One-care offers extended pathways of care, providing a more independent home for people who have met rehabilitation goals and enabling them to return gradually to life in the community, or those who can live independently with support nearby, or for people who require an individual care environment. There were 38 people living at Dearnevale at the time of the inspection.

The last inspection was in April 2015 and we rated the service as good. This inspection took place on 8 and 16 November 2017 and was unannounced on the first day.

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 was a very friendly, welcoming and homely atmosphere throughout the home.

People had highly positive, trusting relationships with staff to help them feel safe.

Robust systems and processes ensured people’s safety, including the safe management of medicines. Individual risk assessments were known and proactively planned with people.

People were supported to have maximum choice and control of their lives and we saw examples of how people had been supported to meet their identified goals and aspirations.

Staff were highly skilled and knowledgeable about each person they cared for and they were highly committed to making a positive difference every day to every person.

There was clear evidence of collaborative working and excellent communication in staff teams and with other professionals.

Care was clearly focused upon each person as an individual, with meaningful and purposeful activities based upon people’s real interests, goals and outcomes. People and their families felt listened to, involved, valued and empowered. Technology was used extensively and individually to support and enable communication.

The management team valued and inspired the staff. There was a clear set of values in the service and these formed the focus of shared purpose. There was mutual professional respect for people, whatever their role in the service and a clear commitment to driving quality.

Leadership and management of the home was highly visible, fair, open and transparent and formed an excellent basis for ensuring people’s needs were met in an individualised and person-centred way.

We carried out this inspection on 07 April 2015 and it was unannounced.

Our last inspection of the service took place on 23 December 2013 and we found the service was meeting the requirements of the regulations we inspected at the time.

Dearnevale was registered on 29 July 2011. It is a nursing home registered to provide accommodation and nursing or personal care to 40 people, aged 18+ years, in four separate units. On the day of our inspection, the home was fully occupied, with 40 people using the service.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was present on the day of our inspection.

People and their relatives told us they felt the service was safe, effective, caring, responsive and well led. Comments included; “It’s great here. They look after me well.”, “I know that if there is anything my relative needs, the home sorts it for them.”, “All the staff are really nice. I’m going on holiday with some of them and I can’t wait.” and “[The registered manager] is brill. I love her. She’s really nice and always manages to find time to chat to me.”

We found the service ensured people were protected from abuse and followed adequate and effective safeguarding procedures. We found care records were personalised and contained relevant information for staff to provide person-centred care and support.

We found good practice in relation to decision making processes at the home and in line with the Mental Capacity code of practice, with the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards being followed.

Medicines at the home were managed well and the registered manager told us they would carry out medication competency assessments on an annual basis.

We found supervision of staff had been carried out on a regular basis. Annual appraisals had not been completed on an annual basis. The registered manager told us they would ensure this was done in future.

There were good quality-monitoring systems in place at the home that were carried out on a regular basis. We saw that, where issues had been identified, the registered manager had taken (or was taking) steps to address and resolve them.

Staff were up to date with their training requirements and a new training matrix identified areas where additional training would be undertaken by staff.

During our inspection, we found the service was fully compliant with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us they received the care they needed and before they were provided with any care, treatment or support, staff asked if they agreed to it. One person using the service said, “It’s alright, they look after you. It is good. We know there’s no place like home, but it’s good. I’d recommend it. You’re given the best life possible.”

On the whole, people were cared for in a clean, hygienic environment. Family members were positive about the cleanliness and hygiene at the home. They told us that they always found the home clean. One family member commented, “It’s spot on.”

The service operated an effective recruitment procedure.

There was a complaints system available. People and family members we spoke with said they would raise concerns if they needed to.

Discussions with people told us their diverse range of needs, views, values and human rights were respected, their dignity and privacy maintained and their independence promoted. They were enabled to express their views and participate in decisions relating to their care and treatment.

When we spoke with people using the service all were pleased with the service they received. One person was able to describe why they were pleased. They said, “They do what they say here and follow procedures. Some are firm, but that’s better.”

People described some of their daily routines. One person said, “I go out myself if I want. They also come with me to watch the rugby.”

A discussion with one person told us there were quizzes, karaoke, visits to the cinema/cinema events at the home and trips to the coast.

People told us and we saw that there was a mini bus available to transport people to events if necessary. For example, we saw one person using the mini bus to go home on a visit.

Everyone we spoke with told us they liked living at the service, had no concerns/complaints and felt safe. Comments included:

“It’s a good place and I’ve been in a couple of places.”

“Complaints are an opportunity for people to improve their performance but they didn’t think it was looked at like that here.” They were aware of the procedure to follow if they needed to make any complaints and that there was a proper complaints procedure.

One person told us of a concern they’d raised about the care provided and this was recorded in their daily report. This told us people felt safe raising any concerns they had.

When we spoke with people they told us there were sufficient staff. For example, one person had moved from elsewhere and said one of the reasons for it being better here was because there were more staff. One person commented that the staff were well trained.

When we spoke with people they told us of the ‘wish book’ where they were able to make requests for activities they might like to do and of the resident’s meeting where they could speak about the care provided at the home.