The inspection took place on 24 November 2016 and was unannounced.

Delamer House provides accommodation and personal care for up to 57 older people and people who may be living with dementia. The service does not provide nursing care. At the time of our inspection there were 57 people using the service.

There was a registered manager in post at the service. . 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 safe because the manager and staff understood their responsibilities to recognise abuse and. keep people safe. People received safe care that met their assessed needs and staff knew how to manage risk effectively.

There were sufficient staff who had been recruited safely and who had the correct skills and knowledge to provide care and support in ways that people preferred.

The provider had clear systems in place to manage medicines and people were supported to take their prescribed medicines safely.

People’s health needs were managed effectively with input from relevant health professionals and people had sufficient food and drink that met their individual needs.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice.

The manager supported staff to provide care that was centred on the person and staff understood their responsibility to treat people as individuals.

People were treated with kindness and respect by staff who understood their needs and preferences. Staff respected people’s choices and took their preferences into account when providing support. People were encouraged to enjoy pastimes and interests of their choice and access the local community so that they were not socially isolated. People’s spiritual needs were met in ways that they preferred.

Staff had good relationships with people who used the service and understood their needs. People’s privacy and dignity was respected.

There was an open culture and the registered supported and encouraged staff to provide care that met people’s needs.

The provider had systems in place to check the quality of the service and take the views of people into account to make improvements to the service. There were systems in place for people to raise concerns and there were opportunities available for people to give their feedback about the service.

The registered manager was a visible presence at the service and was actively involved in supporting people and staff. Staff understood the culture of the service, which emphasised care, support and a lifestyle that was centred on people’s individual needs and wishes. Staff were positive about their roles and their views were valued by the registered manager.

Our inspection team was made up of one inspector who answered our five questions. Below is a summary of what we found. The summary is based on our conversations with the manager, three staff, one person who used the service, two relatives and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. The appropriate recruitment checks had been completed prior to staff being employed. Staff had received appropriate training and guidance. Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty

Safeguards which applies to care homes. Whilst no applications have 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 clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person

said, "The staff are excellent they couldn’t do anything any better.”

Is the service effective?

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 the people well. Relatives we spoke with told us that, "The staff are very knowledgeable about my relative’s needs." People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The training that staff had received equipped them to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said, "The staff worked well with my relative they always ask her how she wants things done.”

Is the service responsive?

Where people's care needs had changed appropriate referrals to the doctor, district nurse, dentist had been made and any recommendations had been acted on.

The manager had regular contact with the relatives of people who used the service. Both relatives told us that the communication between them and the staff was good. Where shortfalls or concerns were raised these were addressed promptly.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. A district nurse told us, "The manager and staff are very good they follow the advice they are giving and they also provide very clear and detailed information when making referrals to us.”

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

During our inspection we used different methods to help us understand the experiences of people who used the service. If people were unable to tell us about their experiences, we used observation and noted people’s responses to staff. We saw that people appeared calm and relaxed.

People told us that they had been given the opportunity to visit the service prior to admission. We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate.

During our inspection we saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. One person who used the service told us: “I am happy here, the staff help me and ask me if I am OK."

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service from abuse. Staff told us that they had participated in regular training, which had enabled them to gain the skills and knowledge required to support people who used the service. Staff told us they felt supported by their managers.

We gathered evidence of people’s experiences of the service during our inspection on 17 January 2013, by talking with six people who lived at the home, relatives who were visiting, the manager and four staff. People we spoke with told us they were happy living at Delamer. They felt that staff treated them respectfully and in a way that they liked.

We saw that people were given opportunities to make decisions about their care and support, including a choice of what to eat and whether to join in planned activities. People told us that they were able to choose what to eat from a menu each day. We were told and also saw that fresh fruit and home made cakes were prepared for people and drinks were available. One person told us, “You always have a life of luxury here, the food is good with very good choices.”

People told us that they were able to choose how to spend their day, which included the times they got up and went to bed.

People who lived and the home and their relatives we spoke with told us they were able to discuss any concerns with the manager, and that these were addressed in a reasonable time. The manager told us there were meetings held with people and relatives to discuss future events and developments at the home. One member of staff told us, “The manager here cares about people; she cares about their well being.”

We carried out an unannounced inspection of Delamer on 19 December 2011. We had conversations of various lengths with five people living in the home and with two people who were visiting at the time of our inspection. We were also contacted by a relative prior to our inspection.

People were very complimentary about the care and support they received at Delamer. One person said “The carers are lovely and there’s a good cook. I’m perfectly happy here, I wouldn’t be anywhere else.” Another told us “I call the home Buckingham Palace – it couldn’t be nicer.” They were very complimentary about the overall management of the home, with one person saying “I can’t speak too highly of the manager.” People were very appreciative of the time staff had spent on decorating the whole of the ground floor of the home for Christmas. The decorations included a Santa’s grotto and people described them as “wonderful” and “so colourful”. People told us that the home was always clean, that the standard of food was good and that there were plenty of choices at every mealtime.