The Devonshire Care Home provides residential care and support for up to 33 people. The service specialises in meeting the needs of older people living with dementia. At the time of our inspection, 31 people were using the service.

At the last Care Quality Commission (CQC) inspection in March 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’. The service demonstrated they met the regulations and fundamental standards.

People continued to be safe at The Devonshire Care Home. Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and wellbeing. There were enough staff to keep people safe. The provider had appropriate arrangements in place to check their suitability and fitness to support people.

The environment was clean and staff followed good practice for minimising risks to people that could arise from poor hygiene and cleanliness. They also ensured the environment was clear of slip and trip hazards to support people to move freely around. The premises and equipment were regularly maintained and serviced to ensure these were safe. Medicines were managed safely and people received them as prescribed.

People continued to receive support that was personalised and met their specific needs. Senior managers reviewed people’s needs regularly to ensure current support arrangements continued to meet these. Staff received relevant training and were supported by senior staff to help them to meet people's needs effectively. Staff knew people well and had a good awareness and understanding of their needs, preferences and wishes.

People were supported to eat and drink enough to meet their needs. They enjoyed the meals they ate at the home. People were also supported to stay healthy and to access healthcare services when needed. Staff encouraged people to participate in a wide range of activities and to maintain relationships with the people that mattered to them in order to promote social inclusion. Staff were warm and welcoming of visitors to the home and friends and families were free to visit when they wished.

Staff were caring, treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to retain as much independence and control as possible with daily living tasks. People were encouraged to make choices and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Since our last inspection the provider had formally appointed a new registered manager. People and staff spoke positively about them and overall leadership and management of the service. The provider was continuously seeking and implementing new ideas and ways for the service to improve. They stayed abreast of best practice and current research in the field of dementia care and brought new ideas into the service in order to enhance people's quality of life. People and staff were encouraged to provide feedback about how the service could be improved. We saw a number of improvements had been made by the provider which had had a positive impact on the quality of care that people experienced.

People were satisfied with the support they received from staff. People knew how to make a complaint if they were unhappy about any aspect of the support they received. The provider maintained arrangements to deal with people’s complaints appropriately. Regular checks and reviews of the service continued to be made by senior staff to ensure people experienced good quality safe care and support at all times.

As part of our visit we spoke with people who use the service, their relatives, staff and the deputy managers.

The people we spoke with all said that they liked the staff and felt happy and safe at the home. One person said "The staff are a good laugh and they are always very happy". A relative commented that the staff were very welcoming when they visited.

We saw that the staff treated the people using the service with dignity and respect. They also encouraged individuals and provided support to people to promote independence. The relatives we spoke with confirmed they had been involved in the development of the care plans for the person using the service.

The people using the service and the relatives we spoke with all felt the food was fine. One person we spoke with said "I really enjoyed the crumble we had for pudding today".

We saw that the lounge, communal areas and individual bedrooms were clean and tidy and there was a cleaner on duty throughout our visit. A relative we spoke with said "The home was always clean and I have never seen it in a mess".

During our visit we spoke with three members of staff, the manager and two people who use the service. We observed there was a relaxed and supportive environment with a lot of communication between the staff and the people who use the service.

One person told us 'the staff were nice' and 'the activities lady is very versatile'. Another person told us that 'the staff do everything for you - whatever you want them to do'.

A member of staff said 'they had never been happier in a job' and another staff member commented 'the home was like one big family'.

People's comments included 'I have a nice room', ' I have all I need in my room', 'the garden is nice', 'I like sitting in the garden when it is sunny' and 'I go on Tuesday outings'.

We received positive comments about the quantity and quality of food provided and here are some of the comments 'the food is usually good', 'lunch was tasty', 'I enjoyed lunch', 'we get a choice', 'there is always enough to eat', 'I like the food' and 'the food is good'.

Comments about staff included: 'staff are lovely', 'staff are kind', 'staff are helpful', 'staff listen and respond', 'staff come when I call' and 'there are enough staff'.

Relatives comments included, 'we looked around a few other places and chose here', 'my relative is settled and happy here', 'we don't have any worries or concerns', 'there always seems to be enough staff' and 'there are different activities and outings'.

Other visitors said they come regularly made positive comments about how they find the home, saying 'it looks like there are enough staff', 'the people I visit are happy', 'I haven't seen or heard of any problems' and 'it is always clean'

This inspection took place on 6 and 9 March 2015 and was unannounced. At our last inspection in May 2013 the service was meeting all the standards we looked at.

The Devonshire Care Home provides residential care and support for up to 33 people. The service specialises in meeting the needs of people living with dementia. At the time of our visit, 31 people were using the service and there was a registered manager in place. 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 they felt safe while using the service. We found that the provider took appropriate steps to protect people from the risk of abuse and discrimination and any allegations of abuse were reported and followed up. Staff received training about safeguarding people from abuse.

People were protected from foreseeable harm because risks to them were assessed and managed appropriately. There were clear instructions for staff about how to manage risks. Staff followed policies about keeping people safe from harm whilst promoting their rights and independence. Managers responded promptly to safety concerns raised by other agencies such as local authorities.

There were systems in place to continually review and adjust staffing levels depending on the needs of the service. This ensured there were enough staff to keep people safe. People confirmed this. Staff were appropriately vetted to help protect people from the risks of being cared for by unsuitable staff.

People received their medicines as prescribed and medicines were stored appropriately. Staff ensured medicine supplies were up to date so they did not run out.

People were satisfied that the environment was clean and staff took precautions to protect people from the risk of infection. For example, they carried out daily housekeeping checks to ensure cleaning was done thoroughly.

Staff had the knowledge and skills required to provide people with effective care. This was developed through training, discussion and other methods. People benefited from several examples of learning from research and guidance being put into practice.

Consent to care and treatment was sought in line with legislation and guidance. This included following the relevant procedures under the Mental Capacity Act 2005 when people did not have the capacity to consent to decisions about their care. The provider followed the requirements of the Deprivation of Liberty Safeguards (DoLS). These are procedures designed to ensure that people receiving care and treatment are not deprived of their liberty without good reason.

People were happy with the food that was provided at the home. They were offered a variety of nutritious meals to meet their needs and preferences. Staff sought and followed guidance from relevant professionals where people had special nutritional needs. They took action to ensure people’s healthcare needs were met by facilitating regular contact with medical professionals and promptly following up any concerns about people’s health.

The environment was designed to meet people’s needs, specifically in relation to mobility and dementia. This included facilities designed to aid orientation and reminiscence. The home was furnished and decorated in a way that was appropriate to the needs of the people who used the service.

Staff were caring and developed positive relationships with people. People spoke positively about the staff and said staff took the time to get to know them. They had different ways of doing this for people who were not able to communicate verbally, including speaking with their relatives and observing people for non-verbal signs. People had a settling in period when they first started to use the service to help manage anxiety around the transition and to help staff get to know people. Staff interacted with people according to what was appropriate for their communication needs.

People’s dignity and independence were promoted because staff followed individual care plans telling them what each person’s care preferences and abilities were. Staff supported people in a way that respected their privacy as far as possible, such as supporting people to eat in private if they requested it.

People had personalised care plans, which staff followed to help ensure their individual needs were met. The care plans took people’s preferences and diverse needs into account. Staff supported people to participate in a choice of group and individual activities that were meaningful to them. The provider had plans to introduce further activities and facilities in response to people’s requests and life history. Where people did not wish to take part in activities, staff ensured they spent time with them to help protect them from the risks of social isolation.

People knew how to complain and were confident to raise concerns with managers. Managers responded to these in a timely manner and took action to prevent reoccurrence of issues that had caused concerns where this was necessary.

The service had an open and inclusive culture in which people felt comfortable approaching senior staff and managers. The leadership structure was clear. Managers involved people in the day-to-day running of the service by seeking and acting on their feedback on a regular basis.

Managers used a number of tools, checks and audits to assess, monitor and continually improve the quality of the service. These included accidents and incidents analysis, policy updates and daily checks of the environment, food and care provided.