The inspection took place on 24 and 25 May 2017 and was unannounced

Diamond House is registered to provide care and support for up to 44 older people a majority of whom are living with dementia. It is situated within a residential area of Leicester. Accommodation is provided on the ground floor and first floor. There is a range of communal areas including lounges, dining rooms, and secluded gardens. At the time of this inspection there were 40 people using the service.

The overall rating of good, which was awarded following the CQC's previous inspection of 11 March 2015, was displayed throughout the service. The service has retained its rating of ‘outstanding’ for the key question, ‘is the service caring?’ At this inspection we found the service was now to be 'Outstanding'.

Diamond House had 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 told us they felt safe in the service and that staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe. During the inspection visit we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly and staff were always present in communal areas to observe people and keep them safe.

Medicine was safely managed in the service and staff provided people with assistance where it was needed to take their medicine. However we found improvements would further promote its safe and consistent use; through the provision of written guidance for staff as to the circumstance and use of medicine to be taken as and when required. The registered manager took action to address to make changes at the time of the inspection visit.

Staff were regularly supervised and had their competence to perform aspects of their role assessed. Staff had undertaken training to meet people’s needs and supported people with confidence and skill. Staff were observed putting their training in practice to ensure people’s needs were met and that people received the reassurance they needed. Staff spoke positively about their training and spoke of the support provided by the registered manager in accessing training and the help and encouragement they received to attain qualifications in care.

People were encouraged to make decisions about their day to day lives. People’s care plans provided information for staff as to what support people required, so that people’s independence was recognised and not undermined by staff. We observed staff supporting people consistent with their care plan.

People we spoke with were very complimentary about the meals provided at the service. Mealtimes were a social affair and meals were enjoyed in a calm and relaxed environment. Where people were at risk of poor nutrition, advice from health care professionals was sought and their recommendations followed.

People we spoke with and their visiting relatives told us they had good access to healthcare. Records showed people were referred to the appropriate health care professionals when necessary and that their advice was acted upon. This meant people were supported to maintain good health.

The environment was decorated and adapted to meet the needs of people living with dementia. The environment was interactive and enabled and encouraged people to take part in activities and perform tasks which provided them with reassurance and a sense of purpose. The garden was accessible and provided areas of stimulation and interest and was used by people to relax a

This inspection took place on 11 March 2015 and was unannounced.

Diamond House is registered to provide care and support for up to 44 older people some of whom are living with dementia. It is situated within a residential area of Leicester. All accommodation is on the ground floor and there is a range of communal areas including lounges, dining rooms, and secluded gardens.

At the time of this inspection there were 44 people using the service.

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 told us they felt safe in the home and staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. Where people were at risk, staff had the information they needed to help keep them safe.

People said there were enough staff on duty to meet their needs at all times and they never had to wait long for assistance. During the inspection we observed staff had the time they needed to support people safely. If people needed assistance this was provided promptly and at no time were people left unsupported. Medicine was safely managed in the home and staff were kind and patient when they administered it.

Staff had undertaken training to meet people’s needs and supported people with confidence and skill. People told us they were always caring and kind. During the inspection we observed and heard about many examples of staff valuing people and helping them to improve their quality of life. People trusted the staff and were at ease with them and happy in their company.

People told us they enjoyed the meals and the food served appeared appetising and wholesome. Lunchtime was a lively occasion with staff and the people using the service socialising together. They told us that they enjoyed each other’s company.

People said that if they needed to see a GP or other health care professional staff organised this for them. If staff were concerned about a person’s health they discussed it with them and their relatives, where appropriate, and referred them to the appropriate health care services, accompanying them to appointments if requested.

People told us they received support that was right for them. The care records we saw were personalised and reflected the needs of the people using the service. Records gave staff insight into the lives of the people they were supporting. Staff said this information helped them to care for people responsively as it gave them an understanding of a person’s history and how they might like their support to be provided.

The home’s activities worker provided a range of group and one to one activities for people. These were activities people had chosen themselves and included pub lunches, shopping trips, and hair and beauty sessions.

People using the service and relatives said that if they had any concerns or complaints they would tell the registered manager or the staff. All felt they would get a positive response and something would be done to put things right.

People told us their experience of the home was positive and life-affirming. The culture of the home was one of innovation and creativity and the registered manager and staff had a ‘can do’ attitude when the people using the service wanted something.

Records showed people were involved in how the home was run. They held regular meetings and discussed aspects of the home that were important to them including personal safety, activities, holidays, decoration, and staffing. Relatives were also invited to attend these meetings. People using the service, who did not want to attend residents’ meetings, or were not able to contribute due to illness or disability, were consulted on a one-to-one basis to help ensure their views were heard too.

The registered manager was passionate about the home and making it a good place to live and work. We observed that she had an excellent relationship with the people using the service. Most of the people using the service and all the relatives we spoke with knew who the registered manager was. Those who couldn’t name her were able to describe her.

The provider had an effective quality assurance system in place which included daily, weekly and monthly audits of all aspects of the service. The registered manager had made changes and improvements to the service as a result of both internal and external audits.

We spoke with seven people who used the services of Diamond House. People told us they were happy with the care and support they received. People’s comments included: “It’s wonderful here and the staff are so caring and kind.” “I’ve not been here long so I’m still settling in, it’s a big change. Everything seems to be okay and up to now I’ve been happy with how things have gone.” We spoke with three visitors who were at Diamond House to visit with their relatives. We asked them for their views about the care their relative received. Visitors told us they were happy with the care provided by the staff and told us they were kept informed as to the health and wellbeing of their relative.

We spent time with people and observed the interactions between people using the service and staff. People were observed to make choices as to where they spent their time. Some sitting in the garden, whilst others sat in a lounge or stayed in their bedroom. People in some instances watched the television, whilst others read a newspaper. People in the morning had the opportunity to visit the domiciliary hairdresser and in the afternoon some people took part in an art therapy session. We spent time with people at the lunchtime meal and saw people chose where to sit with many people conversing with each other during the meal. People were happy with the meals provided. People's comments included: “The meals are lovely, I don’t like everything but there’s always something I like.” Through discussions with the chef and the viewing of records we found people’s meals were made from fresh produce and met dietary needs and expectations.

We viewed a range of records which included people’s care plans, medication records, staff recruitment records and maintenance records for the service and we found them to be in good order.

This is the first inspection of Diamond House carried out by the Care Quality Commission (CQC) since the service was registered by CQC in November 2011. At the time of the inspection there were seven people using the service of which one person was there for a short break.

People told us they were satisfied with the care and support they received and that the staff were helpful and kind. People told us they had been involved in the development and reviewing of their care plan. People we spoke with praised the food provided by the chef’s and told us that nothing was too much trouble as they catered for individual requests.

People’s comments included: - “I’m quite content here.” “I’m quite satisfied, the staff are quite alright.” “Oh I love it and they’re all so nice.” “I couldn’t be more pleased, all a good 'shower' and you can have a laugh and joke, they’ll do anything for you.” And “I’d gone off my food before I moved into Diamond House, but all credit to the staff they’ve persevered and now I enjoy eating again.”

Visitors were seen visiting relatives throughout the day. We had the opportunity to speak with relatives of one person. They told us they were happy with the care and support provided to their relative and they were kept informed as to their relative’s health and wellbeing. People using the service told us that if they had any concerns they would speak with the manager or a member of staff or in some instances their relatives.