Eastbury House is a residential care home for 20 older people with a range of needs catered for. There were two floors as well as two people living in annexes within the grounds.

At the last inspection, the service was rated Good. At this inspection we found the service remained good but also had one domain which was outstanding.

People were valued and made to feel special by staff who went over and above their job roles to help people to realise their wishes.

People felt safe at the home and with the staff who supported them. One person told us, “I feel absolutely safe, if I want any assistance I call via my bell”.

There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people’s needs in a timely manner.

People received effective care from staff who had the skills and knowledge to meet their needs monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs. One health professional told us, “This home offers the most effective care by very well trained staff, it is empowering and inclusive”.

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.

Each person who moved to the home had their needs assessed before they moved in. Staff responded to people’s changing needs and supported them to maintain their independence. Care plans reflected people’s needs and aspirations.

Care plans were in place to make sure staff had the information they required to deliver care to meet people’s needs. Risk assessments held within the care plans identified the additional support people needed to keep them safe.

People were supported by staff who were kind and caring. There was a happy and welcoming atmosphere in the home. The registered manager led by example and constantly observed and monitored standards of care to make sure people were treated with kindness and respect.

The service was responsive to people’s needs and they were able to make choices about their day to day routines. People had access to a range of organised and informal activities which provided them with mental and social stimulation.

People were safe at the home because the provider had systems in place which minimised risks.

The provider learnt from incidents and accidents and took action to minimise further risks.

People were supported to have sufficient to eat and drink where they needed assistance with this. Staff had training in food hygiene and infection control and understood their roles and responsibilities with regard to protecting people form the risks of infection.

Relatives told us there were no restrictions on when they could visit or call and it was evident from people's photographs and the conversations we had, people were supported to stay in touch with their friends and families One relative told us, “My [loved one] is extremely happy, the residents are given so much choice and control in their lives you never see anyone unhappy here”.

People were able to follow their religious and spiritual beliefs. People told us their faith was very important to them and they attended services and were able to receive holy communion within the home if they wished.

People were treated as individuals and were supported to follow their interests and hobbies. Special trips and events were arranged for people to promote their well-being and enjoyment of life.

People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. Staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff and they told us that they felt safe. One person told us "They really look after you here". The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had 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. This meant that reasonable steps had been taken to protect people from abuse.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced risk to people who used the service and helped the service to continually improve. The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly.

The needs of residents were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff. Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that any unsafe practice was identified and people were protected. This helped to ensure that people's needs were always met.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw, and from speaking with staff, that they had a detailed understanding of people's individual care and support needs. Staff had received training to meet the needs of the people living at the home.

People's health and care needs were assessed with them, and they were involved in designing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Although Eastbury House had not been originally built as a care home, people's needs had been taken into account when it had been converted. The layout of the accommodation enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments. Relatives and friends confirmed that they were made welcome when they visited, could share meals with residents and could stay overnight if necessary.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. A visitor said "Everyone is very friendly and caring here".

As well as addressing physical needs, care plans also described specific ways of comforting individuals if they became distressed. Individual preferences were always respected and people who lived at the home were encouraged to arrange their rooms to reflect their own taste and wishes.

The registered manager had developed a good relationship with local healthcare professionals. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. Regular healthcare visits ensured that any long-term medical issues were addressed in a timely manner. We were told that GPs responded quickly if there were more urgent medical problems that needed to be resolved.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. Special attention was paid to nutritional needs and people told us that they enjoyed the home-made food.

People had access to activities that were important to them and had been supported to maintain relationships with their friends, relatives and pets. People took part in a range of activities both in and outside the home on a regular basis. People knew how to make a complaint if they were unhappy. No-one that we spoke with had had cause to complain but they were confident that any problems would be dealt with effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received continuity of care. People who lived at the home confirmed that staff listened to their views. Changes that they had suggested had been acted on whenever possible.

The service has a quality assurance system. Records seen by us showed that any identified shortfalls were addressed promptly. The registered manager of the home was actively involved in the day-to-day care of residents and was able to train and supervise less experienced staff. This meant that any weaknesses in the care provided were rapidly addressed. As a result of these measures the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. They had a good understanding of the ethos of the home and told us that they enjoyed helping the people who lived at Eastbury House. This helped to ensure that people received a good quality service at all times.

We spoke with eight people who lived at the home. All spoke highly of the care they received and the staff that provided their care. People's needs were assessed and people told us that care was delivered to meet their needs. One person said, “I’m really happy with the way I’m looked after.” Another person said, “All I have to worry about here is how best to enjoy myself.”

People were protected from harm as there were appropriate safeguarding procedures and people were protected from the risks associated with medicines.

Staff were supported by the provider through appropriate training and the home had suitable systems to monitor the quality of service provided.

We spoke with three of the 17 people living at the home. They all told us they were treated with dignity and respect. One said, “I am always treated with respect, without exception".

We looked at three care plans and spoke with three members of staff about how they cared for people. We found that people’s needs were known and met. One person said, “I have the most colossal admiration for this place. I am very happy”. We looked at comments made by external health professionals. These were all positive and included, “Very homely – staff go the extra mile”.

We found that medicines were not managed safely. Some were not stored securely and stock levels were not monitored effectively. Also, arrangements for the disposal of unused medication were not always appropriate.

The service was coping with the challenges presented by the design of the building and people were happy with the environment. They told us liked it because it was “more like a home than an institution”,

People were cared for by suitably qualified, skilled staff. The home had been awarded “beacon status” by the Gold Standards Framework for the standard of end of life care provided. We looked at three staff files and saw that appropriate checks were conducted before people started work.

The provider had an effective system to regularly assess and monitor the quality of service people received. There was evidence that learning from incidents took place and appropriate changes were implemented.

The inspection was unannounced and took place on the 14 July 2015 with a further visit on 20 July 2015. Eastbury House, situated close the local town centre, provides personal care and accommodation for up to 20 older people. This includes a service for up to three people in detached accommodation next to the main house. The service does not provide nursing care. At the time of our inspection the service was full.

The service had a registered manager supported by two deputy managers and the service’s training officer. 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 and Associated Regulations about how the service is run.

There was a welcoming, homely and friendly atmosphere in the home. Visitors were greeted warmly and the owner or a member of staff was usually around the entrance and hall area during the daytime to greet or guide people as they came downstairs. One visitor told us, “this is a wonderful place, the care is fantastic.”

People moved freely around indoors and some walked regularly outside into the spacious garden. People were encouraged to follow their interests either individually or in small groups. There was a programme which gave opportunities for planned activities however we saw that people also made their own arrangements and plans either individually or in twos or threes. Some people spent most of their time in their own room, told us they were comforted by their own routine and were visited by members of staff throughout the day.

The service prided itself on strong links with the local community including relationships with local shops and community services and used these to develop opportunities for people to participate in community life or for visitors to the home. One person told us they particularly enjoyed the freedom to go wherever they wanted. Another person told us, “if you have had enough of managing everything on your own, this is the ideal place to be.” We observed lots of positive and warm interactions between people and staff throughout the day. People were relaxed and friendly with each other, often demonstrating concern and empathy with others. People went out of their way to tell us that they enjoyed living in the home and the comfort this gave them.

Care plans were personalised and accurately reflected people’s care and support needs. There was a strong ethos of respect by the service for people’s expressed preferences and lifestyle. We saw staff took time to find out about people’s choices and adapted the service to meet these. For example, arrangements were made for some people to dine in the kitchen as this was their preference.

People were supported by an established, motivated and trained care team. One person told us, “getting to know new carers can be up and down but I tell them how I like things and they listen.” Staff were busy however had time to spend chatting and laughing with people. Senior staff were seen prioritising talking with people and supporting staff. The owner took an active leadership role within the home, promoting values of compassion and respect for people. Both the owner and members of staff we spoke with expressed the determination that people should not have to sacrifice their autonomy or their right to take risks just because they needed assistance. Everyone we spoke with praised the kindness and attentiveness of staff. One person told us, “I like all the staff here, they are very kind”.