The comprehensive inspection of this service took place on 08 and 09 March 2018. It was unannounced. At our last inspection of this service in 2015, we found it to be Good in all the key areas. At this inspection the service was not only meeting the standards, but regularly exceeded people's expectations. We found the management of the service was excellent.

Frank Foster house is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Frank Foster house provides care for up to 80 people including people living with dementia.

The home 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 and associated Regulations about how the service is run.

During our inspection, we found exceptional standards of care. A committed and well-trained group of staff who demonstrated the right values and attributes provided this. We observed staff supporting people in a kind and caring manner. Independence, privacy and dignity was promoted and respected. Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care.

People, family members, staff and visiting professionals spoke very highly about the registered manager and the leadership of the home stating they were approachable, caring and very responsive to people and staff needs. The registered manager sought feedback about the quality of the service provided to people and/or family members, staff and visiting health professionals. There was an on-going quality monitoring process in place to identify areas of improvement required within the service. Action was taken when an area for improvement had been identified.

Staff were trained to protect people from potential abuse and understood how to safeguard them. People had risks to their safety assessed and there were plans in place to reduce the risks, which staff understood and followed. People who lived at the home and staff members we spoke with said there were enough staff on duty to meet individual needs. People received their medication as prescribed and the records were of a good standard. The home was clean, well- maintained and provided a safe environment for people to live and staff to work in. There were systems in place to learn from incidents and when things went wrong to avoid this happening again.

People had their needs assessed and were supported to meet them by trained and knowledgeable staff. People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. The service worked well in partnership with other health professionals to ensure that people received good healthcare. Staff understood and effectively applied in practice the principles of the Mental Capacity Act, 2005 (MCA) and the Deprivation of Liberty Safeguards. People had maximum choice and control of their lives and staff assisted them in the least restrictive way possible. We have made a recommendation that the service find out more about training for staff, based on current best practice, in relation to assessing people’s capacity in keeping with the principles of the MCA.

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People had care plans that were informative and had been regularly reviewed and updated. People and their relatives had been involved in the care planning process and their reviews. There were opportunities for people to follow their interests and take part in a wide range of activities. People's communication needs were considered and they had support to follow their religious beliefs and cultural practices. People understood how to compl

When we inspected this service on 19 September 2013, we found that people’s care was not always planned in a way that ensured they received the care they needed. We also found that staff were not always aware of people’s needs. The manager sent us an action plan to tell us how this would be put right.

At this inspection on 4 February 2014, we found that people experienced care and support that met their needs. Care records had been improved in line with the manager’s action plan. We spoke with six staff. Staff were able to demonstrate their awareness of people’s individual needs and how these were to be met in line with the person’s plan of care.

We spoke with five of the 69 people using the service at the time of our inspection. They told us they received the care they needed. One person said, “The care is very good. They really don’t mind how many times you use the buzzer, including at night. They always come and tell you to ring it anytime. They check on you anyway. The staff give everything, it’s wonderful.”

We spoke with three visiting relatives who all confirmed they were satisfied with the level and quality of the care provided at the service. A visiting relative told us, “I watch what is going on and see that the staff take time to talk with and reassure people if they are a bit upset and even give them a hug if they need it. I am happy with the way [person] is cared for.”

We spoke with eight of the people who lived at the home. They all told us that they were satisfied with the care they received there. One person told us, “The care is brilliant here. It’s the best care home ever. I looked at a couple of others before I came…There is nothing more I could want.”

We looked at the care records of four people who used the service. We found that people’s care was not always planned in a way that ensured they received the care they needed.

People were provided with a choice of suitable and nutritious food and drink. People told us they really enjoyed the food, that there was ample food available and this included snacks at any time, including during the evening. One person told us, "The food is wonderful”.

Staff were supported to deliver care safely and to an appropriate standard. People who used the service told us that staff were helpful and worked hard.

People who used the service told us that while they had no complaints, they would feel confident to raise any complaints and felt that they would be listened to. One person said, “I have never had a complaint. If I did, I would definitely speak with one of the staff. I will tell you why. They would want to find out and want to fix it for you.”

We did not speak with people using the service during this inspection. We visited the home to check whether actions had been taken to address the areas of non compliance we identified during our inspection visits on 17 and 19 July 2012.

We found that the required improvements had been made. We looked at the quality assurance systems in the home. They were implemented routinely so as to be effective and they ensured that people’s views were properly taken into account. This meant that the provider had an effective system to assess and monitor the quality of the service that people received.

We found improvements to the quality and security of people’s personal care records. A plan of care was in place for each person whose file we looked at. They were up to date and regularly checked to ensure they remained so. This meant that staff had the information they needed to help them to meet people’s assessed needs.

We saw that people’s personal care records were locked away when not being used by staff. This meant that people’s information was treated with respect and kept securely.

We were unable to communicate with some people using the service to gather information as a result of their limited verbal communication or limited cognitive ability. We spent time listening to and observing everyday life in the home to help us to understand what it was like for people living there. This indicated that people were relaxed and comfortable and found their experience at the home to be positive.

People we spoke with told us that their privacy, dignity and independence were respected at the home. One person said, “I choose my own clothes everyday. I don’t go to the activities, I prefer to sit here (bedroom) and read, and that is fine. I also prefer to sit here and have my meals”.

People spoke positively about the care and support provided and said that there were enough staff to meet their needs. Comments from people using the service and their relatives included, “I am quite happy with the care. I find the staff are very good in helping me get dressed, you only have to press the buzzer and they come” and “The care is brilliant. I come at different times. I always find them attentive to [person]. Staff all seem aware of each individual person’s needs”.

People told us that that they felt safe at the home and that they would feel able to speak to someone if they had any worries or concerns. One person using the service said, “Staff are very helpful. I find I get on well with them and feel safe. If I had any worries I would complain.”

People found the home to be clean. One person said, “They keep the place really clean. It’s perfect.” A visitor said, “My relative’s room is nice and clean and there are no smells in the home.”

This inspection took place on 9 and 10 September 2015.

Frank Foster House is registered to provide accommodation with personal care for 78 older people. People living in the service may have care needs associated with dementia. There were 71 people living at the service on the day of our inspection.

The manager had been appointed since our last inspection and had made an application to be registered with the commission as required. 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.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were thorough. Risk management plans were in place to support people and keep them safe. There were also processes in place to manage any risks in relation to the running of the home.

Medicines were safely stored and administered in line with current guidance to ensure people received their prescribed medicines.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Staff were well trained and used their training effectively to support people. Staff understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

People had regular access to healthcare professionals. A wide choice of food and drinks was available to people that reflected their nutritional needs and took into account their personal preferences.

People were well cared for by kind and caring staff who treated them with dignity and respect. Visitors were welcomed and relationships were supported.

People’s care was planned and reviewed with them or the person acting on their behalf. This made sure that people’s preferences were included and that staff had information on how best to meet people’s needs. People were supported to participate in social activities that interested them and met their needs.

People felt able to raise any complaints and were sure they would be listened to. Information to help them to make a complaint was readily available.

The service was well led; people knew the manager and found them to be approachable and available in the service. People living and working in the service had the opportunity to say how they felt about the home and the service it provided. Their views were listened to and actions were taken in response. Systems were in place to check on the quality and safety of the service provided and to put actions plans in place where needed.