Frensham House is a residential care home for 14 people who are living with dementia and/or physical disability. Nursing care is provided by the local community nursing team.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good:

People felt safe at the home. One person said "They’re (staff) all very good.” Some people who were living with dementia were unable to talk with us. Everyone looked very comfortable and relaxed with the staff who supported them. People told us there were enough staff to meet their needs and to spend time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely.

People received effective care because staff had the skills and knowledge required to support them. Staff monitored people's healthcare needs and advice and support was sought from healthcare professionals when needed. 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.

Staff provided a caring service to people. People told us, and we observed, that staff were

kind, caring, and patient. Comments included “You’d have to go a long way to find better” and “We have a laugh and joke”. People, or their representatives, were involved in decisions about the care and support they received.

Staff were responsive to people's individual needs. Care and support was personalised to each

person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to.

The service was well led. People and staff told us the management team were open and approachable. The registered manager and provider sought people's views, listened to them and used suggestions to make improvements. One person said “The manager is really good.” Staff said “You can go to (name of manager) with anything”; “(name of manager) is great” and “The senior bosses are easy to talk to, they attended training themselves with the staff”. The registered manager and provider had monitoring systems which enabled them to identify good practice and areas of improvement.

Further information is in the detailed findings below.

Frensham House is registered to provide personal care and accommodation for up to 14 people who are living with dementia and /or a physical disability. Nursing care is provided by the local community nursing team.

This inspection took place on 3 September 2015 and was unannounced. There were 14 people living in the home at the time of the inspection. The service was last inspected on 27 January 2014 when we found accurate records were not being kept. We checked at this inspection and found improvements had been made.

The service 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.

The registered manager managed two care homes owned by this provider. They spent most of their time at the other home, and visited Frensham House one day a week to provide support and guidance to the manager. The manager who worked full time at Frensham House told us the registered manager was always available on the phone if they needed to contact them. Healthcare professionals said “The two managers are a good working team. They focus on making the home better for people” and “The manager is a shining example”. There was an open culture in the service. Relatives commented “They’re 100% approachable” and “They’re always on the end of the phone”. Relatives were confident if they made a complaint this would be dealt with. None of the relatives we spoke with had needed to make a complaint. They said “They wouldn’t be here if I wasn’t happy with it” and “There’s nothing to worry about”. Staff said if they raised any issues with their manager, they would deal with it straight away. One staff member commented “I can go to the manager with anything and everything”.

People, relatives and healthcare professionals were complimentary about the care provided. Comments included “I couldn’t ask for anything more, the staff are ever so kind” and “The staff are all lovely, they’re very caring”. A healthcare professional said “Everything is 100%. The standards are exceptional”. Staff received training to make sure they knew how to deliver person centred dementia care. One staff member told us “We’re proud to care for people and do the best we can”. Staff treated people with respect and kindness. People responded to this by smiling and engaging with staff in a friendly way. Staff knew people’s preferences and spent time speaking with each person individually. People enjoyed the conversations and visibly brightened whilst chatting. People were supported to have enough to eat and drink. Staff spent time encouraging people and chatting with them to make mealtimes a sociable experience. Relatives told us they were involved in the home and always made to feel welcome. One relative commented “They’ve been really good and like a family to me”. Relatives felt involved in people’s care and support and told us they were kept informed of any changes.

People were protected by staff who knew how to recognise signs of possible abuse. One staff member said “I wouldn’t hesitate to raise concerns”. There were sufficient staff to meet people’s needs. Staff responded to people’s needs and requests in good time. One staff member commented “We have time to spend with each person individually”. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people. Staff received regular training to make sure they knew how to meet people’s needs and were encouraged to work towards diplomas in social care. A healthcare professional told us staff knew how to care for and support people who were living with dementia. People benefited from staff who knew them well and delivered care to ensure their needs were met.

People’s needs had been assessed. The majority of people had been assessed as not having capacity to consent to care and treatment. Staff told us if people were not able to make decisions for themselves they spoke with relatives and appropriate professionals to make sure people received care that met their needs and was deemed to be in their best interests. People were being deprived of their liberty. The registered manager had made the appropriate Deprivation of Liberty Safeguards (DoLS) applications to the local authority. The front door was locked to keep people safe whilst the DoLS applications were in progress.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Risk had been assessed for each person. For example, where one person’s behaviour presented risks to themselves or others, staff had discussed the behaviours and agreed a plan to approach this person in a consistent way. The service had also sought advice from a consultant psychiatrist. This minimised the risk to the person and staff. Where accidents and incidents had taken place, the manager reviewed their practice to ensure the risk to people was minimised. Premises and equipment were maintained to ensure people were kept safe and there were arrangements in place to deal with foreseeable emergencies.

People’s care plans contained information about their personal history and interests. The service had a dementia champion who was looking to develop more individual meaningful activities for people. For example, they told us they were trying to source an old typewriter for one person who used to work in administration. The service planned to open a sweet shop with old style sweets for reminiscence. On the day of our inspection, most people spent their time in the lounge. The television was on but not everyone was watching it. During the morning, staff spent time reading with several people. Activities took place every afternoon. People visibly brightened when the staff member responsible for activities entered the room. They brought in picture cards to discuss with people. Group activities including musical entertainment, pet therapy visits, games, reading and reminiscence were held on a regular basis. Arrangements had been made to meet people’s individual religious needs. For example, communion was held at the home for one person.

There were systems in place to assess, monitor, and improve the quality and safety of care. The provider visited the service regularly and the manager carried out weekly and monthly audits. Where issues were identified, action had been taken. The management team wanted to develop and improve the service. The service had applied and been chosen to take part in a dementia awareness project with Plymouth University and the local mental health team. Staff used the information they had received to work towards providing a better service for people.

There were 12 people living at Frensham House at the time of our inspection. During our visit, we spoke with three people who lived at the home. We met others who were unable to give us their views in depth because of their mental or physical frailty. We looked around the home, and spoke with care staff as well as the home manager and the manager of another home owned by the provider.

Care and treatment was delivered in a way that was intended to ensure people's safety and welfare. We saw no evidence to confirm that people were asked for their consent or how the provider acted in accordance with their wishes before they received any care or treatment.

People we spoke with were positive about the support they received. People who lived at the home told us they were well looked after and were happy. One person said “Everything here is good”.

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The home operated a robust recruitment procedure to ensure suitable and properly qualified people had been employed by the home.

People told us that they felt safe and knew what to do if they had concerns. One person said "I would feel happy making a complaint, no problem there."

Accurate and appropriate care records had not always maintained. This meant that people were not always protected from the risks of unsafe or inappropriate care and treatment.

We (the Care Quality Commission) spoke with two people and three staff. We also spent time observing care and lunch time and looked at three care plans. On the day of our inspection 10 people were living at the home and receiving care from the service.

Because of the complexities of people's illnesses, for example memory loss and dementia, most people at the home were unable to express their views about what is was like to live there.

We spent fifteen minutes observing life in the lounge. We call this a short observation framework tool (SOFI). During this time we observed staff being polite, respectful and kind. We heard friendly banter and affection being mutually shared. We did not see any negative interactions during our inspection

We saw that people's privacy and dignity was protected. In twin rooms privacy screens were used and staff were seen helping people in a kind and sensitive way.We saw people looked well cared for and happy.

We saw all areas of the home were clean and well maintained.

Staff were receiving appropriate support in the form of a comprehensive training plan.

The home had a satisfactory quality assurance system in place.

We carried out an inspection at the home. The service does not currently have a registered manager, and the deputy manager had taken up the post of acting manager. They were receiving support from the organisation.

The people that use the service at Frensham House have dementia and therefore not everyone was able to tell us about their experiences of living in the home. We spent time watching what was going on in the home, and the support people got. Some people using the service were able to tell us about their experiences and we also spoke with health professionals.

Staff offered choices to people throughout our visit to the home. People appeared to be happy with the choices given to them. When they answered, staff carried out their wishes. We saw good interactions between staff and people who live in the home. We observed that staff were kind and respectful.

We found that although the service recognised that people were not able to make certain choices and decisions, there was no evidence that a relative or representative had been involved in the care planning process.

We observed people who live in the home, sitting in the lounge. They appeared well looked after and were dressed nicely. Whenever a person asked for help, staff were always available to support them. One person who was able to talk to us told us they were happy living in the home.

A healthcare professional who regularly visits the home told us the home managed their client’s behavioural needs very well. They were confident that staff would contact them if there were any concerns about the person’s health. They told us when they visited, staff were in and out of the lounge, looking after people, talking to them, offering them drinks, and sometimes, sitting holding peoples’ hand and chatting to them. They said “on the whole, the home do very well and manage risks well”.

We saw lunch being served. People were given the choice of where they would like to eat their meal, and staff supported them well, where necessary. People appeared to enjoy their meal. The chef was aware of people’s food preferences.

People appeared to be comfortable in their surroundings.

Staff had time to chat with people, and were available when people needed them. The staff appeared to have a good knowledge of people's individual needs and appeared kind and respectful.

A health professional told us staff were always available to talk to them about people’s needs, and were good at providing information. They had observed there appeared to be enough staff on duty to meet people’s needs and spend time with them.

Staff told us they were given the opportunity to attend staff meetings. They felt able to raise any ideas or concerns and believed these would be listened to and appropriate action taken.

The acting manager told us the service doesn’t hold meetings for people who live in the home due to their dementia. They told us they had regular informal contact with family and would follow up and take action, where necessary.