Grace Muriel 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. They are registered to provide accommodation and personal care to 37 older people some of whom may live with dementia. At the time of the inspection there were 35 people living in the home.

Previously when we carried out a comprehensive inspection at Grace Muriel House on 26 August 2015 we found that the service was Good. At this inspection we found that further improvements had been implemented which enhanced people`s experience about the care and support they received. We found the service Outstanding. This inspection was carried out on the 29 November 2017 by one inspector.

The home had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 were feeling safe in the home and that staff helped them in a way that made them feel comfortable and safe. Staff were knowledgeable about safeguarding processes and how to report any concerns to the registered manager or local safeguarding authorities. Staff were enthusiastic and knowledgeable when they talked to us about the people they supported. They demonstrated a good understanding of people`s needs likes, dislikes and preferences.

People were supported by sufficient numbers of staff who responded to people when they required assistance. Staff were knowledgeable about risk management and how to mitigate risks to keep people safe.

People received exceptionally effective care, based on best practice by staff with an in-depth knowledge of their care and treatment needs, who were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. People`s health and well-being improved due to the effective care they received in the home.

People felt that they were treated as individuals and they mattered. The care people received was exceptionally personalised. Staff paid attention to detail and demonstrated pride, passion and enthusiasm for the people they supported. They continuously looked for ways to ensure people had positive experiences and led fulfilling lives.

People’s choices, likes, dislikes and preferences were well known to staff who delivered care and support in a personalised way. People nearing the end of their life and their families received bespoke care and support.

People were encouraged to socialise, pursue their hobbies and interests and try new things. There was a strong culture within the service of treating people with dignity and respect. People and the staff knew each other well and these relationships were valued by people who used the service.

The provider had a robust recruitment process in place which ensured that qualified and experienced staff were employed at the home. Staff received training and support and were aware of their responsibilities when providing care and support to people at the service.

People and their relatives where appropriate were involved in the development and the review of their care and support plans. Support plans were comprehensive and captured people’s support needs as well as their preferences regarding the care they received. Care plans were updated every time a change occurred which influenced the way people received support. People were supported to take decisions about their care and be independent.

People were supported to have sufficient food and drinks. People had access to healthcare professionals such as their GP as and when required. People re

During our visit, on 31 August 2012, we spoke with several people using the service, and they were complimentary about the care and service provided. People felt that they were well looked after by a team of dedicated staff. A person commented that the staff were ‘marvellous’ and that they had ‘no complaints’ about the staff. This was echoed by another person who said, “The staff are fantastic and I couldn’t wish for anything better. They are always polite and very helpful.”

People told us that there were activities each day, which people could join in if they wished, and organised trips to matinee performances at local theatres. People said that they were given a choice of menu, and were offered three hot dishes to choose from for lunch, and a selection of soup, sandwiches, hot sausages and bacon for dinner. There was a selection of hot and cold drinks available for people throughout the day and at mealtimes.

This inspection was carried out on 26 August 2015 and was unannounced.

Grace Muriel House provides accommodation and personal care for up to 37 older people. On the day of the inspection there were 31 people living at the service.

There was a registered manager in post. 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.

At our previous inspection on 07 January 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards.

People living at the home and their relatives were positive about the home, the manager and the staff. Their feedback was sought and any suggestions were acted upon.

Care records were completed and reviewed regularly. People were involved in planning their own care and changes in their needs were reflected back in their plan of care which were held securely.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that the provider identified people who lived at the service who required DoLS and applications had been made to the local authority. Staff were aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People had their individual needs met. Staff knew people well and provided support which was effective and met people`s needs. There was sufficient food and drink available and people were assisted to eat and drink if they were not able to do so independently.

People had regular access to visiting health and social care professionals. They were encouraged to manage their own medicines where this was possible. Where people were unable to manage their medicines staff ensured they received them in accordance with their needs.

Staff were clear on how to identify and report any concerns relating to a person’s safety and welfare. The manager responded appropriately to all concerns and complaints.

Staff were recruited through a robust procedure and provided with regular training to ensure their knowledge was up to date. Staff were clear on what their role was. People and staff were positive about the leadership of the service.

The manager had established strong links with the community and engaged in several projects which involved people in gardening, growing their own vegetables, learning to use computers, tablets and how to navigate the internet.