About the service: Hartlands Residential Home is a care home that provides personal care for up to 31 people, some of whom are living with dementia. At the time of the inspection 28 people lived at the service. The home had some large rooms that could be utilised as a double room to accommodate couples, friends or family members who wished to share a room.

People’s experience of using this service: We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw that staff were very thoughtful in their approach to people.

People we spoke with gave positive feedback about the home and the staff who worked in it. They told us that the staff supported people well. We saw that warm, positive relationships with people were apparent and one person described the staff as "The best staff ever – they are our friends”

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The food served at the home was of a very high standard. Everyone we spoke with told us that they enjoyed the food and we saw that it was plentiful and good quality.

Care plans were clearly recorded. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. We saw that relatives were involved in supporting staff to understand how people wished to be cared for. There were many activities provided at the home and people told us that they enjoyed them.

The registered manager and the provider used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home.

More information is in the detailed findings below.

Rating at last inspection: The service was rated Good at the last inspection in September 2016.

Why we inspected: We inspected the service in accordance with our ratings programme.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

The inspection was carried out on 13 May 2016 and was unannounced.

Hartlands Residential Home is registered to provide accommodation with personal care for up to a maximum of 31 people who may be living with dementia. There were 29 people living at the home on the day of our inspection.

There was a registered manager in post who was present during the inspection. 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 were looked after safely. Staff were able to identify signs of abuse and knew how to reports concerns of abuse or poor practice. Staff were aware of people’s needs and took appropriate action to ensure risks to people’s health and wellbeing were minimised. Staff were aware of action they needed to take in the event of an accident or incident and there were systems in place to prevent reoccurrence.

People felt there were enough staff available to meet their needs throughout the day and night. The registered manager kept staffing levels under review and increased staffing levels in line with changes in people’s needs. The provider ensured that safe recruitment procedures were followed to ensure prospective staff were safe to work with people before they started work with them.

People were supported to take their medicine as prescribed and there were safe systems in place for the storage and disposal of medicine. People were supported to see health and social care professionals to maintain their health and wellbeing.

People and their relatives were complimentary about staff knowledge and the support they received from them. Staff received training and support that enabled them to meet the diverse needs of people who lived at the home.

People were pleased with the quality and quantity of the food provided. People’s dietary needs were assessed, monitored and reviewed on a regular basis. Where there were concerns about people’s weight or the amount they ate or drank staff sought the advice of the relevant health care professionals.

Staff always sought people’s consent before supporting them. Where staff had difficulty communicating verbally with people they explained things in a way that enabled people to be involved in decisions about their care and support. Where people were unable to make decisions for themselves staff worked with the person, their relatives and other professionals to ensure people’s right were protected.

People were supported by staff who were kind and caring. People felt staff enabled them to remain as independent as possible and treated them with dignity and respect. Staff had built good working relationships with people and their relatives. Staff helped people to keep in contact with relatives and friends who were important to them.

People were involved in decisions about their care and support. Staff knew people well and provided care tailored to their individual need. People were offered choices and staff respected their wish if they declined support.

People were supported to follow their interests and hobbies. There were a range of organised activities available as well as one to one support for people to choose what they wanted to do.

People and their relatives had not had cause to complain but were confident if they had any concerns they would be listened to and acted upon. People’s views were actively sought and suggestions made were used to develop the service.

People, their relatives and staff found the registered manager and management team easy to approach at any time. There was a positive working culture at the home where staff and management worked together to deliver good quality care. The staff felt valued and motivated to deliver the values of the service.

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People who lived in the home and their relatives said that they were well looked after. They told us the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. They told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are really good” and another said, “Everyone is so caring”.

We spoke to several people who lived in the home but due to their dementia not everyone was able to give an informed view about life in the home. People told us that staff looked after them well. We spoke to the manager, five staff and four relatives.

We spent time in the dining room and lounge observing the activity in the home. We saw staff interactions that were respectful and calm and people were relaxed and comfortable.

Measures were in place to make sure that as far as possible people's consent was sought about how their care was given and how medical and healthcare treatment was provided.

We saw that care was given at a pace that did not rush people. The atmosphere was relaxed and staff offered people opportunities to engage with them if they wanted to. Care records included people's individual needs and identified known risks and what measures needed to be in place to reduce these.

People were provided with a range of food but standards and quality varied. Specialist diets and equipment were provided and assistance offered appropriately and discreetly.

The home was clean and tidy and staff had completed training in infection control. The home was adequately maintained and health and safety was taken seriously.

Recruitment systems were in place to make sure staff were suitable.

A complaints procedure was in place so people or their relatives could raise any concerns they had.

We spent an hour in one of the lounges so we could carry out a short period of observation of activity in the home. The general mood of people in the lounge was calm but with a high level of activity and interaction. We observed staff interact with people in a calm, dignified and unhurried manner. There was clearly affection between the people and staff. We observed laughter and fun in this area during the timeframe.

We spoke generally with three people. We then reviewed the care plans of two people we specifically observed and spoke with staff about these (pathway tracking).

We looked at some quality surveys recently returned to the provider. Peoples’ relatives had stated that they were consulted about their care, that their views were taken into account in the way the service was provided and delivered. They considered that peoples’ privacy and dignity was respected and their independence promoted.

People said that they wouldn’t hesitate to ask questions or request help with any aspect of their relatives’ care.