About the service: Hassingham House is a residential care home that provides nursing care and accommodation for up to 46 people. At the time of our inspection, 44 people were using the service.

People’s experience of using this service:

The service met the characteristics of outstanding.

People received exceptionally kind and responsive person-centred report from staff who were motivated and led to provide the best care they could. People’s independence and dignity were cornerstones of staff practice, staff understood how to support and enable individuals to maximise their potential. People were encouraged to meet goals and regain independence when possible.

Staff supported people to make decisions for themselves and frequently engaged with people about their wishes and preferences. People were able to live healthy lives, staff took a proactive approach in helping people improve their health to the extent that people regained lost independence. People felt they were partners in their care and encouraged to make decisions about this. The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. Staff understood how to make people feel valued and people told us this improved their lives and made them happy. The registered manager had created excellent community links that benefitted people. They had a strong focus on reducing isolation, loneliness and promoting intergenerational connection. Activities were creative and diverse to meet different people's interests and needs.

The service was led by a registered manager and management team that were committed to delivering a service which improved the lives of the people in fulfilling and creative ways. Their drive and passion had created an exceptionally dynamic and vibrant service. The leadership team encouraged and facilitated staff to go the extra mile in delivering care that made people feel special. Innovation, creativity and sharing ideas and best practice were common place, staff were regularly involved in local initiatives to trail blaze the best care and support.

Rating at last inspection: Good (Published April 2016)

Why we inspected: This was a scheduled inspection based on our previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Hassingham House provides nursing and personal care for up to 47 older people, some of whom may be living with dementia. There were 36 people living in the home on the day of our inspection.

This inspection took place on 2 February 2016 and was unannounced.

The registered manager had left the service in November 2015. A new manager had been appointed and had started working at the service in November 2015. They were in the process of completing a CQC registered manager’s application. 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’s privacy and dignity was respected by staff. People, their families and staff were all complimentary about the service. People told us and our observations confirmed that they felt the service was caring. Staff were enthusiastic about working with the people who lived at the service and developed positive relationships with them.

The service had policies and procedures in place to ensure that medicines were handled safely. Audits of medicines were carried out by the service manager.

People’s health, care and nutritional needs were effectively met. People were provided with a varied diet and staff were aware of people’s individual dietary needs. Staff, including the cook were knowledgeable about people’s individual nutritional needs. The service worked with external professionals to support and maintain people’s health.

There were range of activities available and people were encouraged to participate in them. People were encouraged to take part in the activities but also offered alternatives where their preferred not to.

Staff received training to help them undertake their role and were supported through regular supervisions. Training records confirmed that staff had training in safeguarding adults. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

Safe recruitment practices were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care environment.

People felt supported by the service manager. Management processes and audits were in place. People and their relatives were involved in their care assessments and care plan reviews. The manager was supported by senior staff, including qualified nurses and a deputy manager. People and staff told us the home was well run and that the manager was approachable.

We considered all the evidence we gathered during this inspection. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This is a summary of what we found-

Is the service caring?

Throughout the day we listened to conversations, observed interactions between staff and people, spoke with staff, relatives and people living in this home. We heard caring and encouraging staff interacting with people as they completed their tasks. Choices were offered and people were given time to make their decisions.

Comments we received told us that staff were caring. Relatives told us they would not want their loved one living anywhere else.

Records we looked through told us that concerns were addressed straight away such as weight loss or pressure area problems.

Is the service responsive?

Medical support was called quickly and the home was supported by the local GP for any health concerns. Records showed when issues arose with a persons’ health, that staff responded quickly to those concerns. We read the support given by an expert on nutrition and pressure area concerns and noted that the home acted in a timely manner.

Relatives told us that they were kept up to date and involved in all aspects of their family members care. One concern regarding a complaint was acted upon quickly and other professionals were involved from the beginning of the concern.

Is this service safe?

The home is purpose built and well maintained. There were secure locks on the front door and staff greeted visitors who signed in to show they were in the building. Maintenance records, service certificates and safety checks were completed regularly and were up to date. This ensured the building was a safe place for people to live in.

Staff were recruited and records were checked prior to staff being employed to ensure the personnel were suitable to work with vulnerable people. We read the managers checks for the month where those records had been reviewed to ensure they were up to date.

Staff we spoke with were competent and up to date with their training. Nursing staff had regular opportunities to update their clinical training and knowledge to ensure they offered safe and up to date care and support to people living in the home.

Is the service effective?

The home had a team of staff led by nurses who were familiar with the needs of the people they were supporting.

There was an open door policy that was led by the manager. We noted that all staff and relatives used this open door approach and involved the manager with what was happening daily.

At 3pm all the staff team gathered to discuss any concerns or ideas that could benefit the home. The staff told us this was an effective way to introduce new ideas and sometimes a better way of working to benefit people living in the home.

The manager told us they were always looking for ways to improve the service provided.

Is the service well led?

The manager gave us evidence to show how the home was managed. We read regular audits completed by both the manager and senior manager for the company to ensure quality was provided.

We read training planners, supervision notes and spoke with staff who told us they were supported well by management to do the job required.

We spoke with relatives who told us the manager was supportive, knowledgeable and approachable. They told us they were asked their views on the service and that any concerns would be acted on quickly and appropriately.

As part of this inspection we checked that people's care and welfare was met. We found examples of how care was personalised for the individual. We were told, "I am really happy living here and this is now my home." "I could not ask for a better staff team who know me well and have my individual needs spot on." "We have lots to do and are offered many choices in activities, meals and trips out." We found not only people who lived at this home permanently but also those who came for respite were offered personalised and safe care that was of their choosing.

During our walk around the home we found all the areas seen to be clean and good hygiene practices in place. Staff that we spoke with gave us an account of their training on infection control and the procedures used in the home to ensure people were protected from the potential risk of acquiring an infection.

The medication management in the home was safely carried out and the home had been supported by medication audits from both NHS Norfolk and their local pharmacist in the last four months with recommendations carried out by the home.

The home acted appropriately and thoroughly on a complaint received. Advice and support from other professionals was used and the outcome for the individual concerned had been successful.

During our visit to this service we spoke with three people in detail and a further three during various activities. One person said “The care staff help with my day to day needs but allow me to manage tasks I can do for myself”. Another person said “I can go to bed at whatever time I like. It is like being on holiday here as there is plenty to do to occupy ourselves with what ever we want.” They said they felt safe and that the staff who supported them treated them well. One person said “I trust the staff team, both day and night and always feel safe when here.”

The people using the service had nothing but positive comments about the staff. They told us that they were supported when they needed it and that nothing was too much trouble. “There is always plenty going on and staff are always interacting with us.”

They told us that the staff who support them were very competent. They said that the team of staff knew them well and helped them with their different needs in the correct way. One person told us, “Due to my illness the staff team need to understand my needs. I know they have had specific training to understand those needs.”

We received positive comments from all the people we spoke with about the care and support offered to them. We were told “The staff team are wonderful both day and night.” “I have tried four other homes in the past but this is the one I choose. It is like coming on holiday.” “The manager is good and will listen to what we say and aim to meet what is requested.”

We spoke with four people who used the service. They told us that their needs were met and that they were consulted about the care that they were provided with. People told us that the staff always treated them with respect and that their privacy was respected. They were complimentary about the staff that cared for them and told us that staff gave them the support they needed, but that they sometimes had to wait a short while for assistance. They told us that they felt safe living at the home and that there were things to do each day.

Relatives with whom we spoke told us that staff members were friendly, kind and understanding towards their relative and themselves. However, they also told us that recently the turn over of staff members had been high, that there were times when their relative had to wait a short while for assistance and that the home sometimes seemed short of staff.

Staff members with whom we spoke told us that they had completed dementia training. They told us that improvements had been made to the information they were given about the care and support each person needed. They told us that they could read in the plan of care of each person up to date details of the changes made to their care and support. They told us that, most of the time, there were enough staff on duty to care and support everyone who lived at the home.

The Manager with whom we spoke told us that every effort was made to ensure the needs of those people living at the home were met and that staff were fully trained. They told us that improvements had been made to the admission and care planning process and staff training. They told us that they had carried out recruitment and had employed more staff to work in all parts of the home.