This unannounced inspection was carried out on the 20 October 2017.

Hendra House Residential Home is a care home that provides accommodation and personal care for up to 28 older people. The home is situated in a residential area of Ludlow. There are car parking facilities to the front of the building. At this inspection, there were 28 people living at the home, a number of whom were living with dementia.

At the last inspection in July 2015, the service was rated Outstanding. At this inspection, we found the service remained Outstanding.

There was a registered manager in post at the time of our 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 continued to receive outstanding care at Hendra House Residential Home. People, their relatives and health care professionals told us staff adopted a compassionate and caring approach towards their work. We saw very positive interaction between staff and people throughout our inspection. People’s rights to privacy and dignity were understood and promoted by staff. People were also provided with a keyworker, who the provider matched to the interests and personality of the person. Staff told us they took pride in knowing each person and knowing and understanding their needs. People were encouraged to be independent, express their views and make choices about the care and support they received. People told us they were listened to by staff and felt able to voice their opinions. They also felt actively involved in decision-making about their care and support needs. The provider and staff supported people’s involvement in decisions that affected them. People continued to be supported when considering their end of life care needs, such as future wishes and cultural needs. Staff had received training in end of life care and the home had a nominated end of life champion. The provider worked closely with local funeral directors to advise or assist with the provision of services.

Leadership at the home continued to be 'outstanding.' People told us the registered manager and the management team continued to lead by example. They regularly met with people and were always available when people wanted to speak with them. People described an open and inclusive culture, where their views and opinions were welcomed and acted upon by the provider. The provider had continued to deliver high standards of performance, especially around encouraging self-development and the provision of training opportunities for staff. This meant people consistently received high standards of care. Consistent leadership at the home provided for continual improvements, which were for the benefit of people who lived at the home. The provider told us that their approach to providing high quality care and support had gained national recognition, where staff had received national and regional nominations and awards. The provider had continued to develop lasting relationships within the local community, which included local churches, schools, and voluntary organisations. The provider was actively involved working with care organisations across the sector both locally and nationally, which involved sharing good practice and expertise.

People consistently told us they felt safe living at the home. There continued to be systems in place to protect people from abuse by ensuring appropriate referrals were made and action taken to keep people safe. Risks to people were managed in a way that protected them and kept them safe from harm. People were supported safely and their needs were met by sufficient numbers of staff. People continued to receive their medicines safely.

We found people continued to receive care and support from st

The inspection was carried out on 30 July 2015 and was unannounced. At our previous inspection on 22 May 2014 we found that they were meeting the Regulations we assessed them against.

Hendra House is a care home that provides accommodation and personal care for up to 28 older people. 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 2008 and associated Regulations about how the service is run.

Staff were very well trained and used their training effectively to support people. People said they were aware of the training that staff were given. The registered manager had also provided training events for people who used the service.

Staff understood and worked within the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Staff were able to demonstrate an excellent understanding and knowledge of people’s specific support needs, so as to ensure people’s safety and protect their human rights.

People told us they felt safe at Hendra House and were protected from abuse. Staff knew how to identify if people were at risk of harm and knew what to do to ensure they were protected.

Staff were recruited through a rigorous procedure. People and their relatives spoke extremely positively about the home and the care they or their relatives received. Staff took time to talk with people or provide group or individual activities.

People had care centred upon them because of strong leadership and good staff support. The management reviewed their business plan every month to determine if the service they intended to provide was still relevant to people’s needs. Staff reflected on their care of people so they discussed what worked well and what they could do better for them.

People had their individual needs met. We saw staff knew people well and provided personalised support very quickly when asked. There was sufficient food and drink available and people ate their meals in a calm, sociable and unhurried atmosphere.

People had regular routine access to visiting health and social care professionals where necessary. District nurses or the GP assessed the initial health needs of people. They provided clear guidance for staff about how they were to meet these needs so that they worked in collaboration. Staff responded to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals. Medicines were managed safely to ensure people received them in accordance with their health needs and prescriber’s instructions.

Staff identified and reported any concerns relating to a person’s safety and welfare. The registered manager had a system to respond to all concerns or complaints appropriately.

The senior management, staff and relatives regularly discussed how to best support people living at the home. The provider also subscribed to an external customer satisfaction feedback scheme. This enabled people and their relatives to comment on the service independently. People and staff were extremely complimentary about the registered manager and their leadership. The registered manager had fully taken on board the changes to guidance and legislation since April 2015 and integrated these into the systems of the service. The provider had on display the many accolades awarded by accredited schemes.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People living in the home told us they felt safe because their rights and dignity were respected and they were involved in making decisions about any risks they may decide to take in their daily lives. One person said, “Hendra House provides a sense of safety and security that I did not have when living at home, especially at night”.

The registered manager had an effective system to manage accidents and incidents and learn from them so they were less likely to happen again.

The staff and the registered manager understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards (DoLS) and put them into practice to protect people.

CQC monitors the operation of DoLS which applies to care homes. While no applications have needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people living in the home were protected from avoidable harm.

Staff followed effective risk management policies and procedures to protect people. This meant that risks to individuals were managed well so that people were protected and their freedom was supported and respected.

Is the service effective?

People living in the home told us that they could express their views about their health and quality of life. The care records we looked at reflected people’s current individual needs, choices and preferences.

Staff we spoke with demonstrated they had the skill and knowledge to meet people’s assessed needs. The registered manager described the equipment they had purchased to enable people to be as independent as possible.

People we spoke with said they felt confident discussing their health needs with staff. They said their health was regularly monitored to identify any changes that may require additional support or intervention such as referral to the GP or district nurse. We saw that referrals were quickly made to health services when people’s needs changed and relatives were kept informed. A relative had commented through a survey, “I was informed of all visits made by GPs and nurses and the recommendations by them”. Another said, “ X recovered well, thanks in no small part to the swift action taken by the Hendra staff at the time, calling the Doctor at night and keeping us fully informed and updated at all times we were confident was receiving appropriate, dignified and gentle care day and night”.

We reviewed records that showed staff received effective support, supervision and training. The registered manager had a staff development plan that encouraged staff to promote innovative practice. As a result the provider had won many accolades within the care sector. This meant that people received effective care from staff who had the knowledge and skill necessary to carry out their roles and responsibilities.

Is the service caring?

People living in the home told us that they were treated with kindness and compassion and that their dignity was respected when receiving personal care. We observed as staff went about their work that people were shown kindness and compassion. People explained how their individual needs were met, including needs around age, disability, religion and belief. This meant that caring positive relationships were developed with people living in the home.

Records were stored in the office so information about people was treated in confidence. Staff we spoke with described how they promoted respectful behaviour and positive attitudes. We were shown records that showed staff had been trained in policies and procedures and how to respect people’s privacy, dignity and human rights in the home. This meant people’s privacy and dignity was respected and promoted.

People and those that mattered to them were encouraged to make their views known about their care and support, and these were respected. For example, one person had commented in a survey, “The staff give us lots of support and treat us with dignity. The home is so comfortable. Like a five star hotel. Anyone who would like to live in a caring home with caring staff should come here”. Another relative commented, “My mother was most excellently cared for including the management of her final days. The staff were supportive, friendly and helpful. I was so impressed by the management’s strong focus on improvement and training”. This meant people were listened to and felt that they mattered.

Is the service responsive?

People said that they and their family were encouraged to make their views known about their care and support. One person explained how staff made sure that they had the time they needed to make decisions about their life. Care records detailed how people’s individual needs were regularly assessed and met.

We viewed records that showed a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. The way staff interacted with people showed that they actively sought and listened to people’s views and decisions. This meant people were supported to express their views and be actively involved in making decisions about their care and support.

Residents attended meetings so that they could put forward their views for activities that were important and relevant to them and they were protected from social isolation. People were very much enabled to maintain relationships with their friends and relatives. Staff we spoke with recognised the risks of social isolation and loneliness with one person and worked hard to balance the risk against this and how they wanted to live their life. This meant that people received personalised care that was responsive to their needs.

Is the service well-led?

Discussion with the registered manager and staff showed there was an emphasis on fairness, support and transparency and an open culture in the home. Staff were supported to question practice through robust supervision arrangements. The registered manager operated a clear set of values that included involvement, compassion, dignity, respect, equality and independence which were understood by all staff we spoke with. This meant that the service promoted a positive culture that was person centred, open, inclusive and empowering.

Robust quality assurance and governance systems were in place and used to drive continuous improvement. There were effective arrangements to continually review health and safety, safeguarding concerns, accidents and incidents, infection control and food hygiene.

The management team had links with organisations that act as sources of best practice. For example the registered manager was working on developing the practice around DoLS in light of recent new guidance. This meant that the registered manager demonstrated good management and leadership.

Staff we spoke with knew and understood what was expected of them. Effective supervision processes were in place for staff to account for their decisions, actions, behaviours and performance. This ensured that responsibility and accountability was understood at all levels. A relative commented in a survey, “There is a strong focus on training for staff at all levels”. Another person said, “Managerially the home has continual improvement as its standard – excellent”.

People shared their experience of the care and support they received. Comments included, "I am well looked after and the staff do everything they can for me, they are so cheerful, they help me do what I can for myself which is very respectful of my wishes".

People told us they were regularly asked if their service was satisfactory. They confirmed meetings and formal surveys were in place to gain their views about their care or how the service was run.

People told us that they attended reviews to ensure that the care they received continued to reflect their needs. People were supported to meet their individual needs in ways that promoted their health and wellbeing. This meant that the care was responsive to people's needs. People considered the staff met their current needs and felt assured that if they became unwell that staff would respond.

People believed staff were well trained to do their job and one person said, "They are very adept at understanding how to assist me". They thought that compassionate care was provided by staff. People considered the service was well led.

People we spoke with told us that they liked living at Hendra House. They told us that nothing was too much trouble and that staff were very kind. Comments included, “everything is excellent” and “I am being extremely well looked after”.

Staff used clear procedures to get valid consent from people who used the service. We viewed records that showed people had been involved in and consulted about their care and support. Where a person lacked capacity, ‘best interest’ meetings were held with people who knew and understood the person.

People told us that they were safe and well looked after. They said staff were kind and attentive. People who used the service said they were able to raise any issues they had with the staff. One person said, “staff do listen and communicate any issues well. I feel assured, as far as possible, that staff can care for me as I prefer”.

People were protected because staff were confident to recognise and report abuse.

People told us that the staff asked them if they were alright and if they were happy with everything. They said they were able to express their wishes and share their views about how they were feeling. People said that if they had any concerns or worries that they would speak with a member of staff or the manager. We saw records that showed the provider had systems in place to monitor and review people’s experiences and resolve complaints.

We carried out this review to check on the care and welfare of people who used this service.

We did not review every outcome for this provider. We were proportionate in our approach and focused on outcome one, four, seven, 14 and 16.

We spoke with people who live at the home, visiting relatives, staff and management.

There were many positive comments and overall people were very pleased with the care and support they received. Many comments were made about staff being kind and caring, helpful and friendly. People repeatedly described Hendra House as being their home. They commented that staff were eager to help them have a good quality of life.

People who used the service said they received information before they agreed to the service. They said they had their needs assessed and were monitored closely by the staff involved with their care.

People said they were treated as individuals and any changes to care communicated to the care workers speedily which ensured consistent quality care.