Our inspection took place on 27 July 2017 and unannounced.

Herewards House provides accommodation for older adults and people, some of whom have dementia. The service provides ongoing care as well as respite stays. The service is located in a residential area of Maidenhead in Berkshire. The service is registered to accommodate a maximum of 27 people. On the day of our inspection there were 22 people who used the service.

The service must have a registered manager.

At the time of the inspection, there was 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.

This was our first inspection of this service since the provider changed their registration, although the service has been operated for many years by the same people.

People were protected from abuse and neglect. We found staff knew about risks to people and how to avoid potential harm. Risks related to people’s care were assessed, recorded and mitigated. The management of risks from the building required some improvement. We found sufficient staff were deployed to meet people’s needs. Medicines management was safe, but improvements were needed in the premises to facilitate better preparation of medicines. We saw some refurbishment had been completed to modernise the building. We made recommendations about window restrictors and Legionella prevention.

Staff training and support was appropriate. Staff had the necessary knowledge, experience and skills to provide good care for people. The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People’s nutrition and hydration was satisfactory. Appropriate access to community healthcare professionals was available.

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. We made a recommendation about DoLS applications.

There was a lot of complimentary feedback about Herewards House. People and others told us staff were kind and caring. People and relatives were able to participate in care planning and reviews, but some decisions were made by staff in people’s best interests. People’s privacy and dignity was respected. We made a recommendation regarding the Data Protection Act 1998.

Care plans were personalised and reviewed regularly. There was a satisfactory complaints system in place which included the ability for people and others to escalate complaints to external organisations. The service had no recorded complaints for a considerable period of time.

Staff demonstrated a positive workplace spirit and enjoyed their roles. People and others felt the service was well-led. A small number of audits were conducted to check the safety and quality of care. People who used the service and staff feedback was noted by the management team in the operation of the service. We made a recommendation about the statement of purpose and related statutory notifications.