Holmesdale House provides accommodation with personal care for up to six people aged over 65 years. It is a small, family-run residential care home. The service was last inspected on 4 December 2013. At that time we found the service was meeting the requirements of the regulations we inspected at that time.

This inspection took place on 5 October 2016 and was unannounced. There were six people living at the service at the time of this inspection.

There was a manager at the service who was registered with CQC. 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.

The service was exceptionally caring. People and their relatives were extremely satisfied with the care and support provided and spoke very highly of all staff. The ethos of the service was that of an extended family. The small staff team had developed very positive, caring and compassionate relationships with people. Staff knew each person as an individual and understood what was important to them and placed their wellbeing at the heart of their practice. People were treated with dignity and respect and staff approach was considerate, friendly and personalised. People experienced a lifestyle which met their expectations and preferences, and satisfied their social, cultural, religious and recreational interests and needs.

Staff supported people to engage in a variety of activities and people’s independence and choice was promoted. Staff spent time engaging people in conversations and activities.

People said they felt safe. They were protected against the risk of abuse. Staff had been trained to recognise what to look for. The registered manager and staff understood their responsibilities to report any concerns.

Assessments identified people's specific needs or risks, and showed how risks could be reduced. There were systems in place to review accidents and incidents and the registered manager ensured action was taken where necessary to reduce future risks. Medicines were managed safely and people were supported to take their medicines as prescribed.

There was a sufficient number of staff deployed to meet people's needs and staff were trained and competent to meet people’s individual needs.

People were protected by good practice in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People were offered a diet that met their needs and wishes. Menus offered variety and choice. People said they liked the food. People had access to a variety of health professionals for specialist advice and support when appropriate.

Staff felt valued and supported by the registered manager and the management team. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service and aimed to promote links with the community. Consistently positive feedback from people and relatives meant the service had achieved a top 20 care home rating in South East England for the past three years.

There were systems in place to monitor the service to identify any improvements that needed to be made. The management team acted on the results of any feedback to improve the quality and safety of the service.

We spoke to five people who used the service in depth, and two staff members.

People told us that they were treated with kindness and respect and that they had given consent to the care and support that was given. One person told us, “I chose to move in here and so I gave my agreement to the support I received.” Another said, "We are so lucky to live here, we are all friends and get on well." One person said, "I knew the home before I came to live here, so I am very content and never want to move."

We examined four care plans and saw evidence that delivery of care was individual and person specific. Care plans and activities were designed and carried out to give people new experiences and independence while keeping them safe.

We found good management processes in place in relation to obtaining, storing, administering and disposing of medicines.

There were robust recruitment processes in place that protected the people who used the service from abuse.

We looked at the systems and processes the home had in place to respond to complaints. There had been no complaints received in the past year.

During our inspection we spoke with all five of the people who used the service. They told us that the home had recently changed ownership. They said, “It was excellent before and it’s carrying on.”

People told us they were involved in decisions about their care and treatment. They told us they had choice in every area of their life. People told us they had, “No complaints.”

We talked with two staff and the manager. These staff were committed to supporting people to live their life in as independent a way as possible. Staff provided the level of support requested by the person who used the service. We observed that people were treated with respect and dignity.

We looked at the arrangements to keep people safe in the home. There were risk assessments, and policies and procedures in place. People told us, “We feel as safe as houses here.”

There were processes in place to review and evaluate the standard of service being offered. There were mechanisms in place to ensure that people were involved in identifying improvements needed in the home.