Hunters Care Centre is a nursing home for 97 older people of whom 30 were living with dementia. At the time of the inspection there were 78 people living there. Nine double sized rooms can provide accommodation for couples wishing to live together although the majority of rooms are occupied on a single/suite basis. Accommodation is divided into communities/units providing a mixture of nursing, residential and dementia care (Memory Lane). Communal areas on the ground floor are shared which include lounges, a dining room and hair dressing salon. There are well kept gardens around the home and within Memory Lane.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by staff who had been through a recruitment process to check their character and knowledge. People’s feedback and experience of their care was mixed. The relatives of people living in Memory Lane had raised concerns about staffing levels. The provider had reviewed staffing levels across the home increasing night staff and day staff. They closely monitored people’s needs in line with their own assessment tool to make sure there were enough staff to support people. A new project had just started to provide further training in dementia for staff working on Memory Lane, refurbish the environment and to review the way in which care was provided.

People received individualised care and support which reflected their individual preferences, needs and routines important to them. They or their relatives were involved in the planning and review of their care. Their care records were kept up to date and reflected their changing needs. Any risks were assessed and hazards minimised. People’s rights were upheld and staff had a good understanding of safeguarding procedures. People’s medicines were satisfactorily administered. 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. People were supported to stay healthy and well through access to health care professionals. Their dietary needs had been considered and they were offered choice about their food and drink. People’s diverse needs were respected. They had access to meaningful activities, to follow their religious or spiritual needs and to receive visits from family and friends.

People were supported by staff who knew them well and treated them with dignity and respect. People said “Staff are absolutely charming”, “Carers are wonderful and do a wonderful job”, “Staff are kind and gentle.” Staff had access to training to equip them with the skills and knowledge they needed. They attended individual and group support meetings and felt supported to develop in their roles and professionally. A manager had been appointed and staff were positive about them saying they were accessible and approachable.

People’s views and those of their relatives were sought to make improvements to the service. People knew how to make complaints and said they would speak with staff or the manager. Residents’ and relatives’ meetings were held to seek their feedback. Quality assurance processes were in place to assess the quality of the service provided. Action was being taken to improve the experiences of people living in Memory Lane and environmental refurbishments were planned.

Further information is in the detailed findings below.

At the time of our inspection there were 80 people living in Hunters Care Centre. One unit that specifically provided care to people living with a form of dementia. This was known as memory lane.

During our inspection we spoke with 13 people who lived in the home, six staff including registered nurses, two relatives, the registered manager and the deputy manager.

We examined the care records for people who lived in the home and observed how staff interacted and supported people in communal areas.

We crossed referenced peoples care plans with the observations that we made. We found people were being supported in line with their assessed needs.

We were supported on this inspection by an expert-by-experience. This is a person who has had personal experience of using or caring for someone who used this type of care service. This person gained the views of people living in the home and their experiences.

People’s comments included; “Staff here are super; I feel safe and have no problems; I can do quite a lot for myself but when I do need help, staff are polite; I don’t feel embarrassed’ if I need anything, I can ask anybody – they would put me right.” “I am very happy here the staff are delightful”.

The provider had systems in place to monitor the quality of the service that was provided.

Throughout the day we talked with many people who lived in the home. One person said, "it's a wonderful place, we couldn't wish for anything better". People living in the home said they had choices as to their lifestyle and daily routines and we saw that this was respected by the home. We observed that staff treated people with dignity and respect.

Lunch time was a sociable event, one person told us that the food was always exceptional. We spoke with the chef who explained that they liaised with the nursing team to find out peoples dietary needs. The chef also had a list of people’s likes and dislikes. We looked at the menus and saw that they were balanced and varied incorporating fresh meat, fish and vegetables.

The staff we spoke with showed a good understanding of the needs of the people who used the service. During the visit, we observed care being delivered in a way that supported people's care needs, welfare and safety. The people we saw were appropriately dressed and had been supported with their personal appearance.

One person living in the home said that the staff were, "second to none". Another person said, "they are really wonderful, so hard working and so caring, nothing is too much trouble". There were many activities in which people could participate and we saw that people enjoyed social interaction. The home regularly sought the views of people living in the home and their relatives.

People told us that they like the home and the staff. One person said, ‘this is a lovely place to live, and the staff are really nice’. Another person said the staff are ‘very good – we can ask if we want something, and if they can do it, they will’. One person said, ’if I need something in the night, someone always comes to help me’.

People told us that their needs for social and family contact were being met: ‘friends and family come to visit me regularly. I am very lucky to live here.’

A number of people told us that they liked to walk in the garden and we received comments such as ‘the grounds are beautifully kept’

Almost all of the people we spoke to were complimentary about the choice and quality of the food at the home. One person told us, ‘the food is nice and there is always a choice’. Another person told us that ‘the food is too modern, they use too much seasoning’. However, this person also told us that staff were now aware that she likes plainer food and give her choices.

People using the service said if they had any concerns they raise them with a nurse or the manager of the home.

People at the home told us that they would talk to staff about any concerns they might have. People told us that their concerns had been acted on when they had done this in the past.

People told us if they are unhappy about anything they will usually raise it with a member of staff and that these issues are usually dealt with quickly.

Hunters Care Centre is part of the Barchester Healthcare Homes Limited and is situated on the outskirts of Cirencester in Gloucestershire. The home can accommodate up to 97 people who require nursing care. The service also provides care for people who are living with dementia.

The service provided consisted of three separate units. A residential unit called The Lodge, which was home to eight people. A nursing unit arranged over three floors and, a unit for people living with dementia called Memory Lane which was arranged over two floors. At the time of our inspection 77 people were using the service.

This inspection was unannounced and took place on 19 and 20 August 2015.

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.

People were safe because the registered manager and staff team understood their role and responsibilities to keep people safe from harm. Staff knew how to raise any concerns regarding people’s safety. The provider acted appropriately when concerns were raised. There were enough suitably qualified and experienced staff. However, the feeling amongst some staff was that there wasn’t always enough staff and that some shifts were too long. The service used a dependency tool to calculate safe staffing levels. However, the tool had not always been consistently and correctly used. Employment checks were carried out on staff before they started work to assess their suitability to work with vulnerable people.

People were supported to take appropriate risks and promote their independence. Risks were assessed and individual plans put in plans to protect people from harm. People were protected from the risks associated with medicines because the provider had clear systems in place and staff had received the appropriate training.

People were provided with effective care and support. Staff had received the appropriate training to meet people’s needs. Staff received individual supervision aimed at improving their skills and abilities in meeting people’s needs. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to eat and drink and their individual needs, wishes and preferences were catered for. Arrangements were made for people to see their GP and other healthcare professionals when they needed to do so. The environment had been designed to meet people’s needs.

People received a service that was caring. They were looked after by care staff who were familiar with their needs and wishes. People were involved in making decisions about how they wanted to be looked after. People had positive relationships with the staff caring for them. Staff treated people with dignity and respect.

People received person centred care and support based upon individual needs assessments and care planning. They were offered a range of activities. People said they enjoyed these activities. However, people said they’d like more trips out. Opportunities for trips tended to be restricted due to lack of space on the minibus. People were encouraged to make their views known and the service responded by making changes.

The service was well led. The registered manager, deputy manager and senior staff were well respected and provided effective leadership. The quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.