We inspected the service on 5 December 2018. The inspection was unannounced. Lammas House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lammas House Residential Care Home is a purpose-built home for older people. It is registered to provide care for a maximum of 23 people. The home has three floors. The ground floor has seven bedrooms, the first floor has nine bedrooms and the top floor has seven bedrooms. All floors have communal facilities. On the day of our inspection 20 people were using the service.

At our last inspection on 21 January 2016 we rated the service ‘good’ overall, but the key question of ‘safe’ required improvement. At this inspection we judged the key question of ‘safe’ had improved to ‘good’; and the key questions of ‘caring’ and ‘well-led’ had improved to be ‘outstanding’.’

People received a safe service. Medicines were now managed and administered safely. People were protected from avoidable harm, discrimination and abuse. Risks associated with people’s health and well-being had been assessed and acted on. The premises were well maintained, and infection control procedures were adhered to. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People continued to receive an effective service. Staff received the training and support they required to meet people’s individual needs. People’s nutritional needs were well met. Staff identified when people required further support with eating and drinking and took appropriate action. Staff worked well with external health care professionals, and people accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People now received outstanding care from staff who were kind, compassionate, and went the extra mile for them. Staff treated people with the utmost dignity and respect. Staff had developed extremely positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. Daily social activities were available which people enjoyed. There was a complaints procedure and the very small number of complaints had been addressed appropriately. People received excellent end of life care.

People now received outstanding leadership, with the service being extremely well-led. The registered manager and her team provided excellent support to staff; and were open and transparent in their management. The management team put people at the heart of what they did, and were well supported by the provider in their quest to deliver an exceptional service.

The inspection took place on 21 January 2016 and it was unannounced.

Lammas House provides accommodation and personal care for up to 23 older people, some of whom, may have a physical disability or sensory impairment. On the day of our inspection there were 23 people living in the home.

The home has 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.

People told us they felt safe and would feel at ease to raise any concerns with staff or the registered manager if they needed to. Care staff knew how to protect people against the risk of abuse and had completed training in safeguarding people so they knew how to recognise abuse and poor practice.

People told us they received their medicines when they needed them and records confirmed this. However, there were some practices in regards to managing medicines that did not follow good practice guidelines to ensure medicine management was consistently safe. People were able to access health professionals such as a GP and district nurses to support their healthcare needs.

People were supported by sufficient numbers of staff who made time for them and did not rush them. People were positive about the staff and felt their care needs were being met. Staff received on-going training considered essential to help them achieve the skills and competences they needed to care for people safely.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). People who lacked capacity to make decisions were appropriately supported.

People were offered choices of nutritious food that met their needs and there were regular choices of drinks available during the day. Where people needed support or encouragement to eat, this was provided.

People were supported to engage in a range of social activities that they enjoyed. Work was on-going to ensure social activities were person centred in accordance with people’s interests and wishes.

There was a warm, relaxed atmosphere in the home and people were looked after by staff who knew and understood them well. Staff treated people with kindness, showed respect and maintained people’s dignity. People were supported to maintain relationships and friendships with those important to them and visitors confirmed they were welcomed into the home.

Each person had a detailed care plan that was personalised and people and their relatives felt the care and support provided met people’s individual needs. Care plans were regularly reviewed and people felt involved in decisions relating to their care.

People knew how to raise any concerns or complaints and were confident to raise these with staff or the registered manager if they needed to.

There was clear leadership within the home and an open culture where staff and people’s opinions about the care and services provided were encouraged and sought. Both the registered manager and the provider carried out regular checks on the quality of care and services provided to identify any areas that needing improvement. People and staff told us their views and opinions were listened to and acted upon. We saw that planned improvements were focussed on people’s experiences and wishes.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with ten people using the service, three care staff supporting them and looking at three people's care records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. One person told us, "I feel completely safe here. The manager and the staff are absolutely fantastic". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

Staff knew about risk management plans and we saw they supported people in line with those plans. This meant people were cared for in a way that protected them from harm.

We found people's nutritional needs were assessed and that people were provided with a choice of nutritional and healthy meals. This meant people were protected from the risk of inadequate nutrition and dehydration.

We found that medicines people needed were stored and administered in a safe way by staff who were appropriately trained and competent. This meant people were protected from the risks associated with medicines.

The manager ensured staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way. The provider had robust recruitment procedures in place to ensure staff were of good character and had the skills and knowledge to support people safely.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had 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.

Is the service effective?

People’s care needs were assessed with them. All the people we spoke with told us they were involved in their care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People were supported by care staff who were kind and caring. We saw care staff gave people encouragement and respected their privacy and dignity. One person told us, "Everyone who works here is very kind".

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

We visited Lammas House on 12 September 2013. At the time of our visit there were 22 people living there. We spoke to five people, three members of staff and the manager. One person said, “I think if one has to live in a home it’s not bad.” Another person told us, “I feel as If I have been here for years. I’m more than settled. I am quite content.”

Care plans contained sufficient information about people and their preferences to support staff in delivering person centred care. Care plans were well ordered and well maintained. Records showed that the advice of health professionals had been sought where risks to people's health had been identified.

During our visit we looked around the communal areas and observed that most areas were suitably clean. There were no unpleasant odours. People looked clean and well dressed.

People we spoke with where happy with the staff who looked after them. We saw that new staff completed an induction to the home. Staff told us they had access to training on a regular basis. Staff received regular management supervision and annual appraisals.

Lammas House had a complaints procedure that was available to people and visitors to the home. We were satisfied complaints were dealt with appropriately. People told us if they had any concerns they would raise them with the manager.

We visited Lammas House on 5 November 2012. Nobody knew we would be visiting. We spoke to six people who lived there, a visiting relative, two staff members and the manager. We also joined people for lunch in the dining room. We spent time observing how people were supported during the meal.

People spoken with were positive about the home and the level of care provided. We received comments such as - "I am quite happy here", "I love it", "we are very happy here" and "they couldn't have done any better".

We saw plans of how care should be delivered were detailed and reviewed regularly with people and their families. People's health was monitored and referrals made to external health professionals when necessary. Relatives were regularly kept up to date with their family member's care. Records were consistently well organised.

We saw adequate staffing levels and staff had received training to support them in delivering care safely. Staff spoken with knew what actions they needed to take if they saw or suspected abuse.

The provider had a system in place to monitor the quality of the service provided. We saw that there were regular residents' surveys and concerns identified had been addressed by the manager.