We carried out an unannounced inspection on 10 May 2018.

OSJCT Hartsholme House 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.

OSJCT Hartsholme House provides accommodation for up to 44 older people with care needs and people living with dementia. It is situated on the outskirts of Lincoln and provides accommodation over two floors. On the day of our inspection there were 43 people living at the home.

At our last inspection in November 2015 we rated the service good with a rating of outstanding for responsive and good for safe, effective, caring and well led. At this inspection we rated the service as outstanding overall. We found responsive and well led to be outstanding and safe, effective and caring to remain as good.

There was a registered manager in place. 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 understood their responsibility to protect people from the risk of abuse and appropriate action was taken in response to any incidents. Staff were aware of risks to people’s health and safety and took action to reduce the risks, whilst not restricting them unnecessarily and maintaining their independence. Incidents and accidents were analysed and used to identify themes and share learning.

Staffing levels were adequate to enable people’s needs to be met promptly and staff were deployed effectively. Staff were recruited safely and received regular and appropriate training for their roles. People received their medicines when they needed them and medicines were stored and recorded appropriately.

The service managed the prevention and control of infection well. Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises. The required checks of the premises and environment were made to maintain a safe environment.

People had enough to eat and drink and staff provided them with support when required. Mealtimes were relaxed and sociable and people were complimentary about the quality, variety and amounts of food provided. People health needs were managed well and staff worked with health professionals to ensure all concerns were managed in a co-ordinated and timely way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Documentation of mental capacity assessments and decision making in people’s best interests was not always fully completed, however this was being addressed by the registered manager.

People received care from a group of staff who were caring and kind. They encouraged people and worked with them to ensure they achieved the best level of independence they could. Staff treated people in a respectful and inclusive manner and their opinions and views on their care were recognised and acted upon.

Staff provided care in a truly patient centred way and staff had an excellent and in-depth knowledge of the people they cared for. People and their relatives told us staff had an excellent knowledge and understanding of peoples’ diverse needs, characteristics and social background that might influence how they wanted to receive support and how they might want to spend their time. The registered manager worked with external agencies to introduce initiatives to further improve people’s experience and well being.

People and their relatives were fully involved in the development and review of their care plans so they felt consulted, empowered, listened to and valued. Care a

The inspection took place on 26 November 2015 and was unannounced.

OSJCT Hartsholme House is registered to provide accommodation and personal care for up to 44 older people or people living with dementia. There were 43 people living at the service on the day of our inspection.

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 (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. No one at the time of our inspection had their freedom restricted under a DoLS authorisation. However, the registered provider had made applications to the local authority and was waiting on assessments.

People felt safe and were cared for by kind, caring and compassionate staff. People were kept safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that had the skills to do so. The registered provider ensured that there were always sufficient numbers of staff to keep people safe.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities. People were given a choice of nutritious and seasonal home cooked meals. There were plenty of hot and cold drinks and snacks available between meals. People had their healthcare needs identified and were able to access healthcare professionals such as their GP or dentist. Staff knew how to access specialist professional help when needed.

People and their relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect and enabled to follow their hobbies and pastimes. People were supported to make decisions about their care and treatment and maintain their independence.

People were at the centre of the caring process and staff acknowledged them as unique individuals. People were enabled by a designated activity coordinator to maintain their hobbies and interests, and build strong links with the local community.

There were systems in place to support people and their relatives to make comments about the service or raise concerns about the care they received. People and their families told us that the registered manager and staff were approachable.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. The service received recognition from other agencies for areas of good practice.

We conducted a Short Observational Framework for Inspection at lunchtime (SOFI). SOFI helps us to understand the experience of people who are unable to explain this for themselves. We observed staff interact in such a way as to enable people to make a choice of where to sit to take their meal. We saw several people had chosen to sit in friendship groups and staff had respected their decision by placing place name cards at their place at the table.

We looked at the care files for three people. We saw their care files were person centred. Risk assessments such as falls, moving and handling and nutrition had been undertaken and care was planned in accordance with the outcomes.

Relatives told us people were well looked after and were safe. One person told us, “This is the best place to live.”

We saw all areas of the home were clean and furniture and equipment was in a good state of repair. There was a refurbishment programme in place and we saw people were involved in choosing new wall decorations, curtains and carpets for their bedrooms.

People told us they thought staff had the knowledge and skills for their role. One person told us, “Everyone is lovely. They’re pretty good really.”

We asked people if they knew how to complain if they were unhappy with any aspect of life in the home. One person said, “They always ask how we are doing. There is no need to complain, I’m very happy.”

When we visited the home we spoke with five people who were able to tell us about their experiences. One person told us, “I am happy with everything, overall it's an excellent service. I am being very well looked after." Another person said, "I'm quite happy with the care."

We spoke with two relatives. They told us, "My wife is being very well looked after. The staff tell me about everything, they even tell me when she has been laughing." Another said, "The staff let me come and have lunch with my husband every day. I know he has settled here as he is not waiting at the door when I arrive."

The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We spent 60 minutes watching people who were sitting in the first floor lounge. We saw people were provided with good quality care by a team of well trained staff who understood the needs of people who had dementia. People were provided with a lot of meaningful stimulation and were involved in planning their care.

We spoke with a Community Nurse who was visiting the home. They told us, "I think the staff provide a very high quality level of care for people who have dementia."

People told us that they liked the home very much. They said that they felt very safe and had no concerns about the way they were treated. People told us that staff were always very helpful and kind. They said they would be happy to complain if they had any concerns but had never had cause to do so.