St Peters House provides accommodation, nursing and personal care for up to 66 older people. There were 53 people living in the home on the day of our inspection. This inspection took place on 26 and 27 September 2017 and was unannounced on the first day.

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 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.

At our last inspection on 10 June 2015 we rated the service ‘Good’ overall and ‘Outstanding’ in caring. We found at this inspection that the people continued to receive excellent care that was personalised to them, taking account of their individual needs and wishes. We have rated the service ‘Outstanding’ in caring and responsive and therefore the rating overall is also ‘Outstanding’.

The service provided exceptional, compassionate care to people. Staff treated people with compassion, kindness, dignity and respect. Staff knew people well and interactions were relaxed. People who used the service and their relatives spoke with great fondness and affection about the staff. Staff were committed to the people who lived at the home and ensuring that their needs were met in an extremely caring manner. We saw examples of staff going above and beyond to meet people’s needs.

People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

Ensuring people received care personalised to meet their needs which enhanced their quality of life was fundamental to the running of the service. The service provided outstanding end of life care. Effective systems and processes were in place to ensure people experienced a comfortable, dignified death in line with their wishes.

A great strength of the service was people had the opportunity to take part in a number of social events and activities based on their preferences. Activities were innovative and involved all areas of the staff team including the catering team. There were strong links to the local community, people had the opportunity to meet and engage with people of varying ages such as college students and nursery school children.

Safe recruitment practices were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care environment.

The home had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager and deputy manager knew how to report any safeguarding concerns to the appropriate local authority if necessary.

People were cared for by staff who received regular training and who were supported through regular opportunities to meet with their line manager to discuss their work and receive feedback. Staff received training in a number of areas relevant to their job role and their development.

People felt supported by the registered manager and deputy manager. Staff understood the values of the service and the management team led by example. Management processes and audits were in place and used effectively to monitor and improve the service. People and their relatives were involved in their care assessments and care plan reviews. People and staff told us the home was well run and that the registered manager was approachable. There were systems in place for people to be involved and feedback on the experiences of the service.

St Peters House provides accommodation, nursing and personal care for up to 66 older people. There were 53 people living in the home on the day of our inspection. This inspection took place on 26 and 27 September 2017 and was unannounced on the first day.

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 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.

At our last inspection on 10 June 2015 we rated the service ‘Good’ overall and ‘Outstanding’ in caring. We found at this inspection that the people continued to receive excellent care that was personalised to them, taking account of their individual needs and wishes. We have rated the service ‘Outstanding’ in caring and responsive and therefore the rating overall is also ‘Outstanding’.

The service provided exceptional, compassionate care to people. Staff treated people with compassion, kindness, dignity and respect. Staff knew people well and interactions were relaxed. People who used the service and their relatives spoke with great fondness and affection about the staff. Staff were committed to the people who lived at the home and ensuring that their needs were met in an extremely caring manner. We saw examples of staff going above and beyond to meet people’s needs.

People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's rights to privacy, dignity and independence were taken into account by staff in the way they cared for them.

Ensuring people received care personalised to meet their needs which enhanced their quality of life was fundamental to the running of the service. The service provided outstanding end of life care. Effective systems and processes were in place to ensure people experienced a comfortable, dignified death in line with their wishes.

A great strength of the service was people had the opportunity to take part in a number of social events and activities based on their preferences. Activities were innovative and involved all areas of the staff team including the catering team. There were strong links to the local community, people had the opportunity to meet and engage with people of varying ages such as college students and nursery school children.

Safe recruitment practices were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care environment.

The home had sufficient staff to meet the needs of the people living there. Staff had received training in how to recognise and report abuse. The registered manager and deputy manager knew how to report any safeguarding concerns to the appropriate local authority if necessary.

People were cared for by staff who received regular training and who were supported through regular opportunities to meet with their line manager to discuss their work and receive feedback. Staff received training in a number of areas relevant to their job role and their development.

People felt supported by the registered manager and deputy manager. Staff understood the values of the service and the management team led by example. Management processes and audits were in place and used effectively to monitor and improve the service. People and their relatives were involved in their care assessments and care plan reviews. People and staff told us the home was well run and that the registered manager was approachable. There were systems in place for people to be involved and feedback on the experiences of the service.

As part of this inspection we spoke with five people who used the service, four staff, five visitors and the registered manager. We looked at four people's care records. Other records we reviewed included staffing records, quality and monitoring records and satisfaction questionnaires completed by the people who used the service. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is the summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe. The service had appropriate policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although at the time of our inspection no applications had been submitted.

We saw the staff rota which confirmed that the service ensured there were sufficient numbers of staff to meet people's needs. People who used the service and visitors all told us that staff were available when they needed them. Two people told us that staff always responded to their call bells promptly.

Contracts for regularly servicing equipment such as hoists, lifts, gas, and electrical items including fire fighting equipment were in place. This ensured that people were protected from unsafe and unsuitable equipment. .

Is the service effective?

People's health and care needs were assessed in consultation with either the person themselves, relatives or their advocate where appropriate. People had a plan of care in place that reflected their healthcare needs in conjunction with support from outside professionals, where required. Care plans included a method of assessing and monitoring people's dietary and nutritional needs in order to ensure that people were protected from the risks of malnutrition.

People's mobility and other needs were taken into account in relation to signage and building adaptation, which enabled people to move around the service freely and safely.

Is the service caring?

People were supported by staff who were kind, caring and respectful. Care workers supported people with patience and genuine affection, assisting people who required additional support in a dignified manner and at their own pace.

People we spoke with commented, "They, (care staff) are all fabulous and extremely kind.” “They, (care staff) smile at you a lot. I like that.” And “We get to sing songs and arrange flowers.”

Is it responsive?

People's care records showed that where concerns about an individual's wellbeing had been identified, staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, this included doctors and community nurses.

People were involved in participating in a range of activities both within the service and were also offered regular visits from outside entertainers.

People's preferences, interests and choices had been recorded and the care and support offered in accordance with people's wishes.

People who used the service, relatives and friends involved in the service had completed satisfaction surveys and issues raised had been addressed.

Is the service well led?

The service had a partial quality assurance system but records seen showed us that not all areas of the service were monitored or reviewed regularly.

Staff we spoke with were positive about the leadership of the service and said that they found the manager approachable and supportive.

The registered manager demonstrated a positive attitude towards developing the service and improving outcomes for people living with a dementia.

We chatted with six people who were using the service and they all confirmed to us that they felt safe, they enjoyed the food provided and that staff were kind to them. One person told us, "The carers are super. I feel at home here." Another person said, "I love the food. It is good home cooking. If I don't like something I can ask for an omelette or baked potato."

We also spoke with the relatives of five people using the service and a health care professional who visited the service regularly. They all confirmed to us that the standard of care was good and that they felt that staff were competent. One relative told us, "Staff here are a lifeline for me. They have supported me and my spouse through a very difficult time and I cannot fault them." Another relative said, "The care is very good. If I have any concerns I am confident to approach the staff."

Since our last inspection, the service has expanded to accommodate up to 66 people. The new wing has been custom built and provided modern facilities for people with dementia. We found that infection control procedures were in place, staff were trained and were following best practice guidance. Staff demonstrated a good knowledge of providing compassionate care to people with dementia and we saw that they communicated sensitively and positively with people. People were provided with a varied and nutritious diet and people's individual preferences and needs were catered for.

People using the service confirmed that staff were polite, respectful, kind and caring. We spoke with five people who confirmed that they felt happy and safe and they enjoyed the food provided. One person told us, “Staff here are very caring and take trouble to help me.”

We spoke with three relatives visiting the service on the day of our inspection. They told us that they felt able to approach care staff and managers if they had any issues and that they were confident that problems would be dealt with in good time. One visiting relative explained, “It has been an emotional journey, leaving my relative to be cared for by others, but I feel that staff are trustworthy and honest. They have helped me a great deal and I am so thankful.”