About the service: Stone House is a residential and nursing home that was providing personal and nursing care to 33 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

•The provider continued to provide a good service. People told us they liked living at Stone House and they felt safe. One person told us, “Yes I do (feel safe) and I can trust the staff.” One relative told us, “I have never seen a member of staff get impatient in the two years I have been coming here.”

The service met the characteristics for a rating of “good” in all the key questions we inspected and achieved a rating of ‘outstanding’ in responsive. Therefore, our overall rating for the service after this inspection was “good”.

• People were always protected against avoidable harm, abuse, neglect and discrimination.

• People’s risks were assessed and strategies put in place to reduce the risks.

• People experienced positive outcomes regarding their health and wellbeing.

• Staff received good supervision and training, which provided them with the knowledge and skills to enable them to provide good care.

• Care was exceptionally person-centred and focused on ensuring people with dementia lived as independent lives as possible. The care was designed to ensure people’s maximum independence was encouraged and maintained.

• There was a workplace culture that was open and honest. Staff told us they felt supported by the manager and they could speak with them at any time.

• 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.

More information is in our full report.

Rating at last inspection:

At our last inspection, the service was rated “good”. Our last report was published on (5 July 2017).

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Stone House Nursing Home provides accommodation and nursing care for up to 35 predominantly older people. This includes people with dementia. At the time of our inspection there were 34 people using the service. Stone House is set in six acres of tranquil gardens with superb views across the Chiltern Hills. The main dining room has spectacular views of the gardens; people can sit and relax and enjoy the views or gather in the main gathering point of the conservatory. Most of the rooms have en-suite facilities and people are able to bring their own pieces of furniture and personal belongings with them.

The service has a registered manager supported by a care 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they were well cared for. One person said “All the staff here are very kind and nothing is too much trouble, they give one hundred and ten per cent”. Relatives told us that all the staff were caring and that everyone was treated with warmth and kindness. Other comments included “Every single member of staff cares and the attention to detail is outstanding”.

Care plans were personalised and accurately reflected people’s care and support needs. The care plans included information about people’s interests and life history which provided staff with sufficient information to enable care to be provided effectively. We observed people were cared for compassionately and with respect. People told us they were respected by staff, “It’s very good here they [staff] do everything for us”.

People were cared for by an established staff team. Managers and directors provided effective leadership to the service and regular residents meetings ensured people were involved in the running of the home.

The atmosphere in the home was inviting and friendly. We saw staff spending time with people at a pace that was dictated by those they were supporting. Staff told us “We work as a team here to support people; everyone is treated with respect and dignity”.

Staff supported and encouraged people to engage with a wide variety of activities available within the home. The service employed three activity coordinators. People commented positively about the activities. “There are plenty of people to talk to, we have enjoyable times here”.

There was good local community involvement with local schools and churches. Visiting professionals to the service were positive about the care provided.

On the day of our inspection we found that thirty three people were living at Stone House Home. Due to their health conditions or complex needs not all people were able to share their views about the care that they received. We observed their experiences to support our inspection.

We met and spoke with five people who used the service, two relatives, the registered manager, the deputy manager, the head for delivery of care, two activity coordinators and two care staff. We looked at six people’s care records and five staff files.

We found that the provider had systems in place to gain the consent to care and treatment of people who used the service.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, “The staff are wonderful, very caring.” One relative told us, “The care is good, nothing is too much trouble.”

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service.

We found the provider had appropriate arrangements in place to manage medicines.

We found that there was an effective recruitment process in place to ensure that staff had the skills to meet people's needs.

We found all records were now securely stored which meant they could not be accessed inappropriately. Records were kept securely and could be located promptly when needed.

Since our visit in November 2012 we saw an air conditioning unit had been fitted to the home's food storage area. Records of the temperature of dry food were being recorded to ensure they were safe and satisfactory. This meant people living in Stone House were protected from any risks associated with food being stored at inappropriate temperatures.

The storage of stock medication had been moved to a specifically designated, secure storage room. The temperature of this room was monitored daily and recorded. We saw storage of refrigerated medication had been monitored daily and recorded. When we checked the temperatures recorded we found they had been within the recommended temperature range. This meant medication was now stored appropriately.

We reviewed medication records. These were accurate and subject to regular checks. This showed people's health, safety and welfare was now being safeguarded by a robust system for the recording of their medication.

People told us they had been able to look around Stone House before a decision had been made about its suitability. Two people told us they had previous experience of the home, which is why they chose it. They were all satisfied they had enough information provided for them to make an informed decision, including about how much it would cost them. We spoke with five people who lived in Stone House and with five relatives who were visiting the home. They told us they were very satisfied with the standard of care they received or saw.

We spoke with staff who told us they had received safeguarding training. All of the staff we spoke with had a good understanding of what constituted abuse and what to do if it had been seen or suspected. People we spoke with did not raise concerns about staffing numbers and praised the quality of the staff team.

We found the temperature of medication storage had not been recorded. We checked the temperature of medication storage in one area of the home and found it was higher than recommended. This may have compromised the effectiveness and safety of the medication concerned. We found the temperature of some dry food storage had not been monitored and some records had not been stored securely

People told us staff had always responded promptly to requests. They said they had received satisfactory responses to any questions they had raised.

During the visit we spoke to six people using the service and two relatives.

People said they liked living at the home. People said staff had been kind, respectful and helpful. People said should they have any concerns they would approach either the manager or a member of staff. One person said that on occasion she had to wait for staff to respond to her requests for assistance.

Most people said they had been involved in planning what care they required and in reviewing their care needs. People said clear explanations’ had been given prior to care being provided and they had been kept informed of changes to their care.

People said they chose which activities to participate in and told us what trips out they had undertaken with the support of the home.

People said they liked the food. People said they had been given a choice of meals at meal times and they could access sufficient drinks.

Some people said they had attended residents and relatives meetings and that they felt confident when airing their views.

The relatives we spoke to said that staff were ‘excellent, caring and nice’. One relative rated the home as excellent; another said she could not praise the home enough’. The home was described as having a ‘homely atmosphere.’ Both relatives said the food was excellent.

Both relatives said care at the home was good. One relative said he had been consulted on his wife’s care and the care identified on her care plans had happened. The other relative said her brothers ongoing health needs had continued to be met by other healthcare professionals.

One relative said he was involved in the homes residents committee and was aware of any planned events due to take place at the home. The other relative said there appear to be limited outings out of the home for people living at the home.