This inspection took place on 5 and 10 July 2017. The first day of our visit was unannounced.

The home is situated in Solihull, West Midlands. It is part of The Royal Star and Garter Homes which was established in 1916 to provide care to military veterans.

The home provides nursing and personal care for up to 60 ex-service men and women. This includes older adults, people with a physical disability, younger people and people living with dementia. During our visit 58 people lived at the home. The home is purpose built and divided into four ‘houses’ called Linley, Roundel, Whiteley and Croucher.

Since our last inspection, a new manager had been recruited and they registered with us in July 2016. 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.

A fundamental aim of the home to promote people’s quality of life and to ensure people had a sense of purpose had been achieved. People were extremely happy with the care they received. At our last inspection we rated the 'Caring' domain as Outstanding. At this visit the rating had been sustained. Staff were kind and spoke about people with warmth and affection. People mattered and people's lifetime achievements were celebrated.

The provider’s values for the home were ‘respect, dignity, companionship and hope’. These qualities were demonstrated throughout our visit. The staff team were committed to maintaining people's dignity and privacy. They continually supported people to maintain and regain their independence.

People’s individual lifestyle choices were embraced. People were encouraged to maintain or develop interests which meant they lived meaningful lives. People maintained positive links with their community that enhanced their lives. People were encouraged to maintain relationships important to them and there were no restrictions on visiting times.

People and their relatives worked in partnership with the staff to plan their care. Care records were personalised and contained detailed information about what was important to people.

People's religious and spiritual needs were recognised and embraced which meant people continued to practice their religions how they wished to do so. People from the LGBT community (Lesbian, gay, bisexual and transgender) were welcomed by an inclusive staff team.

People spoke very positively about the wide variety of social activities available to them. People had positive dining experiences at the home and staff were aware of people's dietary requirements.

The home worked in partnership with local health and social care professionals to ensure people received the care and support they needed.

People felt safe living at the home and procedures were in place to protect them from harm. Staff were knowledgeable about the risks associated with people’s care. Risk assessments and management plans contained clear guidance to support staff keep people safe.

The provider's recruitment procedures minimised the risks to people safety. New staff were provided with effective support when they first started work. Staff understood their responsibilities and had the skills and knowledge to care for people effectively in line with their wishes.

People spoke positively about the way their medicines were administered by the staff. Safe administration systems were in place and people received their medicines when they needed them.

The staff, managers and the provider demonstrated their continual commitment to providing excellent dementia care to people. Since 2011 the home had sustained its high level status with a nationally recognised specialist organisation in residential dementia care.

People received a high standard of care because the inspirational management team

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. The inspection was unannounced.

The service provides nursing and personal care for up to 60 ex-service men and women. The service was provided to older adults, people with a physical disability, younger people and people with dementia. The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

At our previous inspection in October 2013, we found there was a breach in meeting the legal requirements for records. We found that paper and electronic records of care did not always match each other, as theproviderhadrecently changed over to new electronic care records.

During this inspection we found hardcopies of the care plans and risk assessmentsmirrored the electronic records. All the staff we spoke with were confident and competent in using the electronic system and could access computer terminals to update the records immediately after delivering care.

The service had won The Pinder Healthcare Design Award for the design of the building. The home was organised into four wings, which enabled people to belong to a community within a community. Eachwing had its own lounge, dining space and kitchenette, so people could be self-sufficient within a familiar, homely space. Larger communal spaces on the ground floor enabled people to experience the feeling of going out safely, surrounded by familiar faces. We saw people used the large communal space to take part in group activities, such as, a form of push-table-tennis in teams, to have a cup of tea with their visitors, to read the newspaper or to watch the world go by.

Everyone we spoke with was very happy with the quality of the service and the care and support they received. People talked enthusiastically about the activities on offer and the thoughtfulness of staff. Visitors we spoke with told us they were very impressed with what they saw and heard. The local authority commissioners encouraged other local providers of social care to visit the service because it was an exemplar of good quality care.

Staff told us they were proud to work at the home and felt part of a team with shared goals. The registered manager was supported by a team of senior nurses, administrators, volunteers and an executive team who shared a common objective of creating a caring, family environment. Everyone we spoke with gave us confidence that the service achieved its objective.

We saw some people in the dementia unit dancing and singing with staff and other people being supported by staff to engage in gardening and cooking activities. All the staff who worked at the home were trained in dementia awareness so they knew how to support people with dementia. The service had recently achieved the highest possible score at a Dementia Care Matters (DCM) assessment. DCM is an organisation that specialises in training focussed on the lived experience of people with dementia. The care plans we looked at were person centred and all the staff we spoke with understood the importance of putting the person at the centre of care planning. We saw care plans were regularly reviewed and staff asked other health professionals for advice and support when people’s health needs changed.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their families were involved in discussions about who should make decisions in their relation’s best interests. No one was under a DoLS at the time of our inspection because no one was deprived of their liberty.

People who lived at the home and staff told us they had confidence in the registered manager, who was supported by a hands-on team ofthree supernumerarynurses. All the nurses and care staff we spoke with told us there were always senior experienced staff around to guide and support them. There were regular meetings for people who lived at the home which meant their views on the quality of the service were known and understood by the registered manager.

We carried out a routine inspection at the Royal Star and Garter on 17 October 2013. We visited all four wings: Roundel, Whiteley, Linley and Croucher. The inspection team included an expert by experience. We looked at whether people were treated with respect and involved in their care and treatment.

We looked how people were being cared for at each stage of their treatment and care and how this was recorded. We looked at how medication was managed by staff and talked with people who used the service, family members and staff.

We observed staff interacting with people with kindness. They demonstrated through one to one discussions with us that they knew the care needs of the people they were looking after. One person told us, “This place is a 5 star hotel under the disguise of a nursing home"

We reviewed the care of five people on each of the four wings observing how people were being cared for. We saw medication was stored and administered safely. There were enough staff on each wing to meet the needs of the people.

We examined both electronic and paper records and found some discrepancies. For example some care plans, risk assessment tools and repositioning records were not in place to support people’s needs.

We noted appropriate referrals were made to outside specialists on behalf of people who lived there and relatives told us they were very happy with the care and treatment being provided to their love one.

The Royal Star and Garter home provides nursing and therapeutic care to ex-service men and women and to the widows, partners and spouses of ex-service people in a spacious and homely environment.

We saw that people looked well cared for. They told us: “I walked through the door and I liked the feel of this place, this is where I ended up and where I want to be.” “Very, very happy with everything here absolutely.” “They are quick at getting you medical attention….” People told us that if they were not happy they felt comfortable to speak with staff.

We found staff to be friendly, approachable and patient towards people. Staff told us they attended training on a regular basis.

We saw a therapy room where speech and language therapy and physiotherapy was being provided to people. We saw that people were encouraged to maintain their independence and were able to enjoy a large range of social activities and events. One person told us: “Most mornings there is exercise to music, we can go to the bar to have a coffee.” We saw that the home had their own minibus to use on outings.

We saw that people with dementia were engaged in a range of activities including doll therapy, jigsaw puzzles and walking around the garden with a member of staff.

People told us that they enjoyed the meals and we saw a varied range of meals were being provided. Comments included: “The standard of meals is excellent. You have a menu, you have a choice of whatever meal you like.” “You get a choice and if you don’t like what is on the menu they are happy to provide sandwiches etc.”

We spoke to three people living in the home. We observed the care given to people on one wing of the home. We spoke to the relatives of three people living in the home.

People told us they were happy with the care they received. They thought the building was very good. They said the physiotherapist services available on site had improved their medical condition.

People had some individual attention from care workers. Care workers involved people in activities. We were told that there were activities arranged on a daily basis and that they could go on trips out. We saw a full programme of events for November 2011.

People's relatives were happy with the care that was given. One relative told us:

"They treat people (in Roundel wing) like proper people. The care workers are extremely kind. They have a great understanding of people's medical condition. They do not sit people around the edge of the room."

Everybody we spoke to said the food was very good. We saw care workers taking time to ensure that people who needed assistance ate well.