The Royal Star & Garter is a nursing home that provides personal care for older people some of whom have dementia, physical disability and sensory impairment.

The Royal Star & Garter provides accommodation for up to 63 people on three floors of the building. At the time of inspection there were 60 people living at the home. The units on the ground and second floors, Richmond and Sandgate support people who require nursing care. The middle unit, Lister cared for people living with dementia.

This inspection was carried out on 21 and 29 November 2017. The first day of the inspection was unannounced and we let the service know that we were coming on the second day.

At the last inspection, the service was rated Good, with Outstanding in effective. At this inspection we found the service remained Good, with Outstanding in caring.

At the time of the inspection the service had a registered manager. A registered manager is a person who has registered with the CQC 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.

Safeguarding concerns were not always reported to a local authority to ensure that any risks to people were monitored and actions taken to protect people as necessary. We have made a recommendation about this.

Risk management plans addressed the support people required to minimise risks to their wellbeing, however information was not available on the severity and likelihood on some of the risks to people. There were safe staff recruitment processes in place which ensured that staff were suitably employed at the service. Staffing numbers were monitored and increased where required. Staff worked on different floors to have an up to date knowledge about people’s care needs. Medicines were appropriately administered to people and stored according to the service’s requirements. We found the home clean and hygienic. Staff were knowledgeable in safeguarding people from harm and abuse.

People used electric wheelchairs to move around the home freely. Staff were knowledgeable and had training to support people with their individual care needs. Robust induction and ongoing support was provided for staff to ensure they carried out their duties as necessary. People told us their nutritional needs were met and they had access to food at any time they wanted it. The environment was adapted to meet needs of people living with dementia. The premises were designed to accommodate people’s socialising needs. Staff worked together with the physiotherapists to support people mobilising. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We found that the mental capacity assessments for bedrails were not recorded initially, but the service supported this practice and carried out the assessments immediately.

People, their relatives and volunteers told us about the exceptional care provided by the staff team at the service. People said they felt this was their home and they received support that was aimed at their individual care needs. Staff used different communication methods to ensure that people were engaging and expressing their views. Staff were caring and attended to people’s personal care with respect. People’s independence was promoted and assisted by the staff team as necessary. People had support to enhance their religious beliefs.

There were technical issues around the call bell systems at the service. People complained that the call bells were not answered promptly. We have made a recommendation about this.

People’s care records were detailed and available for staff to use as necessary. Staff responded to people’s changing needs promptly where required. People were involved in planning their care. People had a choice and the support they req

During our visit we spoke with the manager, people who use the service, relatives, the director of HR (Human Resources), the practice development nurse and other staff.

We saw that the building was designed to be accessible and was light, welcoming and clean.

A person we spoke with said "The service you get here is excellent" and "The food is excellent and there is normally a good choice but it has been reduced since we moved from Richmond".

We saw that the staff were supportive and treated people with dignity and respect. People were encouraged to take part in activities but they had a choice if they wanted to be involved or not. One person we spoke with said "The concerts are really good but you do get a choice to be involved". Another person said "You can even suggest activities that they will add to the programme".

Staff said "There is really good training and you get plenty of choice" and "You can always request to go on external training as long as it is applicable to your role".

One person said "When we came here my room was too small but they moved me to a larger room really quickly" and "This place is heaven".

The inspection took place on 6 and 7 October 2015 and was unannounced. The last inspection of this service was on 6 November 2013. At that inspection we found the service was meeting all the regulations we assessed.

The Royal Star and Garter is a care home providing personal and nursing care for older people some of whom may be living with dementia. It provides accommodation for up to 63 people on three separate units, one on each of the three floors of the building. There were 49 people living at the home at the time of the inspection. The units on the ground and second floors, Richmond and Sandgate were for people with nursing needs. The middle unit, Lister had 26 rooms and catered for people living with dementia.

The service has a registered manager in post. 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 were extremely positive about the care and support they received at The Royal Star and Garter. We saw staff were knowledgeable about people and understood how to meet their diverse needs. We observed a genuine warmth and affection between staff and people who used the service. Levels of staffing were sufficient to ensure that people received care in an unhurried manner and at a time that they needed it.

Staff had a comprehensive and thorough induction when they started working in the home. Training was on-going and refreshed regularly. There was a lot of in-house expertise for training and in addition, the provider regularly bought in training from external sources. Staff had a shared vision and ethos and were highly motivated to provide the best quality care they could.

The service employed a range of healthcare professionals which meant that some of people’s healthcare needs were assessed and met promptly, and their continuing needs could be monitored. People also had access to community healthcare professionals as and when they needed them. The community healthcare professionals told us the service worked well with them, with a number of professionals, stating ‘the home was the best they came across.’ People’s nutritional needs were assessed and monitored and people received a variety of meals according to their choices and needs. People received their medicines as they had been prescribed to them.

The Royal Star and Garter home was a purpose build care home which opened two years ago. The building had been specially planned to meet the needs of people with dementia and to ensure people could move freely and independently around the home. The home was decorated and furnished to a high standard. The welfare and wellbeing of people was enhanced by the well-planned environment.

People told us they felt safe living at the home. Staff were knowledge about what they needed to do if they suspected anyone was at risk of abuse. People and staff told us they felt they could raise issues with the manager and any concerns would be acted upon.

People were asked their consent before care was provided. If people were not able to give consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to empower and protect people who may not be able to make decisions for themselves and to help ensure their rights are protected.

Care that people received was individualised to meet their needs and provided in a way to take account of their likes and dislikes and their preferences. There was a wide range of social activities people could choose to participate in, within the home or in the community. People were supported by a number of activities co-ordinators and in addition a number of volunteers. Relatives were free to visit whenever they wished to make sure people could continue to maintain contact with their family.

The service had a number of measures in place to monitor the quality of the home. There was a drive towards continuous improvement.