Three Corners is a 'care home'. People in care homes receive accommodation and nursing and personal care as a single package under a contractual agreement with the local authority, health authority or the individual, if privately funded. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Three Corners accommodates a maximum of 46 older people, including people who live with dementia or a dementia related condition, in one adapted building in its own grounds. At the time of our inspection, 37 people were living at the home.

At the last inspection on 28 and 29 October 2015, the service was rated 'Good' overall with a requires improvement in the key question, responsive. At this inspection, we found the service remained 'Good' overall and ‘Good’ in all key questions.

A registered manager was in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were observed to be treated with kindness and compassion by all the staff who valued them. The staff, had worked for the company for some time and built strong relationships with people who lived there. Staff respected people's privacy and treated people with dignity and respect. People, or their representatives, were involved in decisions about the care and support people received.

Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who lived at the home from the risk of abuse.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. Our observations and discussions with staff and people confirmed sufficient staff were on duty.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. All staff had completed a range of training and new staff completed an induction. Staff were supported with regular supervision and appraisal.

Risk assessments had been put in place and were individual to the person. This was to minimise potential risk of harm to people during the delivery of their care and support. Care records were person centred and held details on how people liked their needs to be met; taking into account people's preferences and wishes. Information recorded included people's previous medical and social history and people's cultural, religious and spiritual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and consent to care was sought as much as possible. We reviewed information in relation to capacity assessments and processes which needed to be in place to make decisions in a person's best interest. We made a recommendation for improvement in ensuring that people have maximum choice and control of their lives and staff understand how to assess their capacity to do this.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. This helped ensure people's healthcare needs were met.

The home continued to be well led. People lived in a home where the provider's values and vision were embedded into the service, staff and culture. People, relatives and staff told us the provider and registered manager were very approachable and made themselves available.

People lived in a comfortable clean home which had been designed and adapted to meet their needs. The home was monitored by the provider to help ensure its ongoing quality and safety. The provider's governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

There were 44 people who used the service on the day of our visit. We spoke with six people who used the service, four family members and saw four support plans. We also spoke with four visiting healthcare professionals and six members of staff.

People we spoke with said “they do a good job” and that staff were “very friendly”. Visiting professional staff said “I’m very impressed with clinical handovers, any concerns are actioned immediately and they always do what we ask. There is a good verbal handover and we may have telephone conversations if there are any concerns”.

Some of the people who used the service were able to express their views when we spoke with them. They told us their privacy and dignity was respected by all staff. We observed this in practice during the inspection, through the way staff knocked on doors before entering rooms, spoke with people addressing them by their preferred names and assisted them with their care needs. People said “if you don’t want something done they won’t do it” and “we do what we want”.

We spoke with the activities leader who explained the wide variety of activities available, including access to computers, animal activities, art and craft. People we spoke with said “there’s all sorts going on; always something”.

People told us they were happy at the Three Corners home. One person said "The staff are brilliant, they cheer you up, some more than others." We were told that people had choice over day to day aspects of their lives and we saw evidence that people made decisions regarding their future and that this was respected.

We heard that the home was helpful and welcoming to families. One relative told us that they had been given a welcome pack and that the matron had been particularly accommodating. Another relative told us that they could visit whenever they wanted. We saw that there were facilities for visitors to make tea and coffee.

We observed the handling of medication and saw that it was done by professionally qualified staff and in a safe way, that respected people's choice and medical needs.

We closely reviewed five staff files. We found that staff were checked before they commenced work at the home. We saw that all staff received on going training. We were told by staff about the supervision and support that the senior care team provided. We heard that several staff had worked for the home for many years. We saw that there was always at least one qualified nurse on duty. We were told by the staff that they had enough workers to meet people's needs. This was confirmed by the people who lived there who told us that staff had enough time to sit and chat with them.

We saw that the owner and manager had in place systems to monitor quality of service.

Three Corners is registered to provide accommodation and personal and nursing care for up to 46 older people. Three Corners also provide short term support to people via the Intermediate Care scheme. This scheme enables people who have left hospital to receive support from the home and healthcare professionals before going home. People living at Three Corners had needs relating to living with dementia, mobility and general health.

A registered manager was employed by the service. 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.

The service was last inspected on 8 and 9 December 2014 when it was rated as ‘requires improvement’. Improvements were needed in relation to risk assessments for the environment, decisions being made on behalf of people who lacked capacity, the care planning system, staff did not always display a caring attitude and staffing levels not being reviewed. The registered manager sent us an action plan stating all matters would be completed by 31 July 2015. This inspection took place on 28 and 29 October 2015 when we found improvements had been made. There were 44 people living at Three Corners during the time of the inspection.

People’s care records were comprehensive but they did not always contain the most up to date information. We have made a recommendation in relation to this.

There were quality assurance systems in place to monitor care and plan on-going improvements. However, these systems had not identified that some records were not being completed consistently.

People told us they felt the registered manager was very open and approachable. All staff said they felt well supported to do a good job. They told us “….the management, if you have any problems you can go to them and they sit there and listen”. People told us they were confident any concerns would be dealt with straight away.

The registered manager and registered provider were keen to provide a good service. They planned to install ‘wet rooms’ to enable people shower more easily. Specialist advice had been sought to ensure the environment was suitable for people living with dementia. Changes had been made to the nurses’ station and an area had been provided where visitors could help themselves to drinks.

People had a choice at mealtimes and hot and cold drinks were available at all times. We saw people provided with an alternative when they did not want what was on the menu.

Staffing levels were sufficient to ensure people’s needs were met safely at all times. Call bells were answered promptly and people told us they didn’t have to wait for the help they needed.

Staff were responsive to people’s needs and ensured people’s needs were met in a kind and caring manner. Positive relationships had been developed between staff and people living at Three Corners. People made many positive comments about staff including “The staff are excellent and friendly – I suppose it is the extra touch, and they’re willing to get you anything extra you ask for, and they don’t forget. They go beyond the call of duty; they’ll do anything for you”. People looked clean and well cared for. Staff respected people’s privacy and dignity and all personal care was provided in private.

People were supported to receive the healthcare they needed. Records showed they received regular visits from healthcare professionals such as GPs and physiotherapists. One GP told us “My overall impression is very positive. The staff and systems are very responsive”. People's medicines were managed safely and people received their medicines as prescribed in order to maintain good health.

People and their relatives were supported to be involved in making decisions about their care if they wished to be. People’s care plans were comprehensive and updated regularly. Visitors were welcomed at any time. People were confident that if they raised concerns they would be dealt with quickly.

People were protected from the risks of abuse as staff were aware of how to report concerns and had received training in how to keep people safe. Any staff employed were subject to robust recruitment procedures. This minimised the risks of unsuitable staff being employed by the home. People who were able to, told us they felt safe at the home, one person said the staff member who had assisted them that morning had been “excellent” and had made them feel safe. One visitor told us they felt their relative was “absolutely” safe.

People were asked for their consent before staff provided personal care. Staff told us they would always respect people’s wishes if they declined personal care. Staff who displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). This ensured people’s human rights were upheld at all times.

We recommend the service explores the NHS guidance ‘Benchmark for record keeping’.