The inspection took place on 28 and 29 September 2016 and was unannounced.

Wren Hall is a large care home for older people, most of whom are living with dementia. Wren Hall provides accommodation for 53 people. At the time of the inspection there were 53 people using the service. The service is set in a rural area with a large garden with access onto a terraced area and is split into four separate areas with separate living areas and kitchens. Wren Hall also has a day service which people within the service and community can access.

On the day of our inspection there was a registered manager in place. 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.

Staff developed exceptionally kind, positive and compassionate relationships with people. They demonstrated person centred values, which placed an emphasis on respect for the individual being supported. People's care was individualised, staff put them first and knew them really well.

Staff continually developed their skills, and followed best practice guidance in providing people's care and treatment. People were encouraged to make their own choices and remain independent. All people and relatives told us staff showed the upmost respect and dignity towards people.

People and those important to them were encouraged and involved in making sure people received the care and support they wanted. People and their relatives and friends views were sought through care reviews, surveys and meetings. Care was personalised, staff knew about people's lives, their families and what they enjoyed doing. The service recognised the individuality of each person regardless of the support they needed.

Activities were individualised, meaningful and well thought out with the focus being on people's past history, interests or hobbies. People's care plans were very detailed and written in a person-centred way. People and their relatives were given clear information about how to make a complaint.

Without exception people, visitors, staff and professionals were overwhelmingly positive about the leadership of the service. They felt that the reason for the consistent high quality of service came from the proactive and positive leadership which filtered down to all of the staff.

People received a consistently high standard of care because the registered manager led by example and set high expectations for staff. Staff were highly motivated and enthusiastic, and were committed to ensuring each person had a good quality of life.

The provider and registered manager had ensured staff were provided with a working environment that demanded excellence, but also encouraged them to develop their roles, equipping them with the skills needed to provide all people with high quality, person-centred care. The service worked in partnership with other organisations to make sure they are following current practice and providing a high quality service.

We found there was a strong emphasis on continually striving to improve, recognise, promote and implement innovative systems in order to provide a high quality service. The service had sustained outstanding practice and improvements over time.

Regular audits of care records, medicines management and health and safety checks were carried out, with positive action taken on areas that needed improvement. The registered manager met their legal obligations to submit statutory notifications when certain events occurred, such as when injury to a person occurred.

People were safe living at the service because staff knew how to recognise and report any incidents of harm. Staff were confident that the registered manager would deal with any concerns that they reported. The needs of all pe

During the inspection we spoke with three people who used the service and asked them about their experiences of living at the care home. We spoke with two relatives.

We also spoke with six staff, including the registered manager. We observed the care that was given to people. We looked at some of the records held in the service including the care records for three people.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. Relatives we spoke with also told us they felt their family members were safe.

We used our SOFI (Short Observational Framework for Inspection) tool during the inspection. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We conducted a SOFI observation for 55 minutes in one of the lounges at lunchtime. We saw staff provided appropriate and safe support.

We looked at the care records for three people who used the service. We saw that care plans contained detailed information and were centred around people's individual needs.

People who used the service and relatives told us they had no concerns about the building. One relative said, “They’re always making improvements.” They also said they had no concerns about equipment.

People who used the service, relatives and staff all told us they felt there were enough staff. We found there were enough staff to meet people’s needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the service understood when it was appropriate to contact the local DoLS team to seek their involvement.

Is the service effective?

People who used the service told us they received the care they needed in a timely manner and they were happy with the care. One person said that the care was, “Very, very good.” Relatives were very positive about the care and told us their family members received the support they needed.

Is the service caring?

People who used the service told us staff were caring. One person said staff were, “Very caring.” Relatives also told us staff were caring. One relative said, “[Staff are] very caring” and, “They’re so nice.”

We saw that staff communicated warmly with people as they supported them and staff were caring and kind.

Is the service responsive?

Staff told us how other agencies were involved. This meant the care home involved other professionals in people’s care and treatment.

We saw care plans about different needs and saw these were reviewed regularly. A care plan is a document that should identify a person's needs and how staff can meet those needs.

Is the service well-led?

People who used the service told us they felt the care home was well-led. One person said it was “definitely” well-led.

Staff also told us they felt the service was well-led.

We found that effective systems were in place to regularly assess and to manage risks relating to the health, welfare and safety of people who used the service.

At the time of our inspection there were fifty one people living at the home. The manager explained that the home had four lounges. Each of these lounges was designed to meet the specific needs of people with varying degrees of dementia.

We found that people had received care that was specific and appropriate to their individual needs and that care had been evaluated and reviewed regularly.

We saw that staff treated people with dignity and respect and that people who lived at the home appeared comfortable in their surroundings.

We spoke with members of staff. One staff member told us “It’s brilliant here. I have had induction training and other training to help me understand the needs of people. There are enough staff on duty.”

The relative of a person who was living at the home told us “The care is amazing here I am involved with all decisions about care and there is always plenty of staff on duty.”

Residents told us that that staff showed them respect and ensured that their right to privacy and dignity was maintained. One relative said that staff were, “absolutely wonderful.” The people we spoke with felt that all their needs were met at Wren Hall and the quality of care they received was of a good standard. They were asked by staff about all their personal preferences they were offered a range of stimulating activities. They felt safe living at Wren Hall and considered that staff were very competent at their job.

The people we spoke with were generally very positive about the quality of the service they received. One relative told us, “It’s a nice, happy, friendly, family place.” People told us they could have their say about the service and one relative said they felt they were listened to, “about anything, little or big.”

Due to the complex needs of some people living at Wren Hall Nursing Home they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of one hour over the lunch time period.

We saw staff respected people’s privacy and dignity at all times. We found people who use the service were given information and support regarding their care to enable them to make an informed choice.

We looked at a number of care files. The plans of care were personalised and reflected people’s choices and preferences. Relevant risk assessments were in place and family members had been involved with the care planning.

We spoke with six relatives they were complimentary towards the staff. One relative said, “My husband has been at his best since he has been here.” Another relative said, “The staff are lovely.”

Staff had a good understanding regarding safeguarding concerns and who they should report to and staff told us they felt supported by the management team at all times.

Records were accurate and fit for purpose.