Wren House is a residential care home providing accommodation for up to 14 older people. At the time of our visit there were 10 people living at the home and two staying temporarily on respite. Wren House is a listed Georgian building set on the outskirts of Warminster in Wiltshire. Bedrooms are ensuite and are arranged over two floors. There are landscaped gardens with several seating areas.

At our previous inspection in September 2015 the service was rated as Good, we found that people were receiving good care. At this inspection we have found that these standards have been maintained. This meant that people received good levels of care that responded to their individual needs and preferences. People, relatives and visiting healthcare professionals spoke positively about the staff team; they were described as considerate, caring, helpful and always available. We found that staff were skilled, caring and supported people to live in the way that they chose.

People told us they felt safe. We found the service continued to keep people safe, as staffing levels were appropriate to meet people’s needs. Staff knew and understood their responsibilities for safeguarding people against potential risk or harm, and were able to tell us how they would report any concerns. Staff received supervision and training to support them in their role.

Medicines continued to be stored, administered and recorded safely. People were encouraged to self-administer their medicines where appropriate.

People had access to food and drink and were consulted about their likes and dislikes. Menus were changed every four weeks to adapt to seasonal demand. People and their relatives were very complimentary about the food offered.

People were supported to maintain relationships that were important to them. There were no restrictions on visiting and access to the local community was encouraged and supported where possible.

Care and support plans were individualised and described the person’s needs in detail. 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 practice.

There were robust auditing systems in place for all aspects of the service provision. People, staff and relatives all spoke very highly of the management team and the support they gave to people and staff.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Wren House is a residential care home providing accommodation for up to fourteen older people. At the time of our visit there were ten people living at the home. Wren House is a listed Georgian building set on the outskirts of the town of Warminster in Wiltshire. Bedrooms are en-suite and are arranged over two floors. The gardens are landscaped with several seating areas.

The service had a registered manager who was responsible for the day to day operation of the home. 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 and associated Regulations about how the service is run. The registered manager was present on the day of the inspection.

People and their families praised the staff and registered manager at Wren House for their kindness and compassion. People had developed caring relationships with staff and were treated with dignity and respect.

People enjoyed the surroundings of the home. Staff took time to sit and chat with people. The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. People’s care needs were regularly reviewed to ensure they received appropriate and safe care, particularly if their care needs changed.

Staff worked closely with health and social care professionals for guidance and support around people’s care needs.

People’s rights were recognised, respected and promoted. Staff were knowledgeable about the rights of people to make their own choices, this was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

Staff had received training on how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Regular quality and safety audits were carried out. Staff were encouraged by the registered manager to be involved in improving the service and outcomes for people who live at Wren House.

An adult care social inspector completed the inspection on the 9 June 2014. As part of this inspection we spoke with five people who used the service, the registered manager and deputy manager, two visiting regional managers, two care staff and two relatives.

We also reviewed records relating to the management of the home, for example three care plans, two sets of daily recording documents and monitoring charts, maintenance and audit documents, quality assurance survey responses, policies and procedures and information displayed around the home such as the activity timetable.

At the time of the inspection there were nine people who used the service. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

All of the comments were received about the service were positive, both from people who used the service, relatives and staff. People told us they felt safe in the home.

There were systems in place to ensure that incidents and accidents were recorded and these were followed up as appropriate. There were reporting systems in place to make an alert to the local authority regarding abuse. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. Relevant staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. We saw from the care records kept in their home that people were involved in making decisions about their care and that these were respected by staff. People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were clearly identified and the support they received was meaningful and person centred. People received good care and there were positive outcomes for people.

Is the service caring?

We observed that all staff treated people respectfully and were attentive and caring. All of the comments we received were of a positive nature and confirmed that people and relatives were happy with the support received. Care staff told us they had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service. The service had quality assurance systems in place so that the quality of service could be maintained and shortfalls could be identified. The home had a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person living at the home said “they ask my opinion and give choices”. A staff member said “I try and encourage, I don’t say ‘just get on with it’. I try and empathise”.

One person living at the home said “the home is very good, I always think how lucky I am, staff are very good”.

There were effective systems in place to reduce the risk and spread of infection. One person living at the home said “it is spotlessly clean”.

There were enough qualified, skilled and experienced staff to meet people’s needs. One person living at the home said “there are enough staff, they come if you call”.

Some people’s personal records were not fit for purpose. In some cases they did not contain sufficient information about people’s preferences about how care and treatment should be delivered.

We spoke with five people who lived at the home and two visitors who went to the home for their meals. One person told us the staff always addressed them in a formal way which they preferred. Another person said “I’ve never met better staff.” A third person said “the staff are wonderful and I can’t praise them enough.” One visitor said “staff are most helpful and understanding, I look forward to coming to the home for my meals. Staff are excellent; they are always here if I need them.”

The quality assurance system used ensured the views of people, their relatives and social and healthcare professionals were sought about the home. Where comments were made the manager contacted the person directly to ensure they were satisfied with the action taken. The analysis of the responses received showed people views influenced the way the home was run.

People told us they were extremely happy with the service they received. They said they had excellent support from staff and all their care needs were efficiently met. People told us they could make decisions about their daily routines. They said their rights to privacy, dignity and independence were fully promoted. People said staff treated them with respect and sensitivity. They said staff responded to their call bell without delay. People had access to a range of services to meet their health care needs. They said staff were very good at recognising when they were not well and would always call the doctor when required.

People told us they would have no hesitation in raising any concerns with staff if required. Staff were very aware of their responsibilities to recognise and report any form of abuse. They had undertaken training in safeguarding vulnerable people. More training in safeguarding and the Mental Capacity Act was planned. A review of the storage of people’s medicines was also being considered. Locked cabinets in people’s bedrooms were being considered as a possible option to improve safety.