The Koppers Residential Home

The Koppers is registered to provide accommodation with nursing or personal care, for up to 25 people with dementia. There were 19 people using the service at the time of our inspection. The home is a detached property situated in the centre of the village of Kilmington.

People’s experience of using this service and what we found

People felt safe living at the service. Staff had received safeguarding training and demonstrated an understanding and awareness of the different types of abuse.

Recruitment procedures ensured that people were supported by staff with the appropriate experience and character. The provider always ensured they had skilled, experienced staff on duty to support people’s needs. Staff had received in-depth training when they started working at the home and received refresher training and competency assessments. Staff were supported in their roles by receiving regular supervisions and an annual appraisal.

People were supported by kind, considerate and caring staff. They were treated with dignity, their privacy was respected, and their independence promoted.

People’s changing needs were monitored and were responded to promptly and the involvement of health professionals sought, and their advice followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Families and professional were involved in best interest decisions and staff knew the legal powers family and relatives might have to support people in making decisions.

People’s medicines were safely managed, and their nutritional needs were identified and monitored. People enjoyed the meals provided.

Environmental risks had been assessed and the provider had a clear oversight of the potential risks at the home. Fire safety was well managed. The provider had an ongoing program of refurbishment at the home.

Staff wore Personal Protective Equipment (PPE) in line with current guidance and promoted good Infection Prevention and Control (IPC) practice. Staff helped people keep in touch with their friends and relatives throughout the pandemic, which helped alleviate their worries. Visiting had resumed with the appropriate testing and safeguards in place to prevent cross infection.

Systems and processes to monitor the service had improved and drove improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (report published September 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in June 2019. Four breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care, governance, fit and proper persons employed and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective, Caring and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Kopper’s on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff had received infection control training. Staff were seen using PPE correctly and in accordance with current guidance to minimise risks to people.

The provider had a sufficient supply of PPE to meet their current need and unforeseen outbreaks. The home was clean with no unpleasant odours. There was a Covid-19 cleaning schedule in place. This ensured regularly used areas and touch points were cleaned at least three times a day using chemicals which are effective against Covid 19.

Staff and people were regularly tested in line with the government’s current testing program. In order to minimise risk, when people returned from hospital they were tested and isolated with a designated staff team to minimise the risk of cross infection. We discussed looking at ways to limit the risk of cross infection at the home by supporting people to be able to social distance. The registered manager said they would look at how this could be better managed.

Further information is in the detailed findings below.

The Koppers is registered to provide accommodation with nursing or personal care, for up to 25 people with dementia. There were 18 people being supported at the service and a person’s spouse had moved in during the pandemic lockdown. The home is a detached property situated in the centre of the village of Kilmington.

People’s experience of using this service and what we found

People said they were happy with the care they received. They said staff were approachable, kind, respectful. They confirmed they had the personal care they required and did not feel rushed. Comments included, “Nothing is too much trouble”, “Being looked after well, food is great”, and “I am well cared for here.” There was a pleasant atmosphere at the home, staff were not seen to be rushing and were observed interacting positively with people and taking their time to chat with them.

Medicines were, on the whole, safely managed. People received their medicines as prescribed from staff trained and assessed as competent in the administration of medicines. There were suitable arrangements for ordering, receiving and disposal of medicines. We found improvements were needed in relation to administration of prescribed creams, nutritional supplements and the use of thickening agents. We have made a recommendation that the service follows the NICE National Institute for Health and Care Excellence Guideline, Managing Medicines in Care Homes Published 14 March 2014.

There were enough staff to meet people’s needs and new staff had received an induction and were undertaking the care certificate. Staff had all received a basic fire training but were not always clear about the actions they needed to undertake in the event of a fire. Full fire training was scheduled to take place once the new fire panel had been installed. In the meantime, the provider had recognised this as an interim training gap and had fire procedure worksheets they were going to complete with staff.

Staff responded promptly to people’s call bells and systems were in place to ensure all call bells were working at the home. Where people stayed in their rooms staff undertook regular checks to ensure their safety.

The registered manager had experienced challenges as a new manager at the home. Some staff had been reluctant to embrace the changes they had implemented. This had caused some negativity and unrest and had impacted on staff morale. The registered manager and nominated individual had been working to improve the staff morale and negative culture. They said it had been a difficult time trying to change the culture at the home but felt things were improving. This was confirmed by staff. One staff member commented, “(Registered manager) 100% believe in her and all she is doing for the home…new management does cause unrest because they change things.” Another said, “Now the politics have gone I am getting on better.”

The registered manager had a clear oversight of what was happening at the home and knew people’s needs well. People and staff said the registered manager and nominated individual were approachable and listened to their concerns. One relative commented, “I can only tell you that both (registered manager) and (nominated individual) have been fabulous. They are always available to talk… (registered manager) is so passionate about her role; I'm not going to say 'job' as it is clearly more than just a job to her. If I've called to check on (person), (registered manager) doesn't need to go off and ask someone how he is, she knows herself.”

Staff received regular supervisions and had the opportunity to raise concerns.

Good infection control processes were in use at the home. The home was clean and there were no unpleasant odours. PPE and hand sanitiser were available around the building and readily accessible for use. Most staff were wearing the appropriate PPE; however, some staff kept removing their masks and wore them around their necks and two staff had cloth masks, rather than fluid repellent masks. The registered manager and nominated individual said this would be addressed and confirmed after the inspection action had been taken.

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about staffing levels and induction of new staff, medicine management, safe care and treatment, management style and culture, A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Koppers is registered to provide accommodation with nursing or personal care, for up to 25 people with dementia. There were 23 people using the service on the first day of our inspection. The home is a detached property situated in the centre of the village of Kilmington.

People’s experience of using this service and what we found

Systems and processes to monitor the service were not effective, did not drive improvement. As a result, the quality of care provided to people had deteriorated since the last inspection.

The provider had not always ensured they had skilled experienced staff on duty at all times to support people’s needs. Action was taken during the inspection to review all staff duty allocations to ensure a good skill mix.

The provider had not ensured staff were suitably trained and sufficiently supervised. As a result, new staff did not have the skills to support people effectively. People had received poor care and could have been exposed to the risk of harm.

Recruitment procedures did not ensure that people were supported by staff with the appropriate experience and character.

People who were able said staff were caring and kind. We observed that people were not always treated with dignity, their privacy respected, and their independence promoted. We saw a mixed picture of staff interactions during the inspection with regard to staff being kind, considerate and patient when assisting people, some positive and some negative. We established this was because some new staff had not had the training and supervision to ensure they had the skills to support people appropriately.

Care records were very detailed and reflected the needs and preference of people using the service. However, staff at times worked in a routine orientated manner and did not give people personalised care and choice in line with their care plans. Action was taken during the inspection to address these concerns and after the inspection the provider sent an action plan telling us how they were continuing to address these concerns.

People’s changing needs were monitored and were responded to promptly and the involvement of health professionals sought, and their advice followed. People receiving end of life care were treated respectfully and with compassion by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, improvements were needed in relation to recording family and professional involvement in best interest decisions as this was not always clear and recording of the legal powers family and relatives might have to support people.

People’s medicines were safely managed, and their nutritional needs were identified and monitored. People enjoyed the meals provided.

Activities were offered which people appeared to enjoy. However, it was not clear how activities were set to take into account individual interests and preferences or consider individual’s abilities.

Some aspects of the premises were tired. The provider had a new maintenance person and had started a redecoration program. Environmental risks had not been recently assessed, so the provider did not have a clear oversight of the potential risks at the home although a health and safety audit had been carried out. Overall there were good infection control standards found throughout the home.

We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to good governance, staffing and ensuring fit and proper persons were employed. Details of action we have asked the provider to take can be found at the end of this report.

More information is in the full report

Rating at last inspection and update:

The last rating for this service was good (published 31 August 2018). At this inspection the ratings for the service have changed to requires improvement.

Why we inspected

The inspection was prompted in part by notification of a specific incident. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about accessing prompt medical attention. This inspection examined those risks but did not identify any risks regarding people accessing prompt medical attention.

We have found evidence that the provider needs to make improvements. Please see all of the sections of this full report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Koppers is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We had previously carried out a comprehensive inspection in October 2016 and rated the service as Good in all domains. We returned in June 2017 and carried out an unannounced focused inspection because of concerns we had received about the safe running of the service. We looked at the key questions; ‘Is the service safe?’ is the service effective?’ and ‘Is the service well led?’ This was to ensure people were safe, staff were supported and had the skills to support people and systems were effective to ensure the safe running of the service.

At this focused inspection we found the provider in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Registration Regulations 2009. This was because they did not have systems or processes established and operating effectively to assess, monitor and improve the quality and safety of the services provided. The provider has legal obligations to submit statutory notifications when certain events, such as a death or injury to a person occurred. These had not always been submitted. This meant CQC changed the rating for the service to Requires Improvement for the safe and well led question and overall from Good to Requires Improvement. Following the inspection we were sent an action plan which set out the actions the provider was going to take. At this inspection we found the provider had made the improvements and were no longer in breach of these regulations.

The service had a new registered manager who was registered with CQC in October 2017. 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 2008 and associated Regulations about how the service is run. People, relatives and staff said the new registered manager had made a lot of improvements at the home.

The directors were very active at the service and visited at least twice a week. They met with people and staff and completed a director’s audit. The provider and registered manager had implemented a number of quality monitoring systems to review and monitor the service. These included regular audits where any areas of concern were addressed. The registered manager had reviewed all of the provider’s policies and procedures to ensure they were up to date and reflected current guidelines. They were instrumental in the implementation of the new computerised system which they used amongst other things to undertake audits, supervisions and reviews. They had worked with staff to improve the team work at the home and a lot of new staff had been recruited. The registered manager recognised there was still more to do. They said, “There are still areas where we need to progress it is work in progress.”

The provider submitted statutory notifications as required and provided additional information promptly when requested. The provider had displayed the previous CQC inspection rating at the service and on the provider’s website, in accordance with the regulations.

The registered manager was supported by a deputy manager. They were very passionate about people at the service receiving good care. People and relatives said they had confidence in the registered manager and deputy manager and would be happy to speak to them if they had any concerns about the service provided. A health care professional commented, “I feel the combination of leadership by the manager and deputy manager is very good. They lead by example and have an excellent awareness of their clients and families; they make the place feel more like a home than a care setting.”

People were protected from unsafe and unsuitable premises. Risks for people were reduced by an effective system to assess and monitor the health and safety risks at the home. People’s needs were assessed before admission to the home by the registered manager and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their health needs were identified and met.

There were sufficient and suitable staff to keep people safe and meet their needs. Recruitment checks were carried out. New staff received an induction that gave them the skills and confidence to carry out their role and responsibilities effectively. The registered manager had been working with staff to complete the provider’s mandatory training. The staff had a good knowledge of how to safeguard people from abuse.

Care plans reflected people’s needs, they were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support. Concerns were raised by some healthcare professionals that their advice was not always followed. We discussed with the registered manager and they said they would implement a better means of communication and monitor it was effective.

There was a complaints procedure in place and people knew how to make a complaint if necessary. There had been no complaints since our last inspection.

People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place. The registered manager and staff were committed to ensuring people experienced end of life care in an individualised and dignified way.

Staff were polite and respectful when supporting people who used the service. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted. Residents meetings were held where the registered manager sought people’s feedback. The registered manager had sent out surveys to ask people and relatives their views. The results of these had not yet been collated People and staff spoke highly about the registered manager and deputy manager.

Staff felt supported and received regular supervisions with their line managers. The registered manager had scheduled staff annual appraisals to start in September 2018. Staff meetings took place and staff felt able to discuss any issues with the registered manager and deputy manager.

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. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Best interest decisions had been made and involved relevant people but these had not always been recorded.

People were very positive about the food provided at the home. People had access to activities at the service and were encouraged to take part.

The Koppers is a care home for older people who do not require nursing. There are 19 bedrooms, 14 of which are single and five rooms can be shared. There was capacity for 24 residents. At the time of the inspection, there were 21 people living at the service.

There was a registered manager in post although they made us aware at the inspection that they had handed their notice in to the provider the previous day and would be submitting their application to deregister with the Care Quality Commission (CQC). 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.

At this inspection, we found some of the concerns which had been raised with us were unfounded, in relation to medicines errors, staffing levels but other concerns remained. For example, whilst risks to individuals had been well assessed, this was not reflected in the care plans to guide staff on how to manage concerns. Environmental checks had been delegated to another member of staff because the maintenance person had been on sick leave for several weeks. There had been no additional time allowed for this and there were several gaps in the records. Some safety repairs had not been undertaken. For example, fire strips to reduce airflow in the case of a fire had been reported missing on three bedroom doors but they had not been replaced. We were made aware after the inspection that these have been replaced.

CQC had received concerns in relation to an alleged abuse taking place at the service which had not been reported to the local authority safeguarding team as required. CQC had also not been notified. The registered manager confirmed they were aware of their responsibility to notify CQC but owing to the high level needs of another person at the home they had forgotten to make the appropriate referrals. However, they had investigated the concern and had taken action.

Concerns had also been raised with CQC about the culture at the service and the openness of the registered manager. The registered manager made us aware at the start of our visit that she had resigned from her position and was in discussion with the directors regarding a potential new role within the service. The registered manager said they had recognised that, owing to personal circumstances, they found the role too demanding to fulfil as they felt they should like to do. Since the inspection site visit the local authority safeguarding team have been working with the provider and registered manager in relation to another safeguarding concern which has been raised with them.

Staff had not always received formal regular supervisions and support with their performance and future development. There was a clear system for induction, mandatory training and supervision at the service. However, some deadlines for initial training had not been met and formal supervisions had not taken place. The registered manager was aware of these shortfalls but said she worked alongside staff so they could speak with her at any time. New staff undertook an induction when they started working at the service.

Concerns had been raised with CQC regarding medicine management at the home. We found people received their medicines on time and in a safe way. The pharmacy which supports the service had recently undertaken a review and raised no significant concerns.

The registered manager and staff were very welcoming, open and honest in answering our questions. Before the inspection concerns had been raised with CQC that not all staff were being treated equally in relation to the expectation of the amount of work they undertook, but no action had been taken to address this when it had been reported internally. This was confirmed by a staff member at the inspection although the registered manager did not agree this was the case. Following the inspection we spoke to the directors who said they were aware of this issue. They informed us that they were in the process of recruiting a new registered manager and they would be looking for a new role for the existing registered manager within the service.

Visitors to the service said they felt confident that the level of care being provided was good. During our visit, we saw there was good communication with healthcare professionals who were happy with the quality of care provided.

Staffing levels appeared sufficient to meet people’s needs. There had been a significant staff turnover in recent months with several new staff starting. This meant existing staff and the registered manager had needed to undertake additional duties and support new staff in order to keep people safe. The registered manager had needed to prioritise their work in order to undertake shifts which had meant they had not completed all of the audits and checks required by the provider to monitor the safe running of the service. We had found a comprehensive quality assurance system had been in place at the time of the previous inspection. However, this had not been properly maintained, as gaps were found in several systems. The provider had not recognised that quality assurance checks were not always being completed.

While speaking with staff we spoke to a new member of staff who had a poor understanding of English. We were told by the registered manager that this would be closely monitored and managed.

Accident forms were being completed by staff at the time of incidents and action was being taken by staff to keep people safe. However these were not being reviewed by the registered manager to identify concerns in a timely way. Accident forms had not been reviewed for the three months before this inspection.

People had their nutritional needs met overall. However, there were concerns about one person who had lost weight not being referred to healthcare professionals in line with the guidance on the nutrition tool used by the service. Staff had identified the person had lost weight and had taken action themselves to support the person to increase their nutritional needs. There was no care plan of action in place to direct staff consistently about how to support the person.

The registered manager had a clear understanding of their responsibilities under the Mental Capacity Act 2005. Several applications for authorisation under the Deprivation of Liberty Safeguards (DoLS) process had been made. Any best interest decisions had been discussed with family members.

We found two breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009 (part 4).The action we have asked the provider to take can be found at the back of this report.

We last inspected the service in July 2014. At that inspection, we found the provider was meeting all of the regulations we inspected. There were no breaches of legal requirements at this previous inspection.

The Koppers is a residential care home for older people. It is registered to provide accommodation for up to 24 people who require help with personal care. There are 14 single rooms and five shared rooms. The service specialises in the care of older people but does not provide nursing care. At the time of the inspection there were 22 people living at the home.

There was a registered manager who was responsible for the service. She was registered on 19 May 2015. 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.

In December 2015 four new directors took over the service with a clear vision for how to improve the service. They have embarked on a programme of renovation of the building and a comprehensive review of existing systems, including quality assurance and training. The registered manager has the autonomy to plan, organise and manage training. A new staffing structure was put in place which created progression from care assistant to senior carer to deputy manager. There were now two deputy managers in addition to the registered manager. New shift patterns have been created in order to incorporate more flexible timings to start and end of shift. This enabled wider recruitment to take place. There was a positive culture of teamwork in the home, with directors and the registered manager being very "hands on".

People visiting the service commented on the significant improvements to training, staff morale, and fabric of the building. One person commented, "I would say this place is massively better since the new owners arrived."

Staff understood their responsibility for safeguarding and people living at the service said they felt safe. A programme of induction, training, supervision and appraisal was in place. Staff were able to describe what they had learned and how this had improved their practice. However, better staff awareness and understanding of the requirements of the Mental Capacity Act 2005 was needed.

The registered manager planned to seek additional specialist guidance and training in this area. By the time this report was written she had already implemented additional training for new staff.

People living at the service were cared for by cheerful staff who were sensitive to individual needs. An effective care planning system ensured that each person had the support they required. Staff were seen to work well together as a team, offering mutual support. The Koppers received universally positive comments from family members. "I visited other homes before placing (name) in Koppers. None came close in terms of compassionate care as far as I could tell."

Two visitors commented on how much their relative’s health had improved since moving to the service. Healthcare needs were closely monitored as part of their care.

Five bedrooms were shared and had the potential to compromise people's privacy and dignity and adverse comments were made about this by relatives. However, people had given their consent to sharing and screens were used to maintain privacy of individuals. Staff were aware of how to maintain people’s privacy and dignity when providing support for them in shared rooms.

Whilst there was a range of generic activities organised to suit people in groups, some people were seen to spend most of their time alone. There was a programme of individual activities to stimulate and engage those with more advanced dementia to help avoid social isolation.

There was a sense of strong forward-looking leadership at all levels, with managers recognising the need for improvement, encouraging openness to change, questioning practice and listening to staff, residents and families. The culture is one of continuing to seek improvement. Quality assurance systems were robust and regularly reviewed.

The inspection was carried out by an adult social care inspector. The focus of the inspection was to answer five key questions: is the service safe, effective, caring responsive and well led?

As part of the inspection we spoke with eight people who lived at the home, four relatives, six care staff, one domestic staff, the deputy manager and registered manager who was also the provider. We also reviewed records relating to the management of the home which included, five care plans, daily care and clinical records and six staff files.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found that people were cared for in a safe, clean and hygienic environment. A relative told us that they, "had never encountered an unpleasant odour in the home". There were sufficient staff on duty to meet the needs of people living at the home, with both the deputy manager and registered manager available every day.

We found that the care support and treatment was individually tailored to people's care needs and took account of people's choice and preferences. People were treated with dignity and respect by the staff which meant that people felt at ease and safe in their home. There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe. We saw from records examined that risk assessments had been undertaken which ensured people's safety and which were regularly reviewed. People were given choice and remained in control of decisions about their care and lives.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted and there were policies and procedures in place should this have been needed.

People at the home benefitted from the close communication and cooperation between staff, relatives and professionals who worked together collaboratively to protect individuals from suspicion or allegation of abuse.

Is the service effective?

From observation and from speaking with people and visitors, we were aware that people were happy in their environment. People were smiling and relaxed. People engaged with each other and staff in appreciative ways. People were well supported and staff knew the people they cared for well. Staff told us they worked as a team and we observed how staff communicated with each other to make sure no one was kept waiting and everyone received the appropriate care and support.

From speaking with staff it was clear they understood each person's individual care and support needs. We observed gentle encouragement and positive interactions between staff and people. A relative told us they were, "very impressed" with the care provided and said, "everyone is so calm and happy. The staff keep an eye on everything and they don't miss a thing".

Is the service caring?

People were supported by kind and attentive staff. We noted how staff encouraged people to do as much as possible for themselves and constantly reassured people in their care which meant that no one was left alone or isolated. Staff were intuitive and alert to people's needs. No one was hurried or rushed and there was a feeling of calmness and wellbeing throughout the home. Staff took time to talk with people and we observed warm, sensitive and friendly interactions between people and staff.

Is the service responsive?

People's health and care needs had been assessed prior to their arrival at the home. We looked at five care plans and saw that records were well organised, were up to date and accurate. Records confirmed people's preferences, interests and diverse needs which ensured care and support provided met individual need.

We observed staff that were attentive and anticipated people's changing needs and responded without delay. Visitors were welcomed at the home at any time. A relative we spoke with told us that any issue however small was always, "rectified straight away". Another visitor said, "I am so relieved that Mum is here, everything was so difficult before, but she settled very quickly through the staff's response and understanding".

Is the service well-led?

There were formal and informal systems and mechanisms in place to monitor the quality of the service provided. People, their relatives, outside professionals and the staff were asked for their feedback on the service. Suggestions and ideas for improvement to the service were welcomed and acted on.

One of the relatives we spoke with told us they visited the home very regularly and "never with any notice". They said, "I've not got one bad thing to say about the place, there are no pretences here. Every single time there is a problem it gets sorted out immediately".

Clear management structures and lines of accountability were in place. Staff were clear about their roles and responsibilities and had a good understanding of the ethos and values of the home and to quality processes in place.

The home benefitted from the experience and active involvement of the provider who provided continuity and consistency to the service delivered. People experienced effective leadership of the service, together with a stable staff team. We found there was a strong commitment from the provider alongside other staff to the continuous improvement of the service.

People we spoke with and their relatives told us they were completely satisfied with the care provided by the staff. Comments included 'They are always very kind,' and 'The care is extremely good. I am very, very grateful to them.'

Each person's nutritional needs had been assessed and monitored regularly. People told us they enjoyed the meals. Comments included 'The food is wonderful.' Individual nutritional needs, likes and dislikes were catered for.

We saw that people had been consulted and involved in drawing up and agreeing their care plans. People told us the staff knew how to meet their needs. A relative told us 'The staff are very competent and knowledgeable. They understand dementia.'

We saw evidence that safe recruitment procedures had been followed before new staff began working in the home.

Effective systems were followed to assess and monitor the quality of service that people received. People's views were sought and acted upon.