Hembury Fort House

We carried out an unannounced comprehensive inspection on 6 and 7 September 2018. On the first day of the inspection there were 24 people living at Hembury Fort House as one room was being refurbished.

At our last inspection we rated the service Good. At this inspection we found the service remained Good overall, with one key question now being rated as 'Outstanding'. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Some parts of this inspection report are written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager working at the home. 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. The registered manager is also one of the directors of the company that owns the service.

Since our last inspection, the registered manager and the staff group have shown an excellent understanding of people's diverse backgrounds and responding to their individual needs. For example, staff had enabled a person to build an enhanced sense of well-being and an improved quality of life. A social care professional said, "What is clearly evident on arrival at Hembury Fort or via telephone calls is the professional person-centred and caring attitude of both the manager and her staff team."

The registered manager was a strong role model to staff; her commitment and energy meant the service did not 'stand still.' The registered manager created a culture where there was an openness to learn and improve, recognising practice and good quality care was not static but evolving. Complaints were logged, investigated and responded to in a sensitive manner. People told us staff were approachable and they felt confident concerns or complaints would be addressed.

The registered manager's values and ethos promoted the rights of people living with dementia and were central to the way the service was run. The management team demonstrated acceptance and treated people living at the service as equals. They encouraged staff to consider the world through the eyes of people living with dementia, which care plans and handover notes demonstrated.

People built up friendships with other people at the home which were respected. Some people were more confident and vocal than others; staff ensured quieter people were included in the general conversation.

They took time to ensure they heard quieter people's opinions; staff were patient and kind involving people and offering choices.

People's experiences were at the centre of the service and staff responded in a flexible and responsive manner. People were consulted and treated as equals. The registered manager was open in the way they spoke with people. They were committed to encouraging people in the local village and surrounding area to visit Hembury Fort House and shared information in a local village newsletter to ensure they were included as part of the community. They explained they wanted people not to fear moving into residential care or visiting people in residential settings.

People benefited from a catering team who recognised their role in supporting people to keep well and healthy. In addition, the catering team knew their role was also vital to help people feel comforted and at home.

Staff knew people well so this meant they recognised the changes in people's long-term health care conditions. Care records, feedback and our observation of staff practice confirmed staff responded to health changes or a person's slow decline in health in a responsive, professional and calm manner. Staff worked closely as a team.

People's care and support was planned in partnership with them. Care plans were written in a person- centred way. They were fundamental to keeping staff updated and to promote people's emotional and physical care needs, as well as their choices and preferences. Care plans were tailored to meet people's individual needs and were regularly reviewed.

People benefited from a staff team who respected each other's roles and skills and worked together to provide a consistent standard of care. The registered manager had created systems to improve communication to help ensure everyone knew the individual needs of people living at the home and could plan and respond quickly to their changing needs.

Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns and to report them in a timely manner. There was always sufficient staff available to meet people's needs. People said they felt safe because there were enough staff on duty who knew how to support them, which was reflected by the staff rotas. Staff records showed the staff team was stable and experienced. Feedback from people and staff confirmed the provider recruited new staff who suited the caring values of the service and recognised the importance of team work to provide consistent and safe care.

Risks to people were recorded and reviewed with measures put in place to reduce assessed risks. Environmental checks were completed to help keep people safe, such as covering radiators with a hot surface temperature, restricting windows to help reduce the risk of falls, servicing equipment and fire drills. The service had good systems in place to support staff to administer medicines safely. People visiting and living at the home praised the high standard of cleanliness. A health professional described the home as "spotlessly clean."

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). 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.

Further information is in the detailed findings below.

The five questions we ask about services and what we found