This inspection took place on 2 and 3 March 2017, the first day was unannounced and second day announced. This was the first inspection since a new provider, Doveleigh Care Limited, registered this service on 11 February 2015.

Arcot House is a 23 bed residential home for older people who are physically frail and require help with personal care, it does not provide nursing care. The home is a grade two listed Georgian manor house set in lovely gardens. When we visited, 22 people lived there.

The service has a registered manager. 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.

Staff developed exceptionally positive caring and compassionate relationships with people. The ethos of the home was that of an extended family. Staff knew each person as an individual and what mattered to them, they treated people with the utmost dignity and respect. A relative said, “Nothing is too much trouble, I can’t speak of them highly enough. Its home from home.” The service used the national ‘Dignity in care’ initiative ten good practice steps to guide their practice. A ‘Dignity Tree’ created by people, relatives and staff provided a tangible reminder to uphold those values at all times.

People living at the home with expertise and knowledge of particular conditions such as diabetes and epilepsy, worked in partnership with staff who valued their experience and contributions on ways in which their care could further be improved. For example, they advised on medicines used for epilepsy, on ‘low sugar’ specialist diabetic foods and obtained health information leaflets to inform staff about their condition. People and staff had lead roles, known as “Ambassadors” worked together and promoted improved healthcare outcomes for people. For example, in pressure area care, diabetes, epilepsy, falls management, dementia, dignity and end of life care.

People living with dementia received best practice care because staff understood the different types of dementia, Staff had signed up to the Alzheimer’s society Dementia Friends initiative and undertook ‘Dementia Friends’ training. A staff member had a lead role for promoting best practice in caring for people living with dementia, and had undertaken training and received a qualification in dementia. The promoted people, staff and relatives to learn about various types of dementia, and how it affected people, and encouraged and supported people living with dementia to live well.

People received exceptionally effective care, based on best practice by staff with an in-depth knowledge of their care and treatment needs, who were skilled and confident in their practice. Staff worked with people, other professionals and continually developed their skills. The service used innovative and creative ways to train and develop staff to put their learning into practice to provide outstanding care that met people’s individual needs. Photographs showed how staff used sensory glasses which simulated visual impairment to experience what it was like to be guided by a member of staff to navigate their way around the home using a walking frame. This helped staff appreciate how those people weren’t aware of trip hazards such as steps and how it affected their sense of balance.

Staff followed national best practice such as ‘One chance to get it right’ and NICE guidelines for end of life care (2015). They worked with hospice and community nursing staff during an ‘End of Life’ project to implement best practice end of life care for people. A staff member championed excellent end of life care and helped staff have the skills and confidence to discuss death and dying with people, families and staff in order to help them have a goo