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

Avon House is a large, detached older style property situated close to the town centre of Worthing. It is registered to provide accommodation and care for up to 26 older people living with dementia and, at the time of our inspection, was fully occupied. Most rooms were of single occupancy, apart from one, which two people shared. Communal areas included a large sitting room, adjacent to a quieter sitting area and an orangery overlooking an accessible garden to the rear of the property. There was also a dining room and spacious hall area next to the front door.

A registered manager was in post. 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.

Generally, people’s medicines were managed safely, although we observed spoons and measuring cups containing dregs of an oral solution of paracetamol had been left in a sink near to toilets which people could freely access. This posed a risk of harm. Apart from this incident, medicines were ordered, stored, administered and managed safely by staff who had been trained appropriately. Staff had been trained in safeguarding and understood what action they should take if they suspected people were at risk of abuse. People’s risks had been identified, assessed and managed safely. Staffing levels were sufficient to meet people’s needs and staffing rotas confirmed consistent staffing levels. New staff were recruited safely and all appropriate checks were undertaken.

Staff had received a range of training and many had achieved a National Vocational Qualification in Health and Social Care. New staff followed the Care Certificate, a universally recognised qualification. Staff attended supervision meetings with the registered manager approximately every six weeks and staff meetings were held every two to three months. Staff had been trained to understand the requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards and put this into practice. People had sufficient to eat and drink and were offered a choice of what they wanted to eat and drink throughout the day. They had access to a range of healthcare professionals and services. The home had been decorated and arranged in a way that supported people living with dementia, although a menu display board did not include pictures or photos of food to aid people’s understanding.

People were looked after by kind and caring staff who knew them well. Relatives spoke positively about the staff at Avon House. As much as they were able, people were involved in decisions about their care; relatives attended regular review meetings. People were treated with dignity and respect and some people had planned how they wanted to receive care as they reached the end of their lives.

Care plans provided staff with detailed and comprehensive information about people, their likes, dislikes, preferences and how they wanted to be cared for. A range of activities was planned that met people’s interests and hobbies. People had access to the community supported by staff and minibus outings were occasionally organised. Complaints were listened to and managed in line with the provider’s policy, although no complaints had been recorded within the last year.

People and their relatives were involved in developing the service through meetings and staff were also asked for their feedback in annual surveys. Staff felt the provider and registered manager were supportive and there was an open door policy. Relatives spoke positively about the care their family members received. A range of audits was in place to measure and monitor the quality of c

At the time of the inspection 25 people were living at Avon House. There was a new extension at the back of the house which provided a comfortable conservatory which was due to be opened by the mayor of Worthing the following week, and a hairdressing room.

We spoke with two people who used the service and three relatives who were visiting that day. One person who used the service said it was “paradise”. Another said “I love it here”. One visitor said the staff were “really good”, and two others told us how the staff were working with them to support their relative.

We spoke with five staff, the manager and met with the providers. Two staff told us “the atmosphere is really good here”, and “we get to know people well and we work well together”. A third staff member said how the providers and the manager were open to suggestions. They said “the improvements to the building have made such a difference. It is good for people and good for morale”.

We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans kept current.

People were protected from the risks of unsafe use and management of medication because there were effective systems and processes in place.

People had their health and welfare needs met by staff who were subject to checks before starting work.

People could be sure their comments and complaints were listened to, considered and responded to appropriately.

We spoke with people and their relatives who told us that they were treated as individuals and that they were given information and choices in relation to their care. One person said that "the staff are really nice, they take me for a walk whenever I want to’’. People told us that their dignity, independence and privacy was respected. This was confirmed by our review of people's records as well as our observations.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that activities were altered to suit individual needs.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.

We spoke to some people living in the home, to two relatives, to West Sussex Adult Services and a health professional. We were told that there were some concerns that people were being brought into other peoples’ rooms for care and examinations. People living in the home able to express an opinion told us that they were happy there, that staff were kind and that there was always someone around. Two relatives spoken to expressed satisfaction with the care there.