Berehill House Care Home provides accommodation and personal care for up to 35 people, some of whom are living with dementia. The accommodation is over three floors and is comprised of the original building and a newer part which was built in 2016.

The inspection took place on the 10 January 2017 and was unannounced.

There was a registered manager at the service. 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.

The provider had policies and procedures in place designed to protect people from abuse. Staff had completed training in safeguarding adults and were aware of the different types of abuse and what they would do if they suspected or witnessed abuse. People were protected from avoidable harm and risk assessments were in place. The provider sought references and completed checks before new staff started working at the home. People’s needs were met by adequate staffing levels. People received their medicines as prescribed.

People were supported by staff who had received relevant training to enable them to support people they worked with. New staff (including agency staff) completed an induction to the home and were supported with a variety of training, supervision and appraisal. Staff had training in and followed legislation designed to protect people’s rights and ensured they offered people choices and sought consent. People enjoyed their meals and had access to healthcare professionals when necessary.

Staff developed caring relationships with people using the service. Staff were patient with people, spending time with them if they were confused or upset to reassure them. Staff respected people’s privacy and dignity.

People’s needs were assessed before they moved to the service to ensure staff could meet their needs. Each person had a care plan which included sufficient information for staff to support people’s health and wellbeing and included information about people’s routines, preferences and medical history. People enjoyed a range of activities and the environment was designed to be stimulating for people living with dementia.

The registered manager and provider promoted a positive culture that was open and inclusive. The ethos of the home was one of a relaxed, calm environment. The registered manager had systems in place to monitor the quality of the service provided, which included undertaking a range of regular audits.

At the time of this inspection there were 20 people using the service. We spoke with eight people who use the service, the manager, three staff and the Group Operations Manager. We looked at care and support records for four people who use the service.

We considered our inspection findings to answer 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?

The service is safe because there were enough qualified, skilled and experienced staff to meet people's needs. All of the people we spoke with said they thought there were enough staff and were complimentary about them. One person told us “There seems to be plenty of staff and they are all very good, they chat to me and I never feel rushed”. People we spoke with told us that they felt safe living in the home.

We saw that risks associated with the provision of care and support had been assessed, such as in relation to mobility and falls, nutrition and weight. The records showed that any concerns were followed up and appropriate action was taken. There were arrangements in place to deal with foreseeable emergencies.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

We saw that effective systems were in place to gain and review consent from people who use the service, and to act on their wishes. Of the eight people we spoke with, seven said that staff asked for their consent. One person told us “I can’t remember if they ask consent or not”. We observed care workers asking for peoples’ consent before providing them with personal care or support.

The home was effective in providing people with a choice of food and drink and supporting them to be able to eat and drink sufficient amounts to meet their needs. A person who uses the service told us “We get plenty to eat and drink. We always have a choice of food and if I don’t like what they are offering, I can always have an omelette or a sandwich”. Another person said “The food is excellent. We always have a choice and if I don’t like anything they get me something else. It always arrives hot”.

Is the service caring?

We observed that staff interacted well with people using the service, promoting a warm and inclusive atmosphere in the home. Staff told us “We are encouraged to sit and chat with the residents”. A person who lives in the home told us “I am very happy here”. Another person said “This home is A1. If I have the slightest worry they check me out. I can go anywhere in town, they are very good at keeping me independent”. Another person told us “It is very nice here. I am very independent and like to do things for myself. They help me stay independent”. Another individual remarked “We are very well looked after here; we never wait, the staff come very quickly”.

Is the service responsive?

The service is responsive to people’s changing needs. We saw that people’s health needs were monitored and referred to health professionals appropriately.

There was a system in place to monitor and respond to any concerns or complaints about the service. The manager showed us the records of two complaints, the actions taken in response and the outcomes. These showed that the provider took account of complaints and comments to improve the service.

Is the service well led?

We found that the service is well led. Regular audits of the quality and safety of the service took place and action plans were developed and followed to address any issues that had been identified.

There were monthly residents meetings. A person who uses the service told us “I go to the meetings. Anything can be discussed and we chat about it. They ask our views on the home”. We observed that the manager was approachable and took time to walk about the home and talk with the people who lived there. Another person using the service told us the manager “Asks if I am OK and happy with my care. She is very good to me”.

All the staff we spoke with said they thought the home was well led. One member of staff said “It is getting much better” and “It is all for the good”. Another member of staff said “We can discuss anything. The manager is very clued up and she listens to us and our opinions”.