This inspection was carried out on 25 May 2016 and was unannounced.

Birchams Grange provides accommodation and personal care for up to 29 people. At the time of our inspection there were 27 people living at the home.

There was a registered manager 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 and associated regulations about how the service is run.

People were kept safe by staff that knew how to recognise and report any concerns about people’s safety. Staff understood risks associated with people’s needs and how to keep them safe. There were enough staff on duty to make sure that people’s health needs were responded to effectively. The provider completed checks to ensure staff were suitable and safe to work at the home.

People were positive about the care and support that they received. People were treated with dignity and respect and staff were kind and caring in their approach with people. People had care and support that was centred on them as individuals.

People’s health needs were responded to effectively with people being supported to access doctors and other health professionals when required. People were supported to have their medicines when needed. Medicines were stored and administered appropriately.

People had access to a varied diet of food and drink. People were supported to have their food and drink safely. Where recommendations had been made by other professionals regarding their diet or health needs these had been acted upon by staff.

People’s permission was sought before any care or support was given. Time was taken to make sure that people could make choices and decisions about the care and support they received.

People were supported by staff that had the knowledge and skills to understand and meet their health needs. Staff had access to additional training to match people’s specific health needs. Staff felt that they were able to contact the registered manager at any time if they needed support or guidance.

People and their relatives found the staff and management approachable, willing to listen to their views and opinions. People knew how to complain and who to complain to. Feedback from people and their relatives was gathered on a regular basis and any areas identified for action were acted upon. Audits and checks were completed regularly to ensure that good standards were maintained.

We considered our inspection findings to answer the 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?

Both the people who lived in the home and their relatives were pleased with the care provided and felt that their views were respected and listened to. The staff worked in a safe and hygienic way and used appropriate protective clothing. There were enough staff to meet the needs of the people living in the home and a member of the management team was available on call in case of emergencies.

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults, could identify potential abuse and knew how to report any incidents of abuse.

Is the service effective?

People told us that they were happy with the care that had been delivered and their care records were up to date and signed by them. One relative said: “They all seem very well cared for.” Another relative said: “We have to sign the book to show we have seen the checks done on her weight. They keep us involved.”

Care records confirmed people’s preferences, interests, needs had been recorded and care and support had been provided in accordance with people’s wishes. One relative said: “We are very pleased with the care we are getting.”

We heard that information was shared very effectively between staff. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and encouragement when supporting people. One relative said: “They are so patient.” One person using the service said: “ You only have to attract their attention and they get things done.”

Is the service responsive?

People’s needs had been assessed before they were admitted to the home. People's needs were carefully described so that care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the registered manager and they briefed senior care staff. One relative said: “They are constantly checking, asking us if there is anything which needs attention.”

Where an audit of the home had identified a high number of falls the registered manager had organised falls prevention training for staff.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. People told us they had received customer satisfaction surveys but the registered manager commented they did not get many surveys returned to them. The activities coordinator had been asked to encourage informal feedback about the home when they talked to people. The registered manager had plans to organise a meeting for relatives and people who lived in the home to seek suggestions for any improvements required. Staff told us they were clear about their roles and responsibilities and were : “ Very well supported.”

We spoke with people living at the home and we observed how staff supported them. We saw that staff were kind and caring in their approach. People told us that the staff were, "fantastic" and described the home as having a, "homely feel" and, "a welcoming atmosphere".

Staff supported people to make decisions for themselves, and made sure that people had given informed consent to any procedures. Where people were unable to make decisions for themselves, staff knew how to ensure that decisions were taken in people's best interests.

People told us that they felt safe and well cared for at the home. Records showed that people's needs were assessed and care was planned so that it met each person's individual needs.

Staff received training and professional development to give them the skills and knowledge they needed to meet people's needs.

We spent time at the home watching to see how staff supported people, and talking with people about life at Birchams Grange. We spoke with six people living at the home and three relatives. We also looked at records, and spoke with staff and the manager.

People were very positive about the home. One person said "you'd have difficulty finding anywhere better" and another told us "if everyone could be as comfortable as I am, they'd be very fortunate".

We saw that staff were kind and caring when they provided support for people. Staff were respectful in the way they spoke with people. Staff had a good knowledge of the people they were caring for. They also showed empathy and were sensitive in the way they talked about people.

People said that they felt safe at the home. The manager and the provider's representative were able to demonstrate that systems for monitoring the quality of the service were effective.