About the service: Bishopsteignton House is a care home registered to provide accommodation with personal care for up to 27 people. The service is intended for older people and does not provide nursing care. 22 people were living at the home at the time of the inspection.

People’s experience of using this service:

Without exception all the people and relatives we spoke with praised the home. One person said the registered manager was “very nice” and “approachable” and a relative described the home as “excellent, first class”.

People felt safe and well cared for. People’s preferences were respected and staff were sensitive and attentive to people’s needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well.

There were sufficient numbers of staff employed to ensure people’s needs were met. Recruitment practices were safe and staff were well-trained.

Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. Staff were aware of their responsibilities to safeguard people.

Some care plans required more detail about people’s abilities and preferences in relation to how they wished to be supported with their personal hygiene needs.

People received their medicines safely and as prescribed. Medicine management practices were safe.

Some people and relatives said they would like to see more social activities arranged and the registered manager said they would review this.

The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

Quality assurance processes undertaken by the registered manager and the provider ensured people received high quality care that met their needs and respected their preferences. People and their relatives were involved in making decisions about their care.

Rating at last inspection: Good. The last inspection report was published on 8 August 2016

Why we inspected: This was a planned inspection based on the rating at the last inspection. The home remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 4 and 6 July 2016 and was unannounced.

Bishopsteignton House is a care home which provides accommodation and personal care for up to 27 people living with dementia and other physical health needs. People who live at the home receive nursing care from the local community health teams.

The service has a registered manager. 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.

At the time of the inspection there were 25 people living at the service. Some of these people were living with Dementia. During our inspection we observed a calm and relaxed atmosphere in the home and we saw staff interact with people in a friendly and respectful way.

People, staff and health care professionals told us they were happy with the care being provided at the home. People’s needs had been assessed prior to them moving into the home. Each person had a care plan which had been developed by staff with their and their relatives’ input. These care plans contained information about each person’s needs and how staff should meet these. Care staff spoke confidently about people’s individual care needs and how they met these. Care staff were knowledgeable about the people they were caring for. They described people past histories and their preferences. People’s physical and mental health needs were monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People were treated with kindness, compassion and respect. Relatives said they felt the home was safe and secure. Care staff knew people well and were friendly and supportive. Care staff sought people’s consent for their day to day care.

Care staff knew how to recognise and report the signs of abuse and had received training in safeguarding people. They were confident about how to raise concerns if they were concerned about anyone.

Care staff received relevant training for their role and there were opportunities for on-going training, support and development. There was enough staff on duty when we inspected to care for the people who lived there.

Recruitment systems were in place; new employees underwent the relevant pre-employment checks before starting work. Care staff had completed an application form. One of these did not contain a lot of detail relating to the dates that the person had previously worked. The registered manager had not explored these employment gaps. However this was actioned immediately when we pointed this out.

There was a good system in place for ordering, storing and returning medicines,

Meals were appetising and people were offered a choice in line with their dietary requirements. People told us they enjoyed the food. We found systems were in place to make sure people received their medicines safely.

People and the relatives we spoke with were aware of how to make a complaint and all felt they would have no problem raising any issues. There was a management structure in the home which provided clear lines of responsibility and accountability. The registered manager showed a great enthusiasm in wanting to provide the best level of care possible. Care staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

The premises and equipment were maintained to ensure people were kept safe. There was a Victorian conservatory that was filled with plants and comfortable chairs, making it an excellent area in which to relax, whilst taking in the fabulous garden and estuary views. There were infection control measures in place to protect people and the home was clean and hygienic At the time of the inspection we found th

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

There were 24 people living at the home when we visited, some of who were there for short stays only, and two people present under day care arrangements. Besides care and ancillary staff, three senior staff were present during our visit: the prospective registered manager, the registered manager and the company location manager.

Below is a summary of what we found. The summary is based on what people using the service, a visiting social care professional and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Systems were in place to ensure that the environment, including hygiene aspects, was monitored and maintained. Adaptations were in place to meet needs likely to be experienced by those to whom the service was offered, promoting independence safely.

There were enough staff on duty to meet the needs of the people living at the home, with suitable levels of experience and skills within the staff team.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had needed to be submitted by the service, under the safeguards. However, a policy was in place, with relevant staff trained to understand when an application should be made and having experience of how to submit one.

Is the service effective?

People told us that they were satisfied with the care they received. It was clear from what we saw and from our conversations that staff understood people’s care and support needs, and that they knew them well as individuals.

Is the service caring?

People were supported by friendly and respectful staff. People told us the staff did not rush them, and we saw that care staff gave people their full attention when speaking with them or assisting them. People’s comments included “They are very good to me” and “They’re all very friendly.”

Is the service responsive?

People’s needs had been assessed before they moved into the home. People told us they were consulted regularly about the support they wanted, and staff were accommodating and helpful. Records confirmed people’s preferences, interests and diverse needs had been recorded, with care and support provided that met their wishes and needs. People had access to activities that they enjoyed. They gave examples of how staff or the provider had responded to their comments or concerns to assist them or improve the service they received.

Is the service well-led?

A variety of quality assurance processes were in place. We saw that people had opportunities to give their views of the service through surveys and residents’ meetings. They also told us they could speak with senior staff as necessary. Those who had made complaints were satisfied with the response they received. Staff told us their views were listened to and changes were made as a result of their comments or suggestions.

Systems were in place to identify and manage risks to the health and welfare of people living at the home as well as to visitors and staff.

On the day of our inspection 23 people were living at the home and receiving care from the service. One person was having respite care. We, the Care Quality Commission, (CQC) spoke with three people, one relative, the provider/owner, two senior managers, the manager, two care workers and a visiting healthcare professional. We looked at three people’s care plans.

One person said the home had a “good atmosphere” and described it as “very pleasant”. One relative said “We’re very pleased with it here. The staff have been so nice to X (the person). We’re so pleased with the transition from living at home to moving here.” All the staff we spoke with were positive about the standard of care.

One person described the staff as “absolutely wonderful” and described their experience of living at the home as “very good”. Another person described a senior care worker as “marvellous”.

We spoke with a visiting nurse who said “I like coming here. Staff are willing to tell us their concerns.” They added that they were confident that staff would follow their instructions. They described the manager as “exceptional”.

Medicines were managed safely and the management team were receptive to feedback on areas for improvement. There were effective systems in place to monitor the quality of the service and manage risk. People, staff and management records were accurate, kept safe and confidential.

People we spoke with said they felt safe at the home and were happy with the care they received. One person said "It's the kind of place where I don’t have to worry about anything. Nothing is too much trouble for them."

Another person said "If I was unhappy I could speak to any of the staff. They would then sort it out." Another person said "Why would I complain, it’s marvellous here. I don’t want to be in a care home but I'm here and couldn't wish for a better place."

Staff rotas showed that there had been an increase in staffing since our last inspection.

People told us there had been a "large turnover of staff." One person said "I was worried when I knew they were all leaving but the ones that have come are lovely. They seem very experienced."

People we spoke with were content that the staff had been fully trained to undertake their duties. Staff told us they enjoyed working at the home and felt supported. One member of staff said, "This is a friendly place to work and I feel valued by the management". Another member of staff said, "We have a new manager who is making lots of changes. It has been a positive time and she has listened and is supportive." A new member of staff said "There are a few of us who are new and it already feels like we are part of the team."

On the day of our inspection, 12 June 2012, 25 people were living at the home and receiving care from the service. One person was receiving day care. During the inspection we (the Care Quality Commission) spoke with four people, three care staff, two relatives and three visiting healthcare professionals. Some people, because of their complex needs, were not able to share their experiences and so we used the Short Observational Framework for Inspection (SOFI). This was a specific way of observing care to help us understand the experience of people who could not talk with us. We also spent time observing care and lunch time and looked at five care plans.

All the people we spoke with were positive about the staff. Expressions such as “kind” and “absolutely excellent” were used. One person described the night staff as “excellent”. Another person added that the new staff were “very good as well” and “would do anything for you”. All the people we spoke with considered their rooms to be clean.

Two people we spoke with said there were not enough staff. One person said “They’re always short staffed. There are sandwiches for tea instead of a meal and things don’t get done in my room”.

Two relatives described the staff as “friendly, warm and thoughtful” and made a point of saying “all the staff are like that”.

We spoke with three visiting healthcare professionals who were all positive about the staff. One described the staff as “flexible” and able to “manage people well”. Staff were also described as “good at asking for advice”. Another said they were “really very pleased with the staff”. Staff were described as “very attentive and caring”. They talked of “good relationships and liaison”.

People who live in the home told us that they are happy. Comments included ‘you can have tea in the garden, it’s very nice’; ‘I’m happy here, I have no complaints’; ‘the staff meet my needs’; and ‘the staff helped plant the pots on my patio’.

We spoke with a relative who told us that the person they were visiting was happy living in the home and felt safe. They told us that the staff are very kind and patient.

People told us that the local GP visits every Thursday for people who need to see him. We spoke with the GP during our visit. He told us that the service usually contacts him when they have any concerns.

People told us that they are able to take part in the activities within the home. Two people told us they enjoy the bingo and quizzes. One person told us they access the local area, and know people in the village who regularly visit them. People told us that the service organises regular outings on a minibus. On the day of our visit, a lady had come in to do some flower arranging in the lounge. One person told us that they like to go and watch this.