At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Bushell House is a large spacious Georgian grade two listed building set in its own grounds in the rural village of Goosnargh. It is registered to provide personal care and accommodation for up to 31 adults. Accommodation is provided in single rooms, all of which are en-suite. There are a number of communal rooms including lounges, dining rooms and a library.

People who lived at Bushell House told us they felt safe and supported by staff and management team. Assessments took place to ensure that people’s needs could be met by the service. Care records included detailed risk assessments, which provided staff with guidance on how risks to people were minimised.

People were protected by suitable procedures for the recruitment of staff. We saw records which showed the provider had undertaken checks. This to ensure staff had the required knowledge and skills, and were of good character before they were employed at the service.

Systems were in place to reduce people being at risk of harm and potential abuse. Staff had received up to date safeguarding training and understood the provider's safeguarding adults procedures. People told us there was enough staff on duty and that the staff came quickly to any requests for support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received care that was relevant to their needs and effective because they were supported by an established staff team. They also had received appropriate training such as moving and handling and had a good understanding of people’s needs.

We found the service was pro-active in supporting people to have sufficient nutrition and hydration. People said the quality of the food was good, one person said, “The food here is very good”. Care plans showed where appropriate the staff had made referrals to health care professionals such as the community nursing team and GP's.

We received consistent positive feedback about the care provided at Bushell House from people who lived at the home and their relatives. The management team and staff told us they fully involved people and their families in their care planning. People we saw were well presented and staff sought to maintain people's dignity throughout the day.

We saw, from care records, that staff had discussed people's preferences for end of life care.

People and their relatives were involved in the planning of their care and support. We found that assessments were undertaken by management prior to any person being accepted into the home.

People were encouraged to raise any concerns or complaints. The service had a complaints procedure. People we spoke with said they felt comfortable raising concerns if they were unhappy about any aspect of their care.

Bushell House had procedures in place to monitor the quality of the service provided. Regular audits had been completed. These included reviewing care plan records, infection control, monitoring the environment and medication. This helped to ensure people were living in a safe environment.

The registered manager kept up to date with current good practice guidelines by attending managers meetings at which they shared learning and discussed new developments in care. We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.

Bushell House is a large spacious Georgian grade two listed building set in its own grounds in the rural village of Goosnargh. It is registered to provide personal care and accommodation for up to 31 adults. Accommodation is provided in single rooms, all of which are en-suite. There are a number of communal rooms including lounges, dining rooms and a library. The upper floor can be accessed via a passenger lift and there are various aids and adaptations to support people to maximise their independence.

The service was last inspected on 19th December 2013 and was found to be compliant in all the areas we assessed. This inspection was unannounced and took place on 26th November 2014.

There was a registered manager in place at the time of the inspection. 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.

We consulted people who used the service and their relatives and friends throughout the inspection. The feedback we received was very positive. People spoke very highly of the service and nobody we spoke with expressed any concerns. People’s comments included, “The home is very nice. There is none that come up to this standard.” “The care couldn’t be better.” “It is the essence of what a good home should be.”

We found people were provided with safe, effective care that was provided in accordance with their needs and wishes. People were able to make decisions about their care and were encouraged to express their views.

Staff had a good understanding of people’s daily care needs and where necessary, ensured that people who used the service had access to community health care and support. Any risks in relation to people’s health and wellbeing were understood and there were plans in place to maintain their safety.

People’s rights were respected. Where concerns were identified about the capacity of a person who used the service to consent to any aspect of their care, the key requirements of the Mental Capacity Act 2005 were put into practice to ensure people’s best interests were protected.

People told us they received their care from a kind and caring staff team. People felt their privacy and dignity was respected and they and their relatives could express views about things that were important to them.

People who used the service received their care from well trained, well supported staff. The registered manager ensured that staff at the service had the skills and knowledge to carry out their roles and received regular supervision.

Managers of the service were supportive and approachable. People felt able to raise concerns and were confident any concerns they did raise would be dealt with properly.

There were processes in place to ensure that all aspects of the service were regularly checked and monitored, both by the registered manager and the provider of the service. This meant that any areas for development could be identified and addressed.

People were supported to understand what they could expect in principle from the service. They were regularly consulted about their care and support and had signed their consent acknowledging this. People had an excellent personal profile written that placed them at the centre of their care.

People told us they were treated with respect. “They always call me by my preferred title. I think that’s right and fitting. It’s a wonderful place to be”. “They always remind me to ask if I need help and of course I tell them, I know that, and if I need help I’ll ask. They are very good”. And “I was only talking to (named carer) last week. We had a chat about my care and what I wanted. I’m very happy. I have everything I need, even a front door key”.

We found people had their medication when they needed it and their medication was managed correctly and safely.

People were cared for by staff of good character and who were trained. People said staff were “very good”, “lovely people”, “caring” and “helpful”. One person said, ‘’There is one thing that baffles me and that is, all the staff are so nice, lovely people. I think they must be handpicked. I often wonder how the manager does it. She must take absolutely ages choosing the staff. Whatever she does she has certainly got it right”

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People could give their views and be confident the provider acted on them. There were systems in place to regularly assess and monitor the quality of service that people received.

During our visit we met a number of residents and some family members. We asked people about their experience of the service and received some very positive feedback. Everyone we spoke with expressed satisfaction with the care provided at the home and spoke highly of staff and managers.

Comments included;

‘’They know what they are doing, they don’t need inspecting I’ll tell you that!’’

‘’They are all very nice and always helpful. I’ve certainly got no complaints about them.’’

‘’I find the staff extremely courteous and obliging.’’

‘’I’ve been here for over 5 years. I wouldn’t stay if I didn’t like it.’’

We spoke to some relatives who were regular visitors to the home. They said, ‘’It is really lovely here. We are always made very welcome and allowed to visit in private.’’

We spoke with a contractor who was also a regular visitor. He commented, ‘’I come here all the time and go to other care homes. This is one of the best ones. The way they talk to the residents and the way they look after them seems really nice.’’

We looked at six areas during the inspection including the ways in which residents were enabled to make decisions about their care and the quality of care provided. Other areas included arrangements for the safeguarding of people from abuse, staff training and the environment. We also looked at how the home monitored the safety and quality of the service.

We found positive evidence of compliance with all the areas inspected.

People living in the home told us they were very happy and cared for very well by the staff. They were getting the help they needed and made comments such as, “It’s wonderful. The emphasis is on care“. “When you are ill, you get excellent care.” “They look after me well”, “I’m quite content and happy”.

We were told there were no rules to follow and no rigid routines. They usually pleased themselves what they wanted to do. Staff took into account their views and respected their right to privacy and independence. They could have visitors when they wanted and staff made them very welcome.

People told us staff were very nice. They said, “The staff are polite and helpful.” “The good thing is they don’t take over, they let you do what you can. This is important because I don’t feel helpless.” They also said there were plenty of activities arranged they could join in.

People told us they were confident to raise issues of concern with the manager if ever the need arose.

People said they were involved in running the home. They had meetings to discuss different issues. They were kept up to date with any planned changes. They were comfortable and had everything they needed. The food was good, and they had no complaints.