The service provides accommodation and support for up to nine older adults with a range of support needs due to a learning disability, physical health and/or dementia. At the time of the inspection there were nine people living in the home, some with complex care and communication needs. The provider who was also the registered manager lives on site.

At the last inspection on 21 September 2015 we rated the service as ‘Good’ overall. However, there was a breach of regulation requiring improvement in the ‘effective’ domain because the service did not always follow a best interests process in accordance with the Mental Capacity Act 2005 (MCA), where a person lacked mental capacity to consent to care and treatment. In addition the service was depriving people of their liberty for the purpose of receiving care or treatment without lawful authority. We received a provider action plan on 2nd November 2015 stating the relevant legal requirements had been met. At this inspection we found people’s legal rights were now being protected following the proper legal processes. The service remained rated as Good overall.

Why the service is rated Good.

People remained safe at the home. People told us there were adequate numbers of suitable staff to meet their needs and to spend time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People’s healthcare needs were monitored by the staff and they had access to healthcare professionals according to their individual needs. 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 supported this practice.

The home continued to provide a caring service to people. People told us, and we observed, that staff were kind and patient. Comments included, ”I’ve never been so happy. The staff treat you so well. Everything you want you can get” and “I don’t think I could improve it. The people are lovely, they all are”. People, and/or their representatives, were involved in decisions about the care and support they received.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. The provider had a complaints procedure which was given to people in a ‘service users guide’ when they moved in. The registered manager told us no complaints had been received, and that people or their relatives spoke with a member of staff if they had a concern. Written feedback from a relative stated, “If we should have a problem it is always sorted out with your prompt attention”.

The service continued to be well led. The service had a registered manager who was also the provider. 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.

People and their relatives told us the management within the home was open and approachable. Comments included, “[Manager’s name ] is a wonderful person to talk to” and “They seem to have a light but definite touch all the time”. The registered manager lived on site and, with the deputy manager, was very involved in the day to day running of the home. They sought the views of people and their representatives to make sure they ‘had a voice’ in the way the home was run. Written and verbal feedback showed a high level of satisfaction about the quality of the service provided. The registered man

This inspection took place on 21 September 2015 and was unannounced.

The service provides accommodation and support for up to nine adults with a learning disability and/or dementia. At the time of the inspection there were nine people living in the home, some with complex care and communication needs. The provider who was also the registered manager lives on site. Most of the people had severe learning and physical disabilities including mobility needs, and limited or no verbal communication skills. We were able to engage in short conversations with four of the people. As we were unable to communicate verbally with everybody we also relied on our observations of care and our conversations with people’s relatives and staff to help us understand their experiences.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. At this service the registered manager is also the registered provider. 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. Everyone was positive about them, and felt they were approachable, caring, and committed to the service and the well-being of people there.

At the time of the inspection the service was not fully meeting its requirements in relation to protecting people’s human rights, where people lacked the mental capacity to make certain decisions about their care and welfare.

People received care and support in line with their individual care plans from staff with the necessary skills, experience and knowledge. People appeared very comfortable with the staff who were supporting them and we observed that staff treated them with kindness, dignity and respect. The registered manager deliberately chose staff with the values and compassion she felt were essential in caring for vulnerable people. Care plans consistently reiterated the importance of providing person-centred care and guided staff in how to do this, particularly in relation to communication. This meant that people were able to build meaningful relationships with staff and express their preferences. People at the service, relatives and health and social care professionals praised the caring attitude of staff. One person said, “Everybody is so nice and kind”. Relatives told us they were very happy with the care provided. One person’s relative said “I just think we are really blessed and really lucky to have them in here”. Another health professional told us, “The interactions with staff were heart-warming. It’s the nicest place I’ve been to for a long time. It really was a home for people”.

People’s relatives said they were always made very welcome and were able to visit the home as often and whenever they wished. They said the service was very good at keeping them informed and involving them in decisions about their relatives care.

Care plans contained detailed information to help staff understand the non-verbal ways in which people communicated. We observed staff always checked with people before providing care or support and then acted on people’s choices.

There were enough staff deployed to meet people’s complex needs and to care for them safely. The majority of people chose not to go out into the community or engage with activities. Staff therefore spent time socialising with people within the home.

Staff received appropriate training to support people’s mental and physical health needs. People received their medicines safely and were supported by a range of external health and social care professionals.

The service’s quality monitoring systems enabled the service to maintain high standards of care and to promote continuing service improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Dennyshill Care Home has a comfortable and friendly feel. Staff know the people who live at Dennyshill well and clearly have great affection for them. This was reciprocated. The staff were a stable team, several of whom had worked for the home for many years. Two of the team were related to the manager/owner and we met an aunt and niece who both worked at the home. We were told that the manager's family often assisted if there were staff shortages. All this promoted the "family" feel to the home.

There was a comfortable lounge, but the "heart" of the home was the large kitchen/diner with a tiny office area located to one side.

On the day of our visit people were looking forward to a party in celebration of one person's 90th birthday.

People told us "I've been spoilt, the care and kindness is good and the staff have been so kind" and "staff help you all things."

This inspection was unannounced and took place on 19 September 2012. The visit lasted 3 hours and 45 minutes. We last visited Dennyshill in March 2012 and made compliance actions for six standards. No compliance actions were made on this inspection as the home was compliant under the Health and Social Care Act 2008. There had been a significant improvement in all of the areas that we inspected.

We met eight people during our visit and three people commented directly on their care. We saw that people looked well cared for and were dressed appropriately. People were able to maintain links with family, friends and community to promote their well-being.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people looked at ease with staff, for example choosing to spend time with staff in communal areas. Staff were clear about their role to protect people.

Staff talked to us about recent training and were positive about the quality of the information and how it had influenced their practice. Our discussions with staff and the manager showed their commitment to improvement and reflecting on their approach and practice. The manager had made changes within the service to ensure that people’s views and responses were captured to help influence the way that care was provided.

Our unannounced inspection at Dennyshill took place over two days, 20 and 22 March 2012. In total, it lasted seven hours and 15 minutes. On our first day, we spent the majority of our time in communal areas or met people in their bedrooms. We met all of the nine people living at Dennyshill.

Three people were able to comment on their care, but other people were not able to comment directly so we spent time observing care and people’s interactions with staff. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We used it when people were having lunch, however, we were only able to use this for a short time as people left the room after their meal and went to their bedrooms.

We also spoke to three staff members and the manager, as well as two visiting health professionals. After the inspection, we also contacted the local learning disability team to advise them of the serious concerns we had regarding the non-compliance levels at the home.

During our visit, we spent time with people living in the home, either in communal areas or by visiting people in their bedrooms. This helped us make a judgment about whether their dignity and privacy was respected. We saw that people looked well cared for and were dressed appropriately. Staff told us that the majority of people needed support with their incontinence, which was managed well as people’s rooms were odour free.

We saw that staff ensured that people’s dignity was maintained after they had used the toilet independently and needed their clothing adjusted. On another occasion, we heard a staff member checking if a person wanted help with cutting up their meal. But at other times, staff actions undermined people’s dignity. For example, we saw them talking over people and not including people in conversations about them, wiping a person’s face without asking them and making personal comments, which could undermine people’s well-being.

We saw from care records that people were not always involved in decisions around their care and were not always routinely offered choices, for example with drinks and meals.

We saw that people generally seemed at ease with staff, and that staff knew people well and could pick up on their moods and were attentive. For example, making sure someone was comfortable.

We saw that some people needed additional support to meet their mobility needs. We did not see anyone moved by a hoist but we saw the equipment in place. We saw one person moved inappropriately without equipment, which had the potential to damage their skin.

In some instances, the service worked well with other health professionals and sought their advice. However, other health risks were not managed appropriately.

We saw that people had adapted crockery to help with their independence and were using cutlery of their choice, which was recorded in their care plan.

However, specialist advice was not always followed.

Three people told us that they were not fussy about food and would eat anything serve to them. We saw several people eating their food with enthusiasm. We saw that staff knew people well and could pick up on their moods and were attentive. For example, encouraging people to drink and eat their meal. However, one person who had eaten well was not offered seconds even though staff said they were concerned about their weight loss and their lack of appetite.

We saw that people generally seemed at ease with staff, and that staff knew people well and could pick up on their changing moods. For example, a staff member sat with a person to put their photos in an album and discussed the picture with them, although this would have been more meaningful if they had been at the same eye level. However, risks were poorly managed and incidents were not appropriately reported.

We asked if people at the home were consulted about decisions around the running of the home. The manager told us this was done on an informal basis but not recorded.