This inspection took place on 27 and 28 November 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

Durban House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation, nursing and personal care and support to a maximum of 42 older people, including those who may have a physical disability or be living with dementia. There were 40 people living in the home at the time of our inspection.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences. People were supported to express their views and be involved in making decisions about their care and support.

There were systems and processes in place to protect people from harm, including how medicines were managed. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to the management team.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff were supported to provide appropriate care to people because they were trained, supervised and appraised. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills.

People were supported to have 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.

People received regular and on-going health checks. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

The registered manager was promoting an open, empowering and inclusive culture within the service. Quality assurance systems were in place, however there were sometimes gaps in the way these processes were taking place, particularly in relation to record keeping. We have recommended the provider and registered manager formalise the process for auditing and monitoring gaps in recording, while their new systems are being embedded in practice.

Further information is in the detailed findings below

The inspection took place on 11 October 2016 and was unannounced. We returned on 17 October 2016 to complete the inspection.

The previous inspection took place in February 2014 when we found the service was meeting all assessed standards. Since our last inspection the service had increased the number of people accommodated from 33 to 42 as the provider had extended the building. Durban House is registered to provide care support and nursing care. 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 2008 and associated Regulations about how the service is run.

Most people living at Durban House were living with dementia.

At this inspection we found the service was supporting people safely, effectively and in a caring way. Staff knew people well and were kind and caring. Visitors were welcomed. Staff respected people's preferred routines and activities provided were geared towards people's needs and interests.

People were protected from abuse and avoidable harm. Risk to people's health and welfare were managed appropriately. Environmental risks were regularly considered and managed well.

There were generally sufficient numbers of suitably trained and safely recruited staff to meet peoples' needs. There were some occasions, particularly in the mornings when staff were stretched which meant they could not respond to people's wishes as quickly as they would want, but this did not have an impact upon people's safety.

Staff received appropriate training and support.

The service liaised well with health care professionals when they needed support and guidance about people's health care needs.

People liked the food and were supported to have a diet which suited their needs and preferences. Staff ensured they sought consent before supporting people with their care and adhered to the Mental Capacity Act 2005.

People were given information about what the service could provide and staff were able to provide appropriate support because people's needs were clearly assessed and updated when a change had taken place.

People were encouraged to provide feedback about the quality of the service and complaints were responded to quickly. A particular strength of this service was how they included people in it's development. One dignity champion was a resident. Quality assurance processes helped to ensure the service maintained good standards which met people's needs and expectations.

At the time of our inspection there were 28 people using the service. Twenty-six of them were living with dementia. We spoke with 14 of them. We also spoke with three visiting family members, five members of staff and the manager. We left comment cards at the service for a week and received two responses.

The people we spoke with were satisfied with the care and support they received. They told us staff were caring and responsive to their needs. People’s relatives told us they found people were looked after in clean, comfortable surroundings and that staff respected their dignity and individuality. We observed interactions between people and staff that were positive, encouraging and reassuring.

One family member wrote on a comment card, “Durban House is the best for my mother. The fantastic care and friendliness shown to my mother and other people make our visits just a joy. If we ever had a concern it was always dealt with promptly.” Another comment read, “People are all treated with dignity and respect at all times. Nothing is too much trouble for the staff.” People said they were listened to and were involved in decisions about their care and the service they received.

We found people were supported to access other healthcare services to ensure their needs were met. People living with dementia experienced effective, responsive care which met their needs and was delivered by caring staff. Processes were in place to monitor and assess the quality of the service.

During our visit we observed people being treated with dignity and respect. We saw staff interacting with people in a polite, kind and caring manner. We saw that people's independence was promoted.

People we spoke to told us that they were happy with the care and support they received. They told us they were able to express their views and could make choices about the care they received. We were told by one relative that the home was family focussed. They said "you could not get a happier team." Another told us that they felt the staff were "dedicated."

We saw that each person who lived at the home had a plan of care which detailed their needs and wishes. The plans included their physical, social and healthcare needs. We found that the home worked with a variety of healthcare professionals in order to meet people's needs. These included the speech and language therapist and mental health team.

Staff we spoke to told us they received the training they needed to do their job. We found that whilst training was provided some gaps were identified.

The home had processes in place to monitor the service provided to people who lived at the home. Records showed that regular audits relating to the management of people's medication, care plans and people's weights had been undertaken. We saw that the home also had a system in place to record accidents and incidents.

People able to comment about their care told us they had been asked about the care they needed and were aware that information about the support they needed had been documented. They had mixed views about being involved in the planning of the support they received, but said that changes to their care were made as they arose. People said they received the care they needed. They said that the standard of care was good and their choices were respected.

People told us that staff respected their privacy and dignity. For example, one person said staff were “good natured and always polite”. People’s independence was encouraged and personal choices were supported by staff. Examples we received included decisions about whether to join in activities, where to eat meals, and where in the home people wished to spend their day. They said that staff were available when they needed them and they were warm and comfortable in the home. They were also positive about the food they received, the regular activities provided by staff and external visitors, and the cleanliness of the home.

People told us they raised issues or concerns as they arose with the manager or the staff and that their concerns or issues were addressed.