This inspection took place on 18 and 24 October 2018 and was unannounced.

Eden 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 home is registered to provide accommodation and personal care for up to 21 people and there were 18 people living at the home at the time of the inspection. Eden House is a detached older property which has been extended and adapted to be suitable as a care home. There is a passenger lift so people can access the first floor. Most bedrooms were single rooms and all had ensuite facilities. Communal areas included a lounge and dining room. Around the home there were other quieter areas where people could sit should they choose to do so. An enclosed garden was fully accessible for people.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the overall 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.

The provider had arrangements in place to protect people from risks to their safety and welfare.

Arrangements were also in place to store medicines safely and to administer them according to people's needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams. At the end of their lives people received the care they required to remain comfortable and pain free.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. New staff received appropriate training and arrangements were in place to ensure other staff completed required update training. Staff felt supported by the management team.

Staff were aware of the need to gain people's consent to their care and 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 supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They could make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People and visitors found staff to be kind and caring. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people's individuality, privacy, dignity and independence. The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

Care and support were based on plans which considered people's needs and conditions, as well as their abilities and preferences. Care plans were adapted as people's needs changed, and were reviewed regularly.

People could take part in leisure activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The registered manager and provider acted where these systems found improvements could be made.

This inspection took place on 4 February 2016 and was unannounced. The home provides accommodation and personal care for up to 21 people, including people living with dementia or other mental health needs. There were 19 people living at the home when we visited.

There was a registered manager at the home. 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.

Eden House had a strong, visible person centred culture. Innovative ways were used to ensure people were supported and encouraged to be as independent as possible and able to live the lifestyle they choose. Staff and management were fully committed to finding innovative ways to improve the service. They reflected on their practice finding novel ways to improve the care and support people received.

People, relatives and external health professionals were positive about the service people received at Eden House. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly. A range of activities were offered with people able to choose to participate.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Staff offered people choices and respected their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program in progress.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager and provider’s representatives were aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.

Eden House can accommodate up to 21 people. At the time of our visit we were informed that there were 21people living at the home. We looked around the home which was clean and free of unpleasant odours. All but one of the bedrooms at the Eden House were single occupancy. The bedrooms had their own ensuite toilets and hand basins. The home had recently been redecorated using bright colours to define areas to make the home dementia friendly and help people locate where they were in the home. We saw that individuals had personalised their room with photographs, books, TV’s and pictures. There was a lift so people could access the first floor.

During our visit we spoke with two people who used the service and five members of staff including the registered manager. We also spoke with two visitors who visit the home regularly. Due to the nature of people’s dementia we were able to obtain limited feedback. We observed how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

One person told us that the home was “good” another person told us that they were “happy”. A relative we spoke with told us that the staff were “kind to their relative” and that they “couldn’t be in a better place”. Another visitor told us that “the staff were wonderful” and they looked after the person they visited very well.

We saw that care plans were person centred and all aspects of people's care needs were reviewed. People's assessment of care needs looked at their goals and support required. We found that the home had processes in place to regularly monitor the quality of the service.

We spoke with people who lived at the home. We also spent some time in the home’s main lounge observing people and the way they were cared for.

We also spoke with visitors and following the visit to the home we telephoned some more relatives to obtain their views about the service provided.

We spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met. Professionals were complimentary about the way the service met people’s physical and cognitive needs.

Everyone we spoke with confirmed that people’s privacy and dignity were maintained at all times and that people were able to make day to day decisions such as what time they got up and how and where they spent their time.

We observed that people were enjoying their lunch time meal and those able to respond told us meals were good and that alternatives were provided.

People said that they had no concerns about how their personal care needs were met. They also told us that if they were unwell then staff would contact a doctor for them. We were also told that staff were available when people needed them and knew what care they required.

Visitors said that they felt staff were available whenever their relatives needed assistance. They also said that staff were very pleasant and had the necessary time to meet people’s needs.

People and relatives said that if they had any concerns or complaints they would raise these with the manager. Nobody had any concerns when we spoke with them.

On this occasion we checked to see if Compliance Actions made in our last Compliance Review report had been addressed. We received limited information from people using the service about the outcomes we were reviewing but observed friendly and caring interactions between staff and people when we visited. Further information is available in the previous review of compliance report.

We talked about cleanliness with one person living in the home who thought that the home was regularly cleaned. One person told us they were comfortable living in the home. Another told us that they liked the staff member who was helping them.

A visitor said that they thought the home was always clean and they, and their relative living in the home, were happy with the care provided. Another relative raised some concerns about whether adequate support was provided and this was followed up by the provider.

Care staff told us that cleaning schedules had been revised and changes in cleaning staff had improved the cleanliness of the home. Care staff had taken on more responsibilities for monitoring cleaning activity. They confirmed they received training in dealing with behaviours, including restraint. Sufficient numbers of staff had received the training to cover each shift.

People living in the home told us that the care from staff was good. They said that the care staff were friendly and met their needs. One person said “I have no complaints at all”. They said that the home is comfortable and clean and equipment needed is provided. One person said they were very happy in the home and two people told us they felt safe. People told us that staff listen to them and involve them in conversations. They talked about the pendants and call bells provided for them to summons assistance. They said that help arrived promptly.

We spoke with visitors to the service, a relative and a friend, who told us that they viewed the care provided in the home favourably and gave us examples of care and health needs that had been addressed by staff. One told us that some staff are particularly helpful and approachable and that any matters they raised were addressed.

Information from visiting care professionals included comments that the management acted professionally. Another care professional told us that the service keeps care plans up to date and requests support and advice regularly. A third care professional told us they had recently given advice about a care plan and this had been followed up by the manager.

Staff told us they received training in safeguarding adults and that training had last been provided to them in January 2011. Staff were aware of the types of abuse that can occur in a care home setting and said that they would tell management if they had concerns. They were also aware of how to contact the social service safeguarding office. They told us that they receive regular training and support to do their work.