Endeavour Residential Home provides accommodation to a maximum of 20 people who require support with personal care. The provider is Endeavour Residential Services Limited. At the time of this inspection there were 19 people living there.

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

Why the service is rated Good

People remained safe at the service. There were sufficient staff available to meet people's needs. Risk assessments had been completed and actions taken to minimise harm. People received their medicines safely. A relative told us “It absolutely is the best place for [person’s name]. It couldn’t be more homely. It’s wonderful. She’s happy. We don’t have to worry anymore.”

The service had 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. Comments from people living in the home and their relatives included, “The one in charge is lovely!” and “They always seem well organised.” A visitor told us “In my experience of homes in Exeter, this one is excellent! It is an absolutely lovely place to live. I’ve been very impressed.”

People continued to receive care from a stable and consistent staff team who had the skills and knowledge required to effectively support them. Staff were competent and well trained. People's healthcare needs were monitored by the staff and people had access to healthcare professionals according to their individual needs. Staff were well supervised and supported.

People received a varied and balanced diet to meet their individual nutritional needs and preferences. Each person’s dietary needs were known and understood by all of the staff team, clearly documented in care plans. Staff made sure people were eating and drinking enough throughout the day, and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff were caring and people had built good relationships with the staff. We observed staff being

patient and kind, and they clearly understood how people liked to be cared for. People's privacy was respected. People and their families were involved in decisions about the care and support people needed. There was a strong emphasis on equality and diversity, and treating people as unique and much loved and cared-for individuals. A relative told us, “The staff are so wonderful. The most lovely care. They make it seem every person is so special. They seem to have so much time for everyone.”

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices as far as possible in their day to day lives. There had been no formal complaints since the last inspection and the complaint process ensured any complaints would be fully investigated and responded to. Each person’s social needs, interests and preferences had been carefully assessed. Staff provided each person with the support they needed to enable them to lead interesting and fulfilling lives. People were offered a wide range of activities, outings and opportunities to participate in daily routines in the home. .

The service continued to be well led. People and staff told us the registered manager was approachable. The provider visited regularly and always spoke with people living in the home, visitors and staff. The registered manager/provider sought people's views to make sure people were at the heart of any changes within t

We carried out this inspection to follow up on a compliance action we issued following our inspection of 13 June 2014. The new provider had taken over running of the home in March 2014 and some of the areas highlighted for improvement were historical. At the June inspection we identified infection risks at the home. This was because the arrangements for hand hygiene were inadequate, and because general standards of cleanliness and the management of laundry did not meet the standards required by the Department of Health Hygiene Code. This meant people were at increased risks of infection and improvements were needed. Following our visit, the provider told us they took immediate steps to seek further advice about infection control issues. We also received a very comprehensive action plan. When we visited in September 2014 we found that all the actions had been taken and there were no concerns with infection control and hygiene.

There were 20 people living at the home with one person in hospital at the time of our inspection. We spoke with the registered manager, two staff and two people living at the home. We also did a complete tour of the premises. We looked at records relating to infection control including policies and procedures, training and quality assurance.

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The systems in place to reduce the risk and spread of infection were effective. This was because the home had appropriate arrangements for staff hand washing, for cleaning and decontamination of equipment and for laundry management. The provider had also invested in new equipment and refurbished many areas of the home. Records showed there were clear systems in place to monitor hygiene and ensure staff maintained a high standard of cleanliness and followed infection control policies to keep people safe.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

On the day we visited 19 people lived at the home. Most people at the home were living with varying levels of dementia. The inspection was in response to a number of concerns raised with the Care Quality Commission. These included concerns about moving and handling practices, standards of personal care and general cleanliness, as well as concerns about people’s nutrition and hydration, pressure area care and medicines management at the home. A new provider took over running the home in March 2014 and this was the first inspection under new management.

We spoke with all 19 people who lived there and with three relatives and a visitor to seek feedback about the care provided and looked at five people’s care records. We spoke with eight staff who worked at the home. On the day we visited the registered manager was on leave but we spoke with them by telephone after their return and with the provider. We also received feedback from two health professionals that regularly visited the home. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found people’s day to day care was safe because staff knew people well and how to meet their needs. Where people's needs had increased a GP or other healthcare professionals were consulted. Staff supervised people closely and were available to assist, when needed

However, we identified cross infection risks at the home. This was because of the arrangements hand hygiene were inadequate, and because general standards of cleanliness and the management of laundry did not meet the standards required by the Department of Health Hygiene Code. This meant people were at increased risks of cross infection and improvements were needed. Following our visit, the provider told us they took immediate steps to seek further advice about infection control issues.

Is the service effective?

Our observations showed staff interacted well with people. Staff recognised and understood people’s non- verbal signals and responded to people’s needs appropriately.

We found staff worked in a very structured way with set tasks and care duties carried out at regular intervals. A bathing procedure displayed in one bathroom said, “The duration of the bath should not exceed five to 10 minutes”. Whilst this ensured people received regular care, these practices were not very individual or person centred. The environment of the home was tired and not very ‘dementia friendly’ in terms of decoration, colour schemes, and floor coverings. We spoke with the provider about this who told us they planned to undertake major refurbishment at the home. They told us they would seek further advice about those plans to ensure they met the specific needs of the people who lived there.

Is the service caring?

The service was caring and people appeared clean and well cared for. Care records we looked at showed people were regularly supported with personal care. We saw staff were caring and compassionate towards people and treated them with dignity and respect, with one exception. People who were able to give their views about their experience said they were happy at the home. One person said, “So far, it’s very good, I can do what I like when I like” and a second person told us the home was “comfortable”. Relatives we spoke to told us they were very satisfied with the care provided and how staff communicated and involved them in decisions about the person’s care.

Is the service responsive?

The service responded to people care needs in a timely way and staff noticed when people needed their help. We observed people being helped to the dining room although we saw some people waited in the dining room for between 20-30 minutes for lunch to be served. During this period, one person was getting very cross and another person kept leaving the table. Staff were alert to people’s mood changes and intervened to distract those people. On the day we visited, we found there wasn’t much happening for people as the activities co-ordinator was off sick. One person said, “I don’t like sitting doing nothing”. 18 of the 19 people who lived there spend all day in the lounge and dining areas. In the afternoon, staff played some favourite songs and engaged some people in throwing a soft ball.

Is the service well led?

We found people, staff, relatives and stakeholders views about the service had been sought. We spoke to the provider who told us about the improvements being made in response to that feedback. For example, changes and improvements to the menu and redecoration of the home and replacement of sanitary ware. This showed the provider took account of people's views to improve the quality of the service provided.

We found day to day leadership of staff was effective with regular staff meetings, daily handover and staff supervision. Staff told us they felt well supported by their manager who supervised staff regularly. Staff told us they were able to raise concerns and were confident they would be dealt with.

Endeavour Residential Home provides accommodation and personal care for up to 20 older people. The majority of people living at the home were living with some degree of dementia and so were not always able to tell us about their experiences directly. This service did not provide nursing care.

At the time of our inspection there were 18 people using the service. The service has a registered manager supported by a deputy 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 and associated Regulations about how the service is run.

People were well cared for, relaxed and comfortable in the home. There was a lively feel to the home with staff finding time to sit and chat with people. Everyone we spoke with complimented and praised the staff who supported them. People’s comments included, “The staff are brilliant, 100%.” One relative said “It’s a lovely place, they look after her very well.”

Care records were very detailed and personalised, up to date and accurately reflected people’s care and support needs. The care plans included information about peoples’ likes, interests and background and provided staff with sufficient information to enable them to provide care effectively.

We observed people were cared for compassionately and with respect. People told us “They [the staff] treat you like human beings. They listen to what you say.” People were cared for by an established, motivated and well trained staff team. The registered manager and provider provided effective leadership to the service. Regular residents’ and relatives’ meetings ensured people were involved in the running of the home. Staff were very visible and attentive, noticing when those who could not verbally ask for assistance required help. They responded to people with an understanding about their likes and dislikes, how they communicated and with reference to events such as bereavement or anxiety. Staff told us they felt the team was a family and clearly enjoyed their work and had detailed knowledge about individuals’ needs. They told us “I love working here” and “We have a great manager, we all work well together.”

The registered manager was well supported by the provider who lived outside the area. They visited the home regularly and there were many examples of investment. The provider was visiting during our inspection meeting with the manager and the staff. They were also very involved in discussing any complaints and responding quickly to any concerns.

People were able to go out with staff on organised trips or just to the shops or local eatery. Staff supported and encouraged people to engage with a wide variety of activities and entertainments available within the home. These were tailored to individual needs and capabilities and there were many examples of staff facilitating real friendships between people living at the home.

Professionals who worked regularly with the service told us, “It’s a really good home as far as I’m concerned. They are really doing their job properly. We work well together.” A GP said “I come weekly. They really know the people here and are very supportive. The manager is fantastic and can really see the humanity in people. They cope very well with some challenging situations.” The GP particularly praised the care people received at the end of their lives.