Exmouth House provides care and accommodation for up to 31 older people who are living with dementia. At the time of the inspection there were 31 people living in the service.

Some of the people who lived in the home had limited communication therefore we spent time observing the care and support they received.

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.

At the last inspection, the service was rated Good overall. At this inspection we found the service remained Good in all areas.

Why the service is rated good.

People said; “Oh yes the staff are very caring. Always help me when I want them to.” Another person said; “Everything is very nice here” and a relative said; “I’m very satisfied with the care Dad gets.”

People remained safe at Exmouth House as they received their medicines safely. People able to, visitors, relatives and staff told us there were sufficient staff to meet people’s needs. Risk assessments were completed to enable people to retain as much independence as possible. People received care with minimum risk to themselves or others.

People continued to receive care and support from staff who were well trained and competent. Staff had the skills and knowledge required to effectively support people. 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. People's healthcare needs were monitored and people were able to access a wide range of healthcare professionals according to their individual needs.

People, relatives and visitors all agreed that staff were kind and very caring. One relative said; “Staff are very caring.” There was a busy and friendly atmosphere in the service. People's privacy was respected. People where possible, or their representatives where appropriate, were involved in decisions about the care and support people 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. Complaints were fully investigated and responded to. A relative said; “Never had to raise any concerns- never. If I had any concerns I know they will help me.”

People were assisted to take part in a wide range of activities according to their individual interests. Entertainers visited the service and trips out were also planned for people.

The service continued to be well led. People, relatives, visitors and staff told us the registered manager and management team were very approachable. The registered manager and provider sought people's views to make sure people were at the heart of any changes within the home. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

Further information is in the detailed findings below.

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?

This is a summary of what we found.

The inspection was unannounced and took place over eight hours. We spoke with nine people living at the home and five visitors. We also spoke with the registered manager and twelve staff members about their roles and responsibilities

On the day of our inspection there were 30 people living at Exmouth House.

Is the service safe?

We found the service was safe because the registered manager ensured there were staff on duty with the appropriate qualifications, skills and experience required to ensure people’s needs were met. People who used the service told us that staff were not rushed and had time to meet their needs. Comments included “There are enough staff here; they look after me very well.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLs). For example they told us they had applied to the local DoLS team to restrict the liberties of one person living at the home in line with Deprivation of Liberty Safeguards legislation.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw there was a choice of suitable and nutritious food and drink available in sufficient quantities.

The homes medication management was robust and protected people from medication errors.

The home was clean and had processes in place to maintain a hygienic environment. We found the home to be clean and free from offensive odours.

Is the service effective?

This service was found to be effective because people told us the service supported them in a way that suited their personal needs and maintained their quality of life. All of the people we spoke with were very happy with the care and support provided. They told us, “Everything is good here, I can’t think of anything bad” and “Staff are excellent here, wouldn’t change a thing” and “I love coming to the home, I feel part of the family” and “I am very happy here”.

Staff told us the provider arranged relevant training and support to help them meet the needs of the people they supported.

People’s health and care needs were assessed and their care plans and assessments were reviewed monthly. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking with people and staff that they had a good understanding of people’s care and support needs and that they knew them well.

Is the service caring?

We found the service was caring. People were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave reassurance and encouragement when supporting people. We saw when staff used equipment to support people with their mobility; they appeared competent and clearly explained what they were going to do. They kept the person informed of what was happening and reassured them through the process.

There were good communication systems in place to ensure staff were updated on people’s changing needs.

We saw people’s social needs were met as there were opportunities for people to be engaged in activities.

Is the service responsive?

We found the service was responsive because the service had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and the provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they knew how to make a complaint if they were unhappy. We saw two complaints which had been acted upon promptly and in line with the homes complaints policy and procedure. People can therefore be assured that the home acted upon complaints, which were investigated and action was taken as necessary.

Is the service well-led?

We found the service was well led. The registered manager had been in post for a couple of years and was registered with the Care Quality Commission (CQC). We saw there was good team work at the home. Staff and visitors told us they had confidence in the registered manager and were able to approach her if they had any concerns. Comments included “We are well supported by the manager” and “The ethos of the home is on clients and staff wellbeing”.

The provider’s area manager undertook a monthly compliance visit and supported the registered manager. This showed that they worked with the registered manager and the staff to ensure the standards that people expected at the home were maintained.

This was a planned inspection. We also followed up on concerns from our inspection on 12 October 2013. During that inspection our concerns included people not being treated with respect or dignity. Care and welfare needs not being met. This included not having regular drinks or food. We had concerns about manual handling practice and concerns about the homes quality assurance processes and records.

At this inspection on 19 April 2013 the home had made significant improvements. People were treated with respect. Staff acknowledged people and made time for them. Staff sat with people, talked with them and went through reminiscence.

People were offered choices of food and drink and asked if they liked the food and drink that they were given. Staff were empathetic towards people and took time to listen and determine how people felt based on their body language.

Staff regularly walked around the home and asked each person how they were. People told us that they felt safe. The staff described types of abuse to us and what they would do if abuse occurred. All staff had received training in safeguarding. The home had a current safeguarding policy in place.

The home had comprehensive quality assurance systems which included regular visits and support from a regional manager. Regular staff meetings and management meetings had been held. Service quality was discussed and plans to improve quality reviewed. The homes records were in the process of being developed and improved.

This inspection was a follow up to a Warning Notice that we issued to the home on 05 November 2012 in relation to consent to care and treatment. We found that the home had made improvements.

Observation was used to assess the interaction and engagement between staff and people living at the home. We talked with three people that lived at the home and four staff. We looked at four care records.

People living at the home told us that they were happy living there and staff were very kind and friendly. We observed positive interactions between staff and people living at Exmouth House and saw that people were involved in their care.

We found that the home had communicated with GPs to obtain mental capacity assessments for significant decisions including end of life care. We observed staff respected the rights and dignity of people with advanced dementia.

We found that all of the staff had received additional training in safeguarding, dementia care and use of the Mental Capacity Act (2005). Staff were able to describe when and how they obtained consent from people living at the home.

We found that the service still needed to make some improvements with their paperwork in relation to consent to care and treatment. This was because mental capacity assessments had not been regularly reviewed. Apart from the initial involvement of relatives, continued involvement was not evident from the care plans, care reviews or care records. The manager and provider agreed with this.

Because of the complexities of people's illnesses, most people living at the home were unable to express their views. Observation was used to assess the wellbeing and happiness of people, as well as speaking with them. We spent sixty minutes closely observing people. We talked with seven people that lived at the home, five relatives and six staff. We looked at four care records. We walked around the home and saw it was clean and tidy. The environment was welcoming and homely.

People living at the home told us that they are happy living there and staff were very kind and friendly. Relatives said they were very happy with the home and pleased with the care provided to their family members. We observed some good interaction between staff and people living at Exmouth House and saw that some people were offered choices.

Some people who use the service were not fully involved in decisions made about their care and treatment. We found that mental capacity assessments had not been completed for some significant decisions and some day to day decisions including personal care. We observed poor manual handling techniques. We observed staff not respecting the rights and dignity of people with advanced dementia.

During the inspection we had to intervene because we observed that one person with advanced dementia was left without having any drinks for three hours forty five minutes. We observed that two people were not engaged in any activities during this time and sat unattended.

We carried out an unannounced comprehensive inspection on 30 July and 3 August 2015. Exmouth House provides accommodation without nursing care for up to 31 people. On the first day of the inspection there were 25 people staying at the service with an additional person receiving treatment at the hospital.

We last inspected the service in June 2014, at that inspection the service was meeting all of the regulations inspected.

There was a registered manager who registered with the Care Quality Commission (CQC) in March 2015. A registered manager is a person who has registered with the CQC 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. Feedback we received from staff, visitors and health professionals was positive about the new registered manager and the changes which they had been made. They said the registered manager was approachable and fair and would listen.

People were supported by staff who had the required recruitment checks in place, were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

The staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People were supported to eat and drink enough and maintained a balanced diet. People and visitors were positive about the food at the service. People were seen to be enjoying the food they received during the inspection. People had access to drinks and snacks at all times.

People received their prescribed medicines on time and in a safe way. Staff treated people with dignity and respect at all times in a caring and compassionate way.

People were supported to follow their interests and take part in social activities. People at the service supported by staff, had planted hanging baskets. They had entered the Exmouth in bloom competition and had been given the first prize in the category entered.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. They were personalised and people where able and their families had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The premises were well managed to keep people safe. There were regular checks undertaken and emergency plans and a disaster plan in place to protect people in the event of a fire or emergency.

The provider had a quality monitoring system at the service. The provider actively sought the views of people, their relatives and staff. There was a complaints procedure in place and the registered manager had responded to concerns appropriately.