About the service:

Fessey House is care home that was providing personal and nursing care to 32 people at the time of the inspection.

People’s experience of using this service:

• The provider demonstrated they had made significant improvements since our last inspection. We found the service had improved and met the characteristics of an Outstanding service in caring domain and a Good service in safe, effective, responsive and well-led. We received exceptional feedback on how staff supported people and went the extra mile to get care just right for people.

• The service was designed around people’s needs and wishes and used innovative ways to help people to be as independent as possible. Fessey House was divided into four colour coded units. Each unit had a kitchenette, dining area and sitting area. These units were decorated to a high standard with an emphasis on the building being people’s homes. Colour coordination was used to enable people to find their way in the home and to promote their independence. We saw people easily and freely navigating around the home independently.

• People were valued and respected as individuals allowing them to be partners in their care. There was an exceptionally strong ethos within the service of treating people with dignity and respect. People were at the forefront of the service delivery and the provider was committed to and passionate about providing a high-quality service.

• We received exceptionally positive feedback from all people and relatives. The feedback reflected staff were very kind, caring and committed. People complimented the continuity of care provided by regular staff which contributed to building of meaningful relationships. Staff exceeded in recognising what was important to people and ensured individually tailored approach that met people's personal needs, wishes and preferences was delivered. There was evidence the staff often went 'the extra mile' to meet people's needs.

• People were supported by exceptionally caring staff that knew them well and understood how to maximise their potential. People were supported to maintain relationships with their families and friends and the value of relationships was central to the success of the service. People's independence was highly promoted and they received support to achieve their goals.

•The service had a holistic approach to assessing, planning and delivering care and support. They looked for and encouraged the safe use of innovative and pioneering approaches to care and support, and how it is delivered. New evidence-based techniques and technologies were used to support the delivery of high-quality care and support. For example, the service was taking part in a pilot project called ‘My Sense’ which used technology to maximise safety to people whilst they were at the service as well as when they went back to their own homes.

• There was a thorough approach to planning and coordinating people’s move to other services, which was done at the earliest possible stage. Fessey House supported people requiring short term support in 'discharge to assess' beds which aimed at rehabilitating people back into their homes. This was a tailor-made service which consisted of dedicated care staff, social workers physiotherapists and occupational therapists.

•Staff were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care and support to people. The provider worked collaboratively with the local hospital, GPs and community teams. Fessey House had been recognised in the Health Service Journal (HSJ) Value awards and won both last year’s categories for improving value in the care of frail older patients as well as Improved partnerships between health and local government.

• People living at Fessey house received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff understood their responsibilities to identify a

We inspected this service on 29 November 2017. This inspection was unannounced.

Fessey House is registered to provide accommodation for up to 39 people. At the time of our inspection there were 36 people living in the service. Fessey House is divided in to four units. Two units provide support to people requiring short term support in ‘discharge to assess’ or crisis beds, the other two units provide long-term care for people with dementia. Fessey 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. Fessey House was taken over by a new provider, Swindon Borough Council, as of October 2016.

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. The registered manager worked closely with the deputy manager and the registered services manager.

Medicines were not always managed safely. However, people did receive their regular medicine as prescribed.

There were enough staff to meet people’s needs in a timely way. Fessey House had a low staff turnover resulting in an experienced staff team, who knew people well. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.

Risks to people’s well-being were assessed and managed safely to help them maintain their independence. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interest and legally authorised under the MCA. The authorisation procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Where people had their liberty restricted we found that DoLS had been appropriately applied for and authorised.

We found that people were supported in line with the principles of the MCA. However although staff told us they had received recent training in relation to the MCA decisions were not always recorded in line with the code of practice.

The provider’s systems and processes to monitor and improve the quality and safety of the service were not always effective in identifying areas for improvement. Accidents and incidents were recorded and audited. However, analysis documents did not allow for all trends to be easily identified.

People were supported by staff that had the right skills to fulfil their roles effectively. Staff told us that they received supervision (a one to one meeting with their line manager)' and that they felt supported by the management team.

People were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.

Staff worked closely with various local social and health care professionals, and we saw evidence of excellent multidisciplinary working. Referrals for healthcare were submitted in a timely manner.

People had their needs assessed before admission to ensure staff were able to meet people’s needs. People’s care plans gave details of support required and were updated when people’s needs changed. People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were enc