About the service: Fig Tree House is a residential care home that provides specialist care for up to 26 people with dementia who require personal care and nursing care. At the time of the inspection there were 24 people living in the home.

People’s experience of using this service: People, relatives and staff all felt the service was friendly and a nice place. People and relatives spoke highly of the support from staff and staff demonstrated a kind and caring approach.

The service worked in partnership with other professionals and records confirmed outcomes of these visits. The service was managed by a registered manager who was accessible and approachable.

The service was clean and people were encouraged to undertake tasks of daily living around the home and to access the community including walking the resident walk who was a big part of the home.

People received their medicines safely and when required although keys could be accessed by all staff.

People’s wishes were sought in relation to their care, care plans were personalised, individual and included people’s likes and dislikes and routines.

The service had various activities and people were seen to enjoy participating in them as they wished throughout the day.

The service had received various compliments and there was a complaints procedure in place. People’s, relatives, staff and health care professional’s views were regularly sought so that improvements to the service could be made.

People had access to snacks and drinks throughout the day and they had various meal options everyday which they could enjoy with something alcoholic should they wish.

Audits were in place to monitor the quality of the service and notifications and other legal requirements were being met.

Rating at last inspection: Good (August 2016)

Why we inspected: This was a planned inspection based on the previous rating. The service’s rating remained Good.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

The inspection took place on 18 August 2016 and was unannounced. There were 26 people living in the home at the time of our inspection. At our previous inspection in January 2014, we found that the provider was meeting the regulations in relation to the outcomes we inspected.

Fig House provides accommodation and personal care and support for up to 26 older people living with dementia. Accommodation is arranged over two floors in a large building, which has been converted and adapted for use as a residential care home, plus a large extension. The home has 26 bedrooms of varying size, of which all have an en-suite facilities. There is a range of communal spaces including lounges, dining room and sitting areas. Toilet and bathroom facilities are dispersed throughout the building. The home is situated in a quiet residential area of Weston Super Mare.

The home has a registered 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 2008 and associated Regulations about how the service is run.

People and their relatives spoke of the quality of the care delivered. They told us that staff went above and beyond to ensure they received a person centred service.

Staff maintained people’s privacy and dignity ensuring that any care was carried out in private.

We saw that interactions between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion.

We observed that staff knew and understood the people they cared for and ensured that people were provided with choices in all aspects of daily life. Comments made included; “The care my loved one has received has been second to none; the staff are incredibly attentive and genuinely create relationships with the residents.”

Staff were well trained and used their training effectively to support people and assist them with their daily life and help them wherever possible to retain their independence.

Staff told us that the provider had developed some extra training events for staff to enable them to gain knowledge and skills to enhance the lives of people who were living with dementia.

Staff were able to demonstrate an excellent understanding and knowledge of people’s support needs to ensure people’s safety and protect their human rights.

Staff went through a vigorous recruitment process before starting work. As part of the recruitment process, the provider used value based recruitment techniques, a clearly defined culture statement and staff competency assessments.

People received their medicines as prescribed by their GP. Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions.

There was a well-structured relationship with the local GP’s and District Nursing Team. Staff told us that this assisted them to discuss any issues relating to people’s health and well-being and to assist with regular health checks such as blood pressure readings ‘without fuss’.

Staff were attentive to people’s appetites and ensured that people were provided with a meal of their choice. Special diets were catered for. A choice of two meals was presented to people at meal times and they were able to choose what they wanted at that time. Menus were in place in the dining areas of the home so people’s relatives and friends could see the meals provided.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences.

The experiences of people were positive. Staff had good relationships with people and were attentive to their needs.

Activities were arranged to suit the preferences of the people.

Staff respected people’s privacy and dignity at all times

We spoke with two people who use the service, three relatives of people who use the service, two members of staff and the manager as well as observing activity within Fig House. We also read records and procedures relating to the management of the home.

We saw that people were respected and that their care needs had been planned in a personalised way and that they had been regularly reviewed. One relative told us "Everything is first rate here, I cannot fault it" and another told us "I wouldn't have my relative cared for anywhere else".

We saw evidence of staff training and the two members of staff that we spoke with confirmed that they had received training and felt competent and supported to perform their role. One member of staff told us "I love my job and enjoy supporting the people living here and their relatives". We saw evidence that staff had been trained to protect people who use the service from abuse and the two members of staff and the manager all demonstrated an excellent knowledge of signs of abuse to monitor for and how to report them.

We saw that the provider sought feedback from people who use the service and their relatives and that there were systems in place to monitor the quality of service provided.

Some people who lived at the home were unable to fully express their views verbally because of their dementia. We therefore spent time observing care practices and talking with staff as well as speaking with people who lived at the home.

People who were able to express their opinion said that they were well cared for. One person told us “they look after you well.” Another person commented “I would recommend this place, I always get help when I need it and we have some fun.”

During the inspection we noted that people were treated with respect and dignity. We saw that staff interacted with people in a friendly and polite manner. People spoken with said that staff who supported them were always polite.

There was a very calm and relaxed atmosphere in the home. People appeared very comfortable with the staff who supported them. People said that they felt “safe” at the home.

Throughout the inspection we observed that staff appeared competent in their roles and well motivated. All staff displayed a good knowledge of the needs and preferences of the people they supported.

People who lived at the home were complimentary about the staff. Comments included; “They are all so kind,” “staff are very nice and definitely kind” and “they make sure that you are always happy and comfortable.”

Visitors asked said that they had no complaints but would be able to raise any concerns. One visitor said “the staff always have time to listen to residents and visitors."