Frith House is a residential care home for 83 people. The home specialises in the care of older people including people who have a dementia. The home is divided into two parts. The residential part of the home is able to accommodate up to 53 people. The area of the home which cares for people living with dementia is part of the Somerset Specialist Residential Care (SRC) scheme. This means people living in this part of the home are supported by a specialist NHS community nurse on consultancy basis.

At the last inspection, the service was rated Good.

At this inspection the service had improved to Outstanding.

Why the service is rated outstanding

People felt safe at the home and with the staff who supported them. One person said “I am safe here because I get good care, and staff are on the ball, they know what to do and take action when necessary.” A visiting community specialist dementia nurse told us, “Staff members are very good at raising safeguard alerts, they are able to make their own decisions and they are always appropriate”.

There were sufficient staff on duty and recruitment procedures were safe. People received their medicines as prescribed and infection control practice reduced associated risks to people.

People and their relatives told us they felt that the care received was effective. Care was delivered by staff who had received appropriate training to undertake their role. Staff were also supported through appraisal and supervision. The service had appropriate systems to monitor the applications and authorisations for people being lawfully deprived of their liberty. People were supported to eat and drink sufficient amounts and external healthcare professionals were consulted when needed.

People and their relatives said the service was caring and compliments had been received to reflect this. Staff were observed being caring and supportive towards people and knew the needs of the people they cared for. People were supported to have a dignified death in accordance with their wishes. People and relatives told us staff went above and beyond what they expected of them.

The service ensured they were responsive through a comprehensive pre-admission procedure. People and their relatives were involved in care reviews and care records were personalised. People were supported with their hobbies and interests and the service gave examples of how they had gone the “Extra mile” to improve the quality of some people’s lives. There was a system to ensure complaints would be listened to.

People, their relatives and staff commented positively on the leadership of the service. There were systems to seek the views of people and staff, and additional systems that ensured key messages were communicated. There were governance systems to monitor the health, safety and welfare of people.

The registered manager was passionate about improving the experiences for people living with dementia. She belonged to a number of steering groups to look at innovative ways of ensuring people experienced positive outcomes.

The home had been involved in research with Exeter University. Called “Calmer by Nature.” This involved playing nature DVD’s of rabbits, water running, wind in the meadows, at times of the day when people living with dementia may be unsettled. This meant they were leading the drive to improvement within the organisation.

The registered manager told us they aimed to create a, “homely, comfortable atmosphere. A place where people can do what they want, when they want and we work for them.” Throughout the inspection we saw the registered manager’s vision being put into practice by all staff in the home. Staff waited for people patiently and people were supported to be as independent as possible.

Further information is in the detailed findings below

Some people who lived at the home were unable to fully express their views to us verbally because of their dementia. Therefore in addition to speaking with people who used the service, we also observed care practices and spoke with staff and visitors.

People who were able to express their views said that they were able to make choices about their day to day lives.

Throughout the visit we observed that staff assisted people in a kind and caring manner. We saw that support was offered to people in a way that respected their privacy and dignity. In the areas of the home which cared for people who had a dementia we were particularly impressed by the patient way staff prompted and encouraged people to maintain their independence.

All areas of the home were well decorated and maintained. All communal areas were accessible to people with all levels of mobility including wheelchair users. The home had incorporated research about enabling environments for people with dementia into the décor and design.

Staff personnel files gave evidence of a robust recruitment process which ensured that new staff had the relevant skills and were of good character. The recruitment procedure also minimised the risks of abuse to people who lived at the home by making sure all staff were thoroughly checked before beginning work.

There were systems in place to effectively monitor the quality of the service offered and ensure the safety of people who lived at the home.

Frith House was divided into two parts. The main part of the home had 53 beds and provided personal care to older people. The smaller part of the home provided specialist care to people who had a dementia. During the inspection we visited all areas of the home. Many people who had a dementia were unable to fully express their views. Therefore in addition to speaking with people we spent time observing care practices and speaking with staff and visitors.

People spoken with felt that their privacy and dignity were respected. During the inspection we observed that staff spoke to people in a kind and friendly manner. We saw that where people required assistance this was provided in a discreet and sensitive way to protect people’s dignity.

People felt that they were able to make decisions about all aspects of their day to day life and their care. One person told us “You can do what you like, there are no restrictions” another person said “Obviously there has to be some organisation but it is very flexible around your own routines.”

In the part of the home that cared for people with a dementia we saw that people were able to choose what time they got up and how they spent their time. We observed that some people chose to have a late breakfast and food options were shown to them to enable people to make choices.

People spoken with were very happy with the care that they received. Comments included “We are being well looked after,” “The way they look after you is excellent” and “I’m well cared for; if there is anything I need I only have to ask.”

We were told that people had their needs assessed before they moved to the home to ensure that it was the right place for them. One visitor told us that they had felt fully involved in the assessment of their relative and had had opportunities to make suggestions about what may help their relative to settle into their new home. One person who lived at the home said “They go through everything with you at the beginning to make sure that you get the help you need.”

We observed lunch being served in one area of the home. People were given choices of food and drinks and second helpings were offered. We observed that people were supported to help themselves to vegetables and condiments. Where people required prompting or physical assistance to eat their meal this was provided in a dignified manner.

In all areas of the home we observed that staff interacted with people in a friendly and polite manner. There was a calm and relaxed atmosphere and everyone appeared very comfortable with the staff who supported them. One person told us “Staff are always very polite, I never hear anyone complaining.” Another person said “They all smile and will do anything you ask quite happily.”

Everyone asked said that they would be comfortable to approach a member of staff, or the manager, if they had any worries or concerns. People said that they were confident that any concerns would be taken seriously and fully investigated. One person said “I would complain if I needed to and I know something would be done.”

People living at the home were very complimentary about the staff and management. Comments included; “They know what they are doing, I think that they must have good training for the job” and “The staff are marvellous.”

Frith House is split into two parts, the main home and a smaller area, called Petals, which cares for people who have a dementia. We visited all areas of the home and observed that people were able to choose how and where they spent their time. Some people spent time in communal areas whilst others preferred the privacy of their own rooms.

People living at the home said that they were very happy with the care they received. Comments included “The care is very good” and “They take care of you very well.” Everyone asked said that they were able to make choices about their day to day routines.

People said that they were able to be involved in the creation of care plans and in there review. One person said “Staff are always checking with you that you are happy with everything.”

There are organised activities in the home everyday and people are able to choose which, if any, they join in with. One person, who said they liked to spend most of their time in their room, said that the staff told them what was on so they could join if they wanted to. Another person said “I join in with the skittles and some arts and crafts but I prefer my own company.” In Petals we observed that care staff spent time talking and reading to people who had chosen not to take part in the days’ activities.

There were several compliments about the food in the home and everyone agreed that there was always plenty to eat and drink. One person asked said the food was “Out of this world.” People said that they were able to make choices about their meals and we observed that alternatives were offered to people who did not want anything from the menu.

People said that staff assisted them to access healthcare professionals from outside the home. One person said that they staff were “Very good if you are unwell.” Others said that staff arranged appointments with other health and social care professionals.

Everyone thought that the home was comfortable and people said that they were able to personalise their bedrooms. One person describes the home as “A home from home.” There were several compliments about the cleanliness of the home and people living at the home praised the staff who maintained everywhere to a high standard.

Throughout our visit there were many compliments about the staff. People described staff as “Kind and helpful,” “Always willing to help” and “Good listeners.”

One person living at the home said “The best thing about living here is being safe.” This person said that staff were always kind and helpful and they felt that they could talk about anything. Other people living at the home also said they felt safe and well cared for. People said if they had any complaints they would be comfortable to talk with staff. All felt that any issues would be addressed.

People felt that there were adequate numbers of staff on duty at all times. People said that staff responded promptly if they requested assistance and they never felt rushed by staff. One person said “There’s always someone to help you, day and night.” During the visit we noticed that staff responded to people whenever they asked for assistance and call bells were answered quickly.

One person said “The staff do everything to make you feel at home.”

This inspection was unannounced and took place on 21 & 22 April 2015.

Frith House is registered to provide personal care and accommodation to up to 83 people. The home specialises in the care of older people including people living with dementia. The home is divided into two main areas. The residential part of the home is able to accommodate up to 53 people. The area of the home which cares for people living with dementia is part of the Somerset Specialist Residential Care (SRC) scheme. This means people living in this part of the home are supported by a specialist community nurse on consultancy basis. The SRC unit is able to accommodate up to 30 people.

There is 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 was supported by two deputies, one took a lead role in the residential area and one in the SRC unit. People using the service, visitors and staff all felt the management team were open and approachable. Staff felt well supported and people felt able to share their experiences and concerns.

The registered manager sought people’s feedback and took action to address issues raised. In response to the poor attendance at organised meetings for people who used the service, the registered manager had introduced tea and chat afternoons. One afternoon a month the registered manager made themselves available in a large room and served afternoon tea. Everyone in the home received an invite and this had resulted in much better attendance.

Staff were happy working at the home and felt well supported by their colleagues and the management team. This created a friendly and warm atmosphere for the people who lived there. Many people commented on how kind and caring the staff were and we saw many examples of kind and compassionate care.

People were treated as individuals and were enabled and encouraged to make choices about all aspects of their daily lives. One person said “I make my own decisions about the way I live my life here.”

People told us staff assisted them to maintain their independence. One person said “The staff help me when I ask but they don’t mollycoddle me like a child.” Another person told us they liked to go out and about and there was a risk assessment to enable them to do this.

There were sufficient numbers of well trained and competent staff to meet people’s needs including specialist needs. Visiting professionals told us the staff were pro-active in seeking advice to make sure people’s healthcare needs were met.

The risks to people were minimised because the provider had a robust recruitment procedure and ensured staff received training on recognising and reporting abuse. All staff knew how to report any suspicions of abuse and felt confident action would be taken to make sure people were kept safe.

There were systems in place to make sure people received medicines safely from staff who had received specific training. Support was given to people who wished to administer their own medicines.

People had their needs assessed and were involved in regular reviews of their care. Changes were made to people’s care as needs or wishes changed. Where people lacked the mental capacity to make decisions about their care and support the home involved appropriate representatives in line with legal guidelines.

People told us they were happy with the food provided and said they were able to make choices about food and where they ate their meals. Specialist diets were provided in accordance to people’s assessed needs.