We inspected this service on 14 and 18 September 2017. The first day of our inspection was unannounced.

Galanos House provides accommodation and nursing care for up to 91 people. There are three units providing residential, nursing and care for those living with dementia. The unit for those living with dementia is called Poppy Lodge. There were 88 people living at the home at the time of our inspection visit.

There was a registered manager in post at the service. 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 our last inspection in March 2015, we rated the service as outstanding. At this inspection we found the service had continued to develop and further strengthened a very caring approach and the effectiveness, responsiveness and leadership of the home. People continued to receive excellent care in a community where they felt valued and had a sense of belonging.

Galanos House was exceptionally well-led. The registered manager, supported by the deputy manager, had a strong sense of providing people with an enhanced quality of life which took into account individual wishes and beliefs so each person was valued and treated with equality. This inclusive ethos enabled people to carry on living their lives, pursuing their interests and maintaining and building important relationships. The managers acted as role models for the staff team who were motivated to offer care that was kind, considerate and put people at the heart of everything they did.

The management team were proactive in driving the service forward to improve outcomes for people both within the home and the local community. They worked in partnership with key organisations, both locally and nationally, to support care provision, service development and joined up care.

The provider understood the need to provide staff with the skills, knowledge and tools to provide care that followed best practice. They had an improvement plan to invest in staff development so staff had the motivation and confidence to provide innovative care which promoted people's wellbeing and meant they had a meaningful life.

Staff treated each person as an individual and respected their life history and experiences. Staff knew about people and who and what was important to them and significant events in their lives. They focussed on the uniqueness of each person rather than labelling them with a diagnosis or condition. Staff were able to tell us how they used their knowledge of people to engage and respond to them to show they were valued and to make their lives better. Staff supported people to maintain relationships and build memories with family and friends who were important to them.

People had access to purposeful and meaningful occupation that was personal to them. People’s skills, knowledge and expertise were recognised, celebrated and encouraged.

The home had sufficient staff to meet the individual needs and preferences of the people living there. Staff were recruited after the provider had completed the necessary checks to make sure they were suitable to work at the home. Staff understood their responsibilities to raise any concerns they had about people through safeguarding procedures.

Care plans provided staff with information about risks to people’s health and wellbeing. Risk assessments took into account people’s individual needs and abilities and encouraged people to maintain independence where possible. Medicines were managed, administered and stored safely.

People were supported by staff who understood the principles of the Mental Capacity Act 2005. They gave people maximum choice and involved them in decisions about their care. By understanding people's history and motivations

We inspected this service on 17 March 2015. The inspection was unannounced. At our previous inspection in December 2013 the service was meeting the legal requirements.

There was a registered manager in post at the service. 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 service provides accommodation and nursing care for up to 90 people. There are three units providing residential, nursing and care for those with a diagnosis of dementia. There were 89 people living at the home on the day of our inspection.

The registered manager and deputy manager shared a common vision to provide a care environment where people were enabled to carry on living their lives, pursing their interests and maintaining their relationships. People were provided with stimulation and occupation by staff who demonstrated an understanding of the ethos the management team wished to promote. Every person who lived at Galanos House was seen as an important part of the community whatever their limitations. Friends, relatives, volunteers and people from the local community were welcomed into the home and encouraged to learn more about meeting the needs of people who lived there.

There was a team approach to ensure people’s health and wellbeing was maintained, with every member of staff who worked at the home considered an important member of the team. All staff, whatever their position, were provided with training that supported them to meet people’s needs. They had been trained to understand dementia as it was acknowledged that each one of them would have some interaction with people living with dementia as they carried out their role.

The provider had processes to support staff to carry out their roles safely and effectively and staff were encouraged to take further qualifications to develop their careers. People who lived at Galanos House were involved in the recruitment process to ensure staff had the right personal qualities and values to support them.

People spoke highly of the level of commitment and care provided by staff, and during our visit we saw there were enough staff to respond to people’s individual needs. Staff understood their obligations to report any concerns they had about people and told us they would feel confident to report any poor practice within the home. During the day we observed staff approached people with respect, dignity and friendliness which encouraged people to have meaningful interaction with them.

The provider took a positive approach to risk management and supported people as far as possible to continue to do the things they chose. Staff knew what people were still able to do and not just what they could not do.

Whilst most medicines were managed and administered safely, some records were not accurate and did not always follow good practice recommendations.

The registered manager understood their obligations under the Mental Capacity Act 2005. When decisions had been made about a person’s care where they lacked capacity, these had been made in the person’s best interests.

People’s health needs were monitored and they were referred to external healthcare professionals when a need was identified. There were processes to ensure people received sufficient to eat and drink and people were positive about the choice and quality of food. Snacks were readily available to encourage people to eat.

People were supported and enabled to participate in activities that were meaningful to them and encouraged to participate in activities of daily living such as gardening and cooking. There was a welcoming and positive approach to visitors and the wider community was involved in activities and events. Staff established relationships with people’s families and supported people to maintain relationships when they moved to the home.

Staff had a good understanding of people’s needs and preferences. Where people were at end of life, the service followed the Gold Standards Framework to ensure dignity was maintained. The manager and staff had a strong commitment to providing support to people and their family to ensure a person’s end of life was as peaceful and pain free as possible.

People told us they would raise any concerns or complaints with staff or managers. People were encouraged to share their views about the quality of service provided through regular meetings, groups and questionnaires.

The provider was a member of several good practice initiatives and worked with fellow organisations to develop innovative ways of supporting people, especially those with a diagnosis of dementia. The service had used guidance and research to provide an environment that stimulated interest and senses and kept people safe.

During our inspection of Galanos House we spoke with nine people who lived there, four relatives, six staff and the registered manager. Some people were unable to tell us their views due to their complex health needs. People who we were able to speak with told us they happy with the care they received and liked living there.

We observed a relaxed atmosphere in the home with lots of interaction between people who live in the home, the staff and visitors. We saw that staff were patient, helpful and respectful to people in the home. We found that peoples’ health care needs were being met. We looked at care records and saw that they were comprehensive and reflected the care given.

People we spoke with told us that they were consulted about their care and gave consent for procedures and treatment to be carried out. We looked at medications and found that they were stored and administered safely and recorded correctly. People told us that they received their medication at the correct time.

We found that there was a robust system of assessing and recording care and that records were stored correctly and securely and disposed of appropriately.

We carried out an inspection at Galanos House. The visit was unannounced so that no one living or working in the home knew we were coming.

Some of the people who lived at Galanos House were unable to express their views verbally, so we spent time observing how staff supported them. We were however able to speak with seven people who used the service to obtain their views.

We also spoke with two relatives, the senior nurse in charge of the nursing floor, the manager and four care staff on the day of our visit.

We saw consent to care and treatment had been signed by either the person who used the service or their representative.

People who used the service and their representative told us they had been involved in their care planning or that of their relative.

We saw people’s care files contained up to date information and these had been regularly reviewed.

People and their relatives told us they felt safe at Galanos House. They said “Care staff treat me with dignity and I definitely feel safe.”

We looked at training records and we saw not all staff had received training in key elements. The manager told us further training had been arranged.

We were told by care staff that they met regularly with their manager.

Systems were in place to monitor the quality of care at Galanos House. People who lived at the home were given the opportunity to discuss the day to day running of the home with the manager.

People we spoke with told us that they were extremely happy living at Galanos House and were very satisfied with every aspect of the care they received. People confirmed that they were encouraged to make personal choices and live their lives as independently as possible. People we spoke with said staff encouraged independence and offered people choices whenever possible. Comments included: “Staff will help with anything I want but it’s nice to do things yourself”.

We looked around the home and saw the home was comfortably furnished and well maintained. We saw that the food at breakfast and lunchtime was good quality, home cooked food. A number of people needed support to eat. We saw that that this was offered in an unhurried way. We observed staff interacting with people in a caring and respectful way. On the day of our visit people were appropriately dressed and looked clean and well cared for. We saw that people were spoken to in a friendly way by staff and that there was a pleasant calm atmosphere.

We spoke with staff about the care people received and observed staff when they provided support. Staff had a good knowledge of people's communication style and responded appropriately. People we spoke with praised the staff that cared for them, saying “they are all wonderful it’s a very nice place to live”. Some people we met were not able to express their views to us. So we observed interaction between people and care workers. We saw that people were relaxed with staff and were able to express themselves in words and gestures.

People we spoke with said that the staff were “excellent” and that the manager was “brilliant.” One resident said “It's a very good place to live, the next best thing to home". We observed staff interacting confidently with people, showing patience and understanding and encouraging people to be independent.

People we spoke with told us that they felt safe living at Galanos House and that the staff treated them very well. We observed that people looked relaxed and at ease with the staff who were giving them care and support. Staff we spoke with understood their responsibilities to raise concerns and how to keep people safe from harm. People told us they had information about making complaints and would talk to staff if they were unhappy with anything. One person told us, “I don’t have any concerns about the home. Actually I don’t want for anything, everything I need I get.” People told us they had resident meetings were they could voice their views and opinions about the home.