We carried out a comprehensive inspection on 17 and 24 August 2018. The first day of inspection was unannounced; we arranged the second day of inspection before we visited.

Gittisham Hill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Gittisham Hill House is registered to provide accommodation for a maximum of 39 people who require nursing and personal care. The home is situated near Honiton, Devon. The service specialises in the care of older people, most of whom are living with dementia. When we visited 36 people lived at the service, five of whom were receiving nursing care.

This was the first inspection of the service since being registered by the providers, RV Care Homes Limited.

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. Since the site visit we have been informed that the registered manager had been promoted within the organisation and is no long in day to day charge of the service. A new manager has been appointed and will be registered with the Care Quality Commission.

The service had an extremely positive culture that was person-centred, open, inclusive and empowering. People’s needs were supported by sensitive, compassionate and caring staff. Staff understood individual’s diverse needs and preferences and supported them to enjoy as much independence as possible. Staff respected people’s right to privacy and supported people to maintain their dignity. Comments included, “Carers are marvellous…will do anything for you…I would certainly recommend it” and “Staff try incredibly hard. They have got to know Mum, they are supportive and understanding. They make her feel relaxed…”

The provider was keen to improve the experience of people living with dementia. They had introduced an innovative approach to dementia care which was reflective of best practice guidelines. The new approach focused on wellbeing and comfort, learning and development, and the environment. Feedback and observations during the inspection showed the approach was having a positive effect on people’s well-being.

The registered manager provided strong leadership and support. People using the service, their relatives, staff and professionals acknowledged the improvements achieved since the registered manager’s appointment. The registered manager was developing a learning culture. Lessons were learnt when things went wrong and actions were taken to reduce the risks. Emphasis was placed on continuous improvement of the service and best practice. Working with a range of professionals meant staff’s practice was influenced by current best practice and research. People using the service were involved in decisions about the service. For example, taking part in staff recruitment interviews. The registered manager used effective quality assurance processes to improve the service.

People were protected against abuse and avoidable harm. People involved in accidents and incidents were supported to stay safe and action was taken to prevent further injury or harm. There sufficient numbers of staff available to meet any needs or requests quickly. Staff were recruited safely to ensure they were suitable to work at the service. People’s medicines were safely managed. The service was clean throughout and good infection prevention measures were in place.

The staff team were well trained and supported to have the skills to achieve good outcomes for people. People were supported to maintain their health