This inspection took place on 4 and 7 September 2017 and the inspection was unannounced. Hale Place Farmhouse provides personal care and accommodation for up to 13 older people with dementia. The service is located between two properties on the same grounds, both of which are operated by the same provider and managed as one service. There is also a domiciliary care agency and a day service run from the location but at the time of our inspection none of the people using the domiciliary care service were receiving personal care. As such we have not looked at the domiciliary care service or day service as part of this inspection. Most people at the service were living with dementia and those who did not have a formal diagnosis of dementia were living with other long term health issues that impaired their short term memory.

The service had three managers in post who were registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The service employed three managers and a deputy manager to oversee all areas of the business.

People and relatives were overwhelmingly positive about the service they received. Comments included, “It’s very good: excellent food, lovely people to care for us and listen to us, and we feel like we’re coming home when we come back here” and “ I would say that the standard of care and the way of dealing with people should be held up as a level that other care homes should aspire to.” Other comments included, “I would give them 100 stars and all the staff are so kind and caring. I honestly can’t fault it and they are all angels I’m 100% confident he’s wonderfully cared for.”

People received a highly person centred service that enabled them to live active and meaningful lives in the way they wanted. There were a range of varied and meaningful activities and people could still share their lives with their friends and families if they chose to.

There was an open, transparent culture and people were included in the running of their home. Staff spoke highly of the registered managers and their leadership style. The management team had positive relationships with the care staff and knew people well. The registered managers took an active role within the service and led by example.

People were kept safe. Staff understood the importance of safeguarding people from abuse and knew how to report any concerns. Risks to people's health, safety and wellbeing had been assessed and plans were in place, which instructed staff how to minimise any identified risks to keep people safe from harm or injury.

There were suitable arrangements in place for the safe storage, receipt and management of people’s medicines. Medicine profiles were in place which provided an overview of the person’s prescribed medicine, the reason for administration, dosage and any side effects.

There were sufficient numbers of staff employed to meet people’s needs and staff knew people well and had built up good relationships with people. The registered provider had effective and safe recruitment procedures in place.

People had sufficient food and drink to maintain their health and told us that they enjoyed the food. Relatives commented to us that the food was of a high quality, nutritious and to peoples tastes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff treated people as individuals and with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. People’s privacy and dignity w

At the time of our inspection, we found that care plans for people who used the service were individualised and contained details about people's daily routines, their health care needs and the support they required from staff. Risk assessments were in place to identify and minimise risks as far as possible for people who used the service.

We found that people who used the service received a written statement of the costs, terms and conditions of the care, support and accommodation they received from the provider.

We found that the premises where people lived were suitably designed and that the environment was comfortable and well maintained. We saw that people were supported to personalise their rooms according to their individual preferences and interests.

We found that systems and procedures were in place to recruit appropriately skilled and qualified staff, who were supported to provide the appropriate levels of care and support to meet people’s needs.

We found that the provider undertook regular checks and audits to monitor and assess the quality and safety of the service on an on-going basis.

People’s needs were assessed and care and treatment was planned and delivered according to their individual needs. Care plans gave staff guidance, which enabled people’s personal, social and health care needs to be met.

Staff received training and support, which helped them to meet the needs of people who used the service.

We saw that staff were patient and encouraged people to do what they could for themselves and allowed people time to voice their own opinions and views. We saw letters from family members, which contained positive feedback and praise for the care their relative received. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

People who used the service were protected from the risk of abuse. The provider responded appropriately to a potential safeguarding issue, which had been previously raised with the local safeguarding team for investigation.

We saw that staff supported people to make decisions and choices as far as possible.

One person told us “I get to go outside; I can do what I fancy really. I can sit with the others, or chat with the staff. I enjoy it here – I’ve got to know people.”

One other person said “Sometimes we go out in the garden, or to the club. We have fish and chips there too. I’m very happy. We had a trip to Eastbourne recently too.”

One person told us “We’re well taken care of here – I feel very safe.”

People told us they thought there was sufficient staff at Hale Place Farmhouse. One person said “Oh yes – there’s always someone to help”.

The inspection was unannounced and carried out by one inspector on 02 December 2014 and 04 December 2014. Hale Place Farmhouse is a period property that is registered to provide care and accommodation for up to ten older people living with dementia. Ten people were living there at the time of our inspection. The home is situated on the same site as a second home which is also owned and managed by the same provider. The two homes that share the same grounds also share other facilities including an office outbuilding, garden and laundry room. Staff work as one team across both locations during the day.

People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to with one to one support from staff.

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 was supported by two managers and each specialised in specific areas relevant to the management of the service. The registered manager was the owner and oversaw the quality assurance of the service. Another manager oversaw care and treatment and relevant documentation that were specific to people’s individual needs. Another manager oversaw the recruitment, training and management of staff. The managers worked closely together to ensure the smooth running of the service.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual and included risks when people were out in the community. Staff followed clear guidance to reduce the risk of harm whist ensuring people’s freedom was not unnecessarily restricted in any way.

There were sufficient staff on duty to meet people’s needs. Staff had time to spend supporting people in a meaningful way that respected individual needs. Staffing levels were calculated and adjusted according to people’s changing needs.

There were safe recruitment procedures in place.All staff were subject to a probation period and disciplinary procedures if they did not meet the required standards of practice.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

People lived in a clean and well maintained, warm and welcoming environment that was suited to meeting their needs. People’s own rooms were personalised to reflect their individual tastes and personalities. There were clear signs displayed to help people find their way around. Staff had a thorough understanding of infection control practice that followed the Department of Health guidelines which helped minimise risk from infection.

Staff knew each person well and understood how to meet their support needs. Each person’s needs and personal preferences had been assessed before they moved into the service and were continually reviewed. This ensured that the staff knew about and responded to their particular needs and wishes when they moved in and during their stay.

Staff used their training and skills to communicate with people in ways they could understand. Interaction between people and the staff showed that staff promoted people’s independence and protected their rights.

Staff’s training was renewed annually and staff received further training specific to the needs of the people they supported. Staff received regular one to one supervision sessions and an annual appraisal to ensure they were supported to carry out their role. Staff were supported to study and gain qualifications in health and social care.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). All care staff and management were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation.

Staff sought and obtained people’s consent before they helped them. One person told us, “The staff always check with me that it’s OK before they do anything”. When people declined, their wishes were respected and staff checked again a short while later to make sure people had not changed their mind.

The staff provided meals that were nutritious, in sufficient quantity and well balanced. People were able to have wine, beer, water or fruit juice with their meals. One person told us, “The food is really good”. One relative told us, “The food is unbelievable”. Staff knew about and provided for people’s dietary preferences and restrictions. People were supported by staff with eating and drinking whenever they needed this help.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People told us they were satisfied with the way staff cared for them. One person told us, “I really like the girls (Staff); they are like my own family”. Two relatives said, “We could not ask for better staff”.

People were able to spend private time in quiet areas when they chose to. People’s privacy and dignity were respected and maintained at all times.

Clear information about the service, the management, the facilities, and how to complain was provided to people and visitors. Menus and the activities programme were displayed in communal areas. A relative told us, “We got all the information we needed”.

People’s care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us, “We feel involved, they listen to us”. One of the managers told us, “It is vital to know the whole person who may no longer know themselves, to talk with all the people who know them, their likes and dislikes, so we can connect with them”. People were referred to health care professionals in a timely way. A G.P. told us, “They provide excellent care in all categories”.

People were at the heart of the service. The staff promoted people’s involvement with their community and took groups or individuals on outings and ensured they took part in attending special events to minimise social isolation.

A wide range of activities and outings that included innovative ideas was available. This had a positive impact on people’s wellbeing. People were kept occupied, entertained and their interest in what was going on outside of their routine was stimulated. “The activities on offer are fantastic, our Mum has never been so alert and stimulated by all that is going on, we don’t recognise her since she has moved in Hale Place”. The registered manager told us, “Our goal is to keep people as active as possible and prevent social isolation to enhance their wellbeing”.

People’s views were sought and acted on. People’s relatives were asked about their views when they visited the home and via an internet website. The service sent annual questionnaires to people’s relatives or representatives, analysed the results and acted on them.

Staff told us they felt valued and inspired under the registered manager’s leadership. The provider, the registered manager and staff had won several Great British Care Awards which are a series of regional and national awards throughout the UK.

The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.

The registered manager kept up to date with any changes in legislation that may affect the service, and participated in monthly forums with other managers from other services where good practice was discussed. They pro-actively researched specialised publications and websites to identify innovative ways to enhance people’s quality of life and introduced these to the service.

The registered manager and two other managers carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.