We carried out an unannounced inspection of Highlands Borders on 15 May 2017. Highlands Borders provides care and accommodation for up to 18 people who required accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 18 people were living at Highlands Borders.

There was a registered manager who was responsible for the home and had worked there for some time. The registered manager was on holiday at the time of the inspection so we were assisted by the deputy 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. The provider, Highlands Care Home Limited also ran another care home in Exeter and were in the process of buying a third home close by.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "It’s a lovely place, I never have to worry. I come regularly and I can join in and dance and sing with people.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. At the time of the inspection people were mostly relaxing, chatting and playing games in the large, airy conservatory or sitting at tables in the open plan dining area. They looked comfortable and happy to spend time in the large conservatory. People were encouraged and supported to maintain their independence. The majority of people living with dementia were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.

People were provided with good opportunities for activities, engagement and trips out. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or spent time in their rooms. Some people were spontaneously going out with a care worker to the high street close by or for a walk. The activity co-ordinator knew people well and engaged people in activities and games which suited them. For some people with limited understanding staff used smaller items such as ‘fiddle muffs’ or sensory items to touch and interact with when there was not an organised activity planned. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them. Most people preferred to spend time in the communal areas, including a smaller, quiet TV lounge.

People and relatives said the home was a safe place for them to live. Most people were living with a degree of dementia meaning they were not always able to tell us directly about their experience at the home. People looked happy and comfortable chatting with staff and each other. Staff knew people’s personalities and what they liked such as who liked to spend time with who. One person was able to tell us, "It’s like a hotel, I can do what I like. All the staff are really nice and there is a lovely manager. If I had a problem I could talk to them or anybody.”

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegati

Highlands Borders Care Home is a care home which is registered to provide care for up to 17 people. The home specialises in the care of older people but does not provide nursing care . There is a manager who is responsible for the home. They had applied and were currently going through the process to apply for registration with CQC. 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 and associated Regulations about how the service is run.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

People were well cared for and were involved in planning and reviewing their care or their relative was involved if they were unable to. There were regular reviews of people’s needs and staff responded promptly to changes in need. However, care records were being transferred to the new computer system which had meant that not all care records showed clear instructions to staff about how to meet people’s needs fully. For example, some instructions to staff were recorded in the daily records rather than the care plan. This meant their was a risk staff may not know about ong-oing care if this was not mentioned verbally in the shift handover .

People said the home was a safe place for them to live. Most people were living with a degree of dementia meaning they were not always able to tell us directly about their experience at the home. People looked happy and comfortable chatting with staff. One relative said the care at the home made them feel more relaxed as it was reassuring to know their relative was cared for so well. Another relative said the home was “even better than a home from home” and they had made many friends.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One relative gave an example where they had spoken to the manager about a concern which had been dealt with quickly and had not occurred again. They felt confident any issues were addressed.

People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had good knowledge of people including their needs and preferences. Staff were well trained; there were good opportunities for on-going training and for obtaining additional qualifications. Comments about staff included “I congratulate the manager for running such a good establishment. The staff are excellent.” And “I have nothing but admiration for the staff at Highland Borders”.

People’s privacy was respected. Staff ensured people kept in touch with family and friends. Where people had no close family staff ensured they spent time with that person and took them out regularly. Relatives confirmed they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private. One relative said “The staff make my relative feel at home. Nothing is too much trouble and they are so keen to help in any way they can”.

People were provided with a variety of activities and trips. People could choose to take part if they wished. During the inspection people were enjoying a beanbag game, going out to town and chatting with staff about music and Valentines Day. Staff at the home had been able to build strong links with the local community including regular visits to the local church, pub, shops and memory café.

There was a management structure in the home which provided clear lines of responsibility and accountability. The manager showed great enthusiasm in wanting to provide the best level of care possible. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. One staff member was moving further away but had wished continue to work at Highlands Borders “as it’s so lovely here”. The manager had taken into account travel time when organising their shifts to make this possible. Staff said they felt valued and always enjoyed coming to work.

There were effective quality assurance processes in place to monitor care and plan on-going improvements. There were systems in place to share information and seek people’s views about the running of the home. People’s views were acted upon where possible and practical. A comment from a relative in the 2014 quality assurance survey said “We cannot believe how lucky we were to find Highland Borders. Nothing is too much trouble for the staff who are caring and most of all give people time”.