We carried out this inspection on 7 February 2017. It was an unannounced inspection. When John Wills House was previously inspected in July 2014, no breaches of the legal requirements were identified.

John Wills House is registered to provide nursing and personal care for a maximum of 80 people. At the time of the inspection there were 72 people living at the service.

The service comprised of two floors. The Willows accommodation on the ground floor provides general nursing care to people. The Orchards unit, which is also on the ground floor, provides care for people living with dementia. The Beeches accommodation on the first floor primarily provides shorter term care. This includes to people receiving end of life care or to people recently discharged from hospital who are receiving care and support for reablement and rehabilitation.

A registered manager was in post at the time of our inspection. 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.

People at the service told us they felt safe and spoke positively about the staff that provided their care and treatment. People received their medicines as prescribed. Risks associated with people’s care and treatment were assessed and managed. There were sufficient staff on duty to meet people’s needs and safe recruitment processes were completed. There were systems that monitored accidents and incidents to reduce the risk of reoccurrence and further harm. The service was cleaned to a high standard. There were effective systems that monitored the safety of the environment of the service and the equipment within it.

People said they were supported by effective staff that met their needs. The service had nominated ‘Champions’ in different specialisms to support staff in delivering care that provided a positive outcome for people. Staff understood the principles of the Mental Capacity Act 2005 and gave examples of how this legislation impacted in their work. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff knowledge in DoLS was good and conditions attached to people’s DoLS authorisations were understood where applicable. DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm.

Staff received appropriate training, supervision and appraisal to ensure that effective care was delivered to people. Where an opportunity had arisen, the provider had registered with a national pilot for staff to receive training in a new role being formally introduced into health and social care. The service could evidence outstanding practice through accredited schemes and there were systems in place to proactively motivate staff to provide a high standard of service. The environment had been adapted to meet the needs of people at the service in consultation with people and their families. The service was able to demonstrate they understood the importance of eating and drinking well and excellent relationships had been built with other health and social care professionals.

People commented very positively about staff and told us they were well cared for at John Wills House. The ethos of the service was, ‘Residents are not living in our workplace, we are working in their home’ and this writing was displayed at the entrance of the building. The service had received numerous compliments about the care provided. Observations made by all of our inspection team supported the compliments we read. Staff understood the people they cared for well and were able to tell us about people’s needs during conversations. People’s visitors

At the time of this inspection there were 14 people living at John Wills House in an area called the ‘Orchards’. The registered manager told us that all people living in the Orchards were living with a form of dementia and were at various stages of their dementia journey.

The care we observed was provided in a respectful and timely manner to people and staff displayed a good understanding of people’s care needs. The home was clean and had a calm and organised atmosphere.

The expert by experience gained the views of people living in the home and their experiences. People we spoke with were positive about the care and support they received. Comments included; “You get everything you need’, ‘If I need help they do it’.

We left comments cards at the home for people to complete in order to gain their views. Four people completed a comment card. Comments included; “It is a safe environment, there is good care and friendly staff”. “My X receives very good care. All staff treat them with respect and compassion. I have witnessed other residents being treated the same way. St Monica's trust is a fantastic facility for people with this dementia disease.

The provider had systems in place to monitor the quality of the service provided. Various audits were undertaken by the provider. However the care plan audit failed to highlight the shortfalls in some people’s care plans.

Although two registered managers are identified in this report we can confirm that the registered manager at the time of the inspection was Ms Wendy Alison Leaman.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our visit all the people we spoke with told us that they liked living at the home. One person said “I have been here for 2 years and don’t have a moment of regret.”

People told us that they discussed their care and support needs with staff. One person told us “I am able to tell them (my key worker) how I want things done; my key worker knows what I want even before I do sometimes because we get on very well.”

We saw that the home had meetings for the people who lived at the home. They told us that they feel listened to at these meetings and are able to influence how the service is run.

People told us that they liked the food and were able to choose what they wanted to eat and when they wanted to eat it. One person we spoke with told us that they preferred to eat in their room at meal times. They said “I am a quiet person; I like to be in my room.” This person told us that this choice was respected and their food was brought to their room.

The people we spoke with told us they felt safe at the home and were all aware of how to raise a complaint. One person told us they had made a complaint about a member of staff to the lead nurse on the unit. They felt they had been listened too, reassured and their complaint had been acted on.

We observed that the staff were confident and suitably trained to fulfil their role. One relative we spoke with said “If you have the right amount of staff and the right staff how can anything go wrong? This place has both.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

In February 2014 our inspection found the provider had breached regulations relating to care and welfare. The provider sent us an action plan telling us the improvements they were going to make to address the breach of regulation. During this inspection we looked to see if these improvements had been made.

John Wills House provides accommodation, personal and nursing care for up to 80 people. They have three separate parts of the home, the Orchards supporting people living with dementia, the Willows providing nursing care and the Beeches providing respite and rehabilitation. At the time of our visit there were 80 people living at the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

During the two days of our visit we observed care staff responding and supporting people in a caring and supportive way. People told us care staff were “kind and friendly” and “the care is amazing it makes one’s body strong and able to be independent”. People told us they felt safe in the home and had confidence in the skills of care staff to meet their needs. Relatives were very positive about the care provided and felt involved in how care was delivered.

We saw how staff had a good understanding of people’s needs and how these could be met. There was a person centred approach to providing care with respect for people’s choices. Where people had complex needs either of a physical or mental health nature the service liaised and sought the advice and guidance of other professionals.

There was positive feedback from all the professionals we spoke with. Comments made by professionals who had regular contact with the home included: “I would say John Wills House is a home of choice for many people", "I find staff to be caring and efficient in dealing with people’s needs”, “the care team have worked extremely hard to get to know this individual, involving both the family and the team in an attempt to resolve issues and alleviate their distress”.

We noted how the service had made improvements in providing a more supportive environment for people living with dementia. Care staff we spoke with had a good understanding and knowledge of people’s specific and individual needs particularly in relation to responding to people who were distressed or agitated or whose behaviour could challenge staff.

People’s welfare and best interests were protected. Any actions taken without consent were agreed as part of a best interest’s approach to providing care and support with a positive approach to risk taking.

People and their relatives had opportunities to express their views about the quality of the service. People told us they felt their views were listened to and any concerns acted upon. They described the management as “approachable and open”. One person told us “I know I could make a complaint if I wanted and they would do something about it”. Another person told us how approachable the manager was and “I would go to her she would listen”.

There were a range of methods used to look at the quality of the service provided at John Wills House. Included were internal and external audits and action had been taken to address any shortfalls or need for improvement in the quality of care.