This inspection took place on 27 July 2016 and was unannounced.

Malmesbury Lawn Care Home is registered to provide accommodation and personal care services for up to 35 older people and people who may be living with dementia. At the time of our inspection there were 32 people living at the home. The main part of the home is a two-storey, rectangular building around a central, enclosed garden. There were a variety of shared areas, including lounges and dining areas.

There was a registered manager in place. 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 had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Arrangements were in place to store medicines safely and to administer them according to people’s needs and preferences.

Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people according to their needs. Staff were aware of the need to gain people’s consent to their care and support. Where people lacked capacity to make certain decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. We found the home to be meeting the requirements of the Safeguards.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs. People were supported to access healthcare services, such as GPs and community nursing teams.

Shared areas of the home had been decorated and adapted with exceptional imagination and creativity to support people living with dementia.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, dignity and independence.

The provider involved people in the care assessment and planning processes. Care and support were based on plans which took into account people’s needs and conditions, but also their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regularly. People were able to take part in leisure activities and hobbies which reflected their interests. Group activities and entertainments were available if people wished to take part.

The home had an open, friendly atmosphere in which people were encouraged to make their views and opinions known. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

We carried out this inspection as part of our routine inspection programme to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? The inspection was carried out by a single inspector. At the time of our inspection there were 35 people using the service. The manager told us all 35 were living with dementia. We spoke with three of them in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with the registered manager, four members of staff and a visiting healthcare professional.

This is a summary of what people told us and what we found.

Is the service safe?

People told us they felt safe and comfortable in the home. They said they had good relationships with staff. They said, “I couldn’t wish for better” and “It is very nice and comfortable”.

We found there were sufficient staff employed to support people safely. The provider had taken appropriate steps to protect people from the risk of abuse.

We saw staff were mindful of people’s welfare and safety. Appropriate risk assessments were in place. People were assisted to move around the home safely. If equipment used required two members of staff, two care workers were available.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person said, “I have no complaints.” Another said, “No problems”.

We found people’s care and support were based on assessments of their needs. Care plans were detailed and personalised. Systems were in place to ensure care was delivered according to people’s plans.

We found day to day care was delivered with people’s consent. The provider followed suitable procedures where people did not have capacity to consent.

People were cared for and supported in an environment that was maintained and adapted to the needs of people living with dementia. The service made arrangements for people to maintain their involvement with the wider community.

Is the service caring?

Staff we spoke with were motivated to provide good care. They knew about people’s needs and how they preferred to have their care delivered. One member of staff said they were “One big, happy family”.

We observed positive, friendly interactions between staff and people who used the service. Staff took time to make sure people understood what they were saying, spoke clearly and made eye contact with the person they were talking to.

Staff were seen to make sure people were comfortable and that their dignity and privacy were respected. When people sat outside, staff made sure they were protected from the sun.

Is the service responsive?

People told us staff listened to them. People’s care plans were individualised and person-centred.

We found the service had systems in place to ensure the care provided was appropriate to people’s changing needs. People were supported by other healthcare providers as appropriate.

Is the service well-led?

Staff told us they were supported to deliver quality care in an open culture. People who used the service were satisfied with the care and support they received.

We found risks were assessed and appropriate action plans were in place in people’s individual care plans. Effective systems were in place to regularly assess and monitor the quality of service provided. The provider sought the views of people using the service and others. Incidents, accidents and complaints were handled appropriately and lessons were learned.

We spoke with five people who use the service and they told us that they liked living in the home. One person told us how they still missed their home but had now adjusted to living here. They told us it was "like one big family." Another person told us: "I like being here." One relative told us: "My mum loves it here. She has put on weight and when I take her out, she longs to come back here."

During the inspection we spoke with five people who used the service, two relatives of people who used the service, two care staff, the deputy manager, and the registered manager. People who used the service told us that they were happy living in the home and the staff were kind and treated them well. We saw people who used the service approach staff without hesitation and they accessed their bedrooms, communal areas including the garden freely.

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to get up and go to bed. Staff interacted with people who used the service in a respectful and very sensitive manner. Comments from people who used the service included "I can choose what to do," "I couldn't be better looked after," "I have help when I need it," "the staff are always very busy," and "I am happy living here."

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People's health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. Staff had the skills to meet people's needs and they received appropriate support and advice from the manager.