The inspection visit took place on 18 July 2017 and was unannounced. The inspection visit was carried out by two inspectors.

The service provides accommodation, support and personal care for up to 31people. There are three buildings at the location which provide specialist care for people living with dementia. Merevale House provides care for up to 14 older people living with dementia. Merevale Lodge provides care for up to 13 people living with early–onset dementia, and 5th Lock Cottage provides care for up to four people living with alcohol related dementia. On the day of our inspection there were 30 people living there.

At the last inspection in August 2015, the service was rated outstanding. At this inspection we found the service remained outstanding.

The home is required to have 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 and associated Regulations about how the service is run. At our last inspection the home had two registered managers who shared their time across the homes operated by the providers; Merevale Care Homes. Sadly, the long serving registered manager, who was also one of the providers, had passed away. At the time of this inspection the home had a registered manager in post, who shared their time between this home and another nearby care home operated by the provider. At the time of this inspection, the registered manager was on planned leave.

People were extremely happy with the quality of the care and support they received. They described their care as being given in a way they preferred and they were supported to be as independent as possible. People were supported extremely well with their personal hobbies and interests and to go out when they wanted to. Staff used their knowledge about people’s past to create opportunities to engage with people in a positive way and make new memories for the person and their relatives.

Staff received training in how to care and support people living with dementia, and this enabled them to support people to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The provider’s values in good dementia care and their policies and systems in the service supported this practice.

Living ‘care’ plans contained very detailed information about people. This enabled staff to take a person centred approach, which contributed to the positive culture. Staff had received excellent dementia care training which enabled them to provide a safe, supportive and homely environment for people.

The culture of the home was very positive and staff embraced the provider’s values. People described all of the staff as being calm and relaxed and saw them as ‘equals;’ there were no divisions between people that lived at Merevale and the staff that supported them.

People and their relatives’ feedback was sought by feedback surveys. The provider had systems and processes in place that ensured a very good service was given to people through regular quality assurance checks.

People felt safe living at the home and were supported by staff who were trained to protect them from risks of abuse. Risks were assessed and actions implemented to minimise those risks. Staff knew people very well and knew how to meet their individual needs.

People were supported to access healthcare professionals when needed, and felt staff were consistently kind to them. People had choices about what they ate and drank and their nutritional needs were met.

People felt there were always enough staff on shift to meet their individual needs in a person centred way. The provider’s recruitment processes had ensured workers were safely recruited through a series of checks on their character.

People had t

We inspected this service on 20 August 2015. The inspection was unannounced. At our previous inspection in November 2013 the service was meeting the legal requirements.

The service provides care and accommodation for up to 31 people. On the day of our visit there were 28 people in the home. There are three buildings at the location which provide specialist care for people living with different types of dementia. Merevale House provides care primarily for 14 older people living with dementia, Merevale Lodge provides care primarily for 12 younger people living with dementia, and 5th Lock Cottage provides care to four people living with alcohol related dementia.

The service has two registered managers. 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 two registered managers shared a passion for working with people living with dementia. The provider, who was also one of the registered managers, had received awards for their work in the dementia care field. The passion they both demonstrated for providing high quality care for people living with dementia was shared by the staff group.

People living at the home were safe. Staff and the management team understood their responsibilities in safeguarding people. The service had a positive approach to risk. They assessed how people could be supported to continue to live the life they wanted. Staffing levels were determined so staff were able to support people well with their physical, social and emotional needs. Checks were made to determine whether staff were suitable to work with people, had been undertaken before staff started working at the home.

People were actively encouraged to be part of the local Atherstone community, and likewise, people from the local community, and professionals wishing to learn more about dementia care, were welcomed into the home and encouraged to learn more about good dementia care and share understanding.

People received care and support from a highly trained, motivated group of staff. Staff were responsive to people’s individual needs and people’s preferences and wishes were at the heart of the care and support they provided. Caring relationships had been built between staff and people, and excellent support was provided for their family members. Staff were friendly and kind to people and treated people with utmost respect. We observed a lot of laughter and friendly banter between staff and people who lived at Merrevale.

People were encouraged and supported to pursue their individual hobbies and interests. . People made excellent use of local community facilities; as well as the resources in the home which engaged people with activities such as arts and crafts, reading, sensory activities, and reminiscence.

The cooks provided good quality food and catered for people’s individual preferences. This included people’s specific health and cultural dietary requirements. Food and drink was available to people throughout a 24 hour period. Staff gave excellent support to those who required extra help in eating and drinking.

The registered managers understood their obligations under the Mental Capacity Act 2005. When decisions had been made about a person’s care where they lacked capacity, these had been made in the person’s best interests.

Where people were moving towards the end of their life, the service followed the Gold Standards Framework to ensure their dignity was maintained and they received better care to meet their needs. The manager and staff had a strong commitment to providing support to people and their family to ensure a person’s end of life was as peaceful and pain free as possible.

People and relatives were encouraged to inform the registered managers if they were not happy with any aspect of their care or service received. They told us the management team responded well to any identified concerns and rectified them quickly. No formal complaints had been made about the service.

Everyone we spoke with, including people who lived at the home, staff, relatives and healthcare professionals involved with people told us Merevale House provided very good or excellent care to people who lived there.

The management culture of the home was open, dedicated to providing excellent care to people, and equipping staff to provide excellent care. Standards were high, and staff responded to this well.

We spoke with two people who lived at Merevale House Residential Home about their experiences of the service. We also spoke with three relatives about their family member's experience. We observed the care that was given to people during our inspection. We spoke with a range of staff including the manager.

People and relatives we spoke with told us that the care planning was discussed with them regularly. We saw that people or their relatives were involved with the care planning of their care.

We found that staff listened to people about their care needs and their wishes. We saw people's independence was promoted within their care plans and on the day of our inspection.

We found that the care plans were person centred and reflected people’s individual needs. We saw that staff supported people as detailed within their care plans. We observed that staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. We spoke with staff who knew what people's care needs were and how they needed to be supported.

We spoke with five staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found the service was well led and there was a system in place to monitor the quality of service being provided.

We carried out this inspection to check compliance against the minor concern we identified at the inspection on 3 January 2013. At that time we found care records did not always have the information in them necessary for the delivery of a person's care. Following this visit the provider told us in their action plan that immediate action been taken to ensure care records were up to date and in good order.

When we visited the care service on 24 January 2013 we checked four care records and spoke with the deputy manager. We found the care records we looked at were up to date and in good order.

We found the care records documented information about a person’s capacity to give consent to their care or not. We saw that when people had been involved in the planning and reviewing of a person’s care they had signed the relevant documentation to confirm this.

Staff members, (co-workers), had each been allocated time during the week to keep care records up to date and in good order.

Co-workers were in the process of receiving refresher training from the deputy manager on completing care plans.

When we visited Merevale House we met with most of the people living there and spoke with two people about their experience of care at Merevale House. We met and spoke with one relative, the registered manager and the deputy manager. We spoke briefly with members of staff delivering care at the time and spoke in depth with two staff members about how they delivered care to people that lived at Merevale House.

People who lived at Merevale House told us they were happy with the way staff supported them with their care. One person told us, “It is very good here. I can do what I want pretty well.” Another person told us, “I am really happy here.”

When we spoke with a relative they told us. “I chose Merevale House deliberately because it was ‘small scale’ and I saw there was a ‘closeness’ with the staff team.”

We saw that mealtimes were a relaxed and social occasion. We saw that people had a choice about what they wanted to eat and drink.

Staff told us they had regular training, which meant they could support the specific needs of people who used the service. Records we looked at showed that staff communicated people’s changed needs to managers, so that care needs could be re-assessed promptly.

We found care records did not always have the information in them necessary for the planning of a person’s care.

On the day of our visit on 8 December 2011, we spoke with the manager, deputy manager, care staff and ancillary staff, two visiting family members and those people living in the home who were able to verbally communicate.

We used a range of methods to gather evidence about how well the service met the needs of people living there. We spent time sitting with people in the lounge and dining room watching to see how they were supported, how staff spoke with them to ensure that they were treated with dignity.

We found that staff treated people with kindness; they knew people as individuals and understood their personal needs and ways of communicating those needs.

We saw that there was a ‘family’ atmosphere in the home with a lot of joking and people taking part in day to day routines. One staff member commented, “The whole place is happy, we are one big happy family.”

The exterior and interior of the home was decorated for Christmas and one person spoke about how much they enjoyed looking at the Christmas figures in the front garden.

We looked at the care planning documentation to see what guidance was given to staff, to ensure that people received their care as they required to meet their needs. We looked to see if systems were in place to offer this in a safe way. We found that care plans were detailed and contained the kind of information that would ensure staff understood aspects of each person as an individual and would be able to meet their needs effectively and safely.

All of the people we spoke with were complimentary about the staff with one person commenting, “You can’t fault the staff, I can’t complain.” A visiting family member told us, “The staff are so natural, they teat my relative like a member of the family. I would know if they were unhappy here.”

We were told that Merevale House had recently won an award as ‘Best Dementia Care Home’ at the National Dementia Care Awards. This award was based on testimonials from relatives, visitors and people who use the service. Staff and people who use the service were very proud of this achievement. The manager explained that it was a team effort and the award was due to dedicated staff and supportive families.

We spoke with staff about training to ensure that they had the skills to meet the needs of people living in the home. Staff spoken with told us that they were well supported by the manager and other staff. Comments received included; “We have a brilliant team here,” and “This is a lovely place to work, I am lucky and privileged to be here.”

Staff felt that they received a good level of training to ensure that they knew how to deal with incidents and understood how to protect people from the potential of abuse and keep people safe in emergencies.