The provider had systems, processes and practices in place to protect people from the risk of abuse. Potential risks to people had been assessed and measures were in place to manage them for people’s safety, whilst not restricting their freedoms. There were sufficient numbers of suitable staff deployed to keep people safe and meet their needs. Processes were in place to ensure the proper and safe use of medicines.

The provider had taken action to ensure sufficient cleaning of the service took place whilst a new housekeeper was being recruited. The registered manager ensured learning took place from incidents to improve people’s safety.

People’s care and treatment was delivered in line with current, national legislation and guidance to ensure effective outcomes for people. The provider ensured staff had the required skills, knowledge and experience to provide people with effective care.

People were supported by staff to eat and drink sufficient amounts for their needs. The registered manager listened to our feedback with regards aspects of the lunch service which required attention and took immediate action to address them for people.

Staff worked both as a team within the organisation and across other services to ensure people received effective care. People were supported by staff to access health care services as required. The building was not originally designed to meet the needs of people living with dementia, but relevant equipment was in place and staff supported people where required.

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 supported this practice.

Staff treated people with kindness and compassion when delivering care. Staff supported people to make decisions about their care and people’s choices were respected. People’s privacy, dignity and independence were upheld during the provision of their care.

People received personalised care that was responsive to their individual needs. People were provided with opportunities for social stimulation. People were supported by staff to receive their end of life care at the service if this was their wish.

The provider had a clear set of values which underpinned the provision of people’s care. People and their relatives told us the registered manager and the deputy manager were visible and supportive, which we observed. There were clear staff responsibilities and accountability within the service. People and staff were encouraged to provide their views on the service. People felt their concerns and issues were listened to and dealt with to their satisfaction.

There were processes in place to monitor the quality of the service and to identify areas for improvement. The service worked in partnership with external agencies to ensure people received effective care.

Further information is in the detailed findings below.

The inspection took place on 12 and 13 September 2016 and was unannounced.

Old Alresford Cottage House provides accommodation and care for up to 44 older people, some of whom may also be living with dementia. At the time of the inspection 42 people were using the service.

Old Alresford Cottage has 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.

People said they felt safe. Staff had received safeguarding training and were able to explain how to protect people from abuse and how to report suspected abuse.

People’s individual risks were appropriately assessed and care plans were in place to mitigate against known risks. Staff were knowledgeable about risks to people and what actions needed to be taken to keep people safe.

There were sufficient staff on duty. People’s needs were met whether they were in communal areas or being cared for in bed.

Staff recruitment and induction practices were safe. Relevant checks were carried out to ensure that suitable staff were recruited.

Medicines were stored and administered safely. Records in relation to medicines were accurate and staff had received training in medicines administration, and had their competency checked regularly.

Staff had received appropriate training to meet people’s needs. Records showed that staff had received training in key areas such as fire training, moving and handling, food hygiene and first aid. Staff were supported to study for health and social care vocational qualifications. Staff told us they felt supported in their role.

Staff were knowledgeable about people’s needs and how to support them. Staff said they knew about people’s needs from handovers, care plans, risk assessments, people themselves and their families. We saw that staff interacted with people appropriately and kindly, appearing to know them well as individuals, and treating them accordingly.

People were asked for their consent before care or treatment was provided and the provider acted in accordance with the Mental Capacity Act 2005 (MCA). People made their own decisions where they had the capacity to do this, and their decision was respected.

People were supported to have sufficient to eat and drink and maintain a balanced diet. Drinks were readily available throughout the day and staff encouraged people to drink. For lunch a choice of main meal was offered, with alternatives available. The chef was knowledgeable about people’s individual requirements such as those people who required a soft diet or a diabetic diet.

People were supported to maintain good health through access to ongoing health support. Records showed that district nurses, continence and falls specialists and the GP had been involved in people’s care and referrals were made where appropriate.

Staff were kind and patient with people, using gentle persuasion and encouragement to support them. They took time to listen to people and understand how they were feeling. People’s dignity was respected. People were supported to be as independent as possible.

People were involved in decisions about their care and were offered choices in all aspects of their daily life. Where they had capacity, people had signed their care plans showing that they agreed with the plan of care.

Staff were able to respond appropriately to people’s needs because they knew them well and understood their care needs. Staff had taken the trouble to get to know people personally so they could respond to their preferences, likes and dislikes in order to provide personalised care. Care plans were reviewed and updated every six months and when necessary to ensure that staff were always aware of people’s needs.

People were ab

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas reading newspapers, completing jigsaws and watching television. We observed staff spending the majority of their time with people who used the service. They frequently checked on them to ensure they were alright when spending time on their own.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were very understanding, they always had time to listen, were approachable and helpful, and that their privacy was respected whilst they were supported to maintain their independence. One person told us "we get a lot of choice here - I can have sausages every day if I want" and another said "they are very good here, friendly."

We observed that staff asked people about how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis. One person spoke about a particular member of staff saying "she is wonderful - very considerate."

A family member told us "they are very good here - if I have concerns they get the doctor straight away."

On our visit we were able to speak to a number of people who used the service, along with staff members, and three managerial staff. The people we spoke to were, on the whole, very happy with the level of care they experienced, and with the staff. The staff we spoke to were very praiseworthy of the service, and appeared to be very experienced and appropriately qualified for their roles.

We were able to look at care plans and discuss the care planning process and found that the needs of people were being met through the processes that were in place.

The premises appeared safe and well maintained, and we were able to check the record of works and refurbishment, which indicated that there was a system for managing ongoing maintenance.

We were able to look at staff rotas, and training records, which showed that there were sufficient numbers of staff with suitable skills to provide the care and support to people using the service. We observed staff interactions with people who used the service and staff appeared to relate to people in a courteous and appropriate manner.

We found that the service had a complaints procedure in place and saw evidence that people were encouraged to raise concerns and complaints, which they did through talking to staff members or to relatives.

People told us that they were looked after in a way that suited them and that they could chose what they wanted to do. They said that they felt safe living at Old Alresford Cottage and that staff would come quickly when needed. They said staff were always very kind.

People said that the home was cleaned to their satisfaction and that their medications were managed well.