Spencer Grove is registered to provide personal and nursing care for up to 68 older adults, which may include some people living with dementia. This inspection was unannounced and took place on 27 July 2016. At the time of our inspection there were 58 people living there.

There was a registered manager at this service. 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. At our last inspection in January 2014 the provider was fully compliant in all areas inspected.

During our inspection visit we observed that staff were friendly and approachable. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and appropriate way.

There were training and processes in place for staff to follow to keep people safe and staff followed these. People’s physical and mental health was promoted. Staff were trained to care for people living with dementia. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were comfortable and had a familiar object such as a photograph or a magazine that offered them comfort or stimulation. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. However, lunch for people on the ground floor was more relaxed and more of an occasion than for those on the top floor.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day. Staff responded to body language of people who were without verbal communication.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time and were invited to join their family member for meals so that family time could be enjoyed. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual and group preferences. Suitable occupation was offered to people living with dementia. This included reminiscence and other therapies. Activities also included one-to to-one time and outings, or time in pursuit of personal hobbies or interests

People, relatives and staff spoke very highly of the registered manager and felt the home was well-led.

The service was managed in an inclusive manner. People and staff had their wishes and knowledge respected. Staff were aware of their roles and responsibilities for people’s care. The registered manager had systems in place to review the service and to ensure the service responded to ongoing needs of people.

During this inspection we followed up on the action plan submitted to the Care Quality Commission on 30 April 2013.

We found that the people were cared for in a clean and hygienic environment. One person we spoke with told us "My room is lovely, I have new bedding now". A relative we spoke with told us "I can't praise them enough, they keep it clean and take wonderful care of my mother".

We found that the provider had put in place systems to ensure that risk and health and safety were regularly assessed and managed at the home. We saw evidence that concerns raised were appropriately managed and addressed.

We found that the provider took action to address issues raised by their own quality monitoring systems.

We found that people understood the care and treatment they received. People able to express their views told us they were satisfied with the care and treatment they received. We found that care plans were developed in conjunction with people who used the service or their relatives and reflected peoples needs and preferences.

We found that some areas in then home were not cleaned effectively and found that checking systems were not adequate to ensure people were protected from the risks associated with poor hygiene.

People we spoke to and their relatives told us that staff were caring and thoughtful in their approach. Documentary evidence showed us that the staff received supervision and training appropriate to their roles.

Although the provider had systems in place to obtain peoples views about their care and treatment, we found that they did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

In addition to the methodology identified at the beginning of this report, we undertook focused observations of staff interactions with people using our Short Observational Framework for Inspection (SOFI). We observed three people accommodated on the personal care unit for one hour during the morning of our visit and repeated the same for three people accommodated on the nursing unit before lunchtime.

From those observations we found that staff interacted positively with people at all times. Conveying warmth, acceptance and respect, whilst promoting their privacy, dignity and inclusion. Staff observed were also seen to adopt a relaxed pace with people and to appropriately support the individual reality of people with significant confusion.

People we spoke with told us that either they or their representative acting on their behalf, received the information they needed to assist them in choosing the home and in living there. One person commented that senior management had a high profile in the home and regularly asked them for their views about the care and services they received.

Two people told us they were suitably supported to access the local community and said that meetings were held with them on a regular basis to discuss activities and events and menu planning. Another person told us about the home’s regular newsletter providing them with news, events and staff working in the home. They said they had also written an article for the newsletter.

People spoken with all expressed satisfaction with the care and support they received. Examples of comments made by them, included, ‘They have sorted out my pain relief, which really helps,’ and, ‘My care is discussed with me and I have the equipment I need for my physical and sensory disability needs.’

All people spoken with expressed satisfaction with meals provided. One person told us, ‘The meals are usually quite good. Likes and dislikes are accounted for.’ Another said, ‘They regularly bring round hot and cold drinks and they always leave me a fresh jug of water each day.’

Two people said they were particularly pleased with their own rooms, as they were spacious and accommodated for their own personal furnishings and equipment they had chosen to bring with them. One person told us, ‘Cleanliness is very good. They have arranged for a phone and broadband line to be put in today for my computer.’

All people we spoke with described suitable arrangements for their access to relevant outside health and social care professionals, including for the purposes of their routine health screening. They also said that staff, were usually available when they needed them. One person said, ‘Staff are really good, I don’t usually have to wait too long for help when I need it.’ Another said, ‘Staff are brilliant, they’ve really helped me settle in here.’