This inspection was carried out on 31 January 2018 and was unannounced.

St Brelades is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Brelades accommodates up to 37 people living with dementia in one adapted building. There were 37 people using the service at the time of our inspection. St Brelades exclusively offers a service to women.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the last inspection on 3 November 2015, we asked the provider to take action to make improvements to the way people’s capacity to make decisions was assessed and how decisions main in people’s best interests were recorded and this action had been completed.

The registered manager had oversight of the service. The registered manager and management team checked that service met the standards they required and worked to continually improve the care people received. However, processes were not in operation to complete regular checks and audits of all areas of the service and use these to drive improvement. We have made a recommendation about checks and monitoring the service.

Staff felt supported by the management team, they were motivated and enthusiastic about their roles. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff and community professionals we spoke with told us they would be happy for their relatives to live at St Brelades. Records in respect of each person were accurate and complete.

Staff were kind and caring and treated people with dignity and respect. They had taken time to get to know each person well and provide the care they wanted in the way they preferred. People received the care and support they wanted at the end of their life. Since our last inspection the provider had begun to implement the Gold Standards Framework (GSF) for end of life care. The GSF is a recognised approach to ensuring that everyone receives appropriate and individualised care which takes account of their wishes and preferences at the end of their life.

Staff knew the signs of abuse and were confident to raise any concerns they had with the management team. People were not discriminated against and received care tailored to them. One person’s relative said, “The staff know my relative inside out now and every part of her day is catered for just how she likes it to be. She is most content now she is being so thoroughly cared for in every aspect of her day and night”. Complaints were investigated and responded to. People had enough to do during the day, including taking part in activities they had enjoyed.

Assessments of people’s needs and any risks had been completed and care had been planned with them and their relatives, to meet their needs and preferences and keep them safe. One person said, “I am really so safe here and content”.

Changes in people’s health were identified quickly and staff contacted their health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet of food they liked and that met their cultural needs and preferences.

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 sup

There were 36 people using the service and we met and spoke with some of them and to some relatives. People told us or indicated that they were happy with the service. They said that the staff were kind and that there were enough staff to meet their needs. We observed that staff spoke with people in a calm, positive reassuring manner.

One relative told us, “The home is welcoming and offers a peaceful environment. People receive individual holistic care and families are also looked as well”.

We found that the service obtained suitably detailed information about people’s needs to enable staff to provide effective care. People were asked for their consent before any care or treatment was given.

We saw that people who used the service and/or their relative/representative had been involved in the planning of their care. They received care and support that was well planned and sensitively delivered.

People maintained good physical and mental health as the service worked closely with health and social care professionals. Activities were provided which people looked happy to join in with. For example, creative activities were on offer during the afternoon of the visit.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The staff were given appropriate training and support, and had opportunities to develop their own professional portfolios.

Effective quality assurance procedures ensured that people were provided with a good service.

There were 36 people using the service and we met and spoke with some of them and to some relatives. People told us or indicated that they were happy with the service. One person said “We are all very well looked after.” People told us that the staff were kind and that there were enough staff to meet their needs. Staff spoke with people in a calm, positive reassuring manner.

People maintained good health and mental health as the service worked closely with health and social care professionals. Activities were provided which people looked happy to join in with. For example, a hairdresser was at the home washing and drying people’s hair, an exercise class was held during the morning and art and craft activities were on offer during the afternoon.

People said that they were happy with their rooms and with the environment in general. Visiting relatives told us “I think (my relative) is very happy here. She has been lovely today, the best she has been for a long time” and “This home is very well staffed and very well run” and “It is very good here, it has been known for years as a very good home.”

We made an unannounced visit to the service and spoke to people who use the service, some visitors, the manager and to staff members. There were thirty seven people using the service. We met and spoke to most of them and everyone we spoke to said or expressed that they were very happy living at St Brelades.

People told us or expressed that they felt safe and well looked after. Everyone said that the food was ‘good’ or ‘very good’.

People said “I have no complaints, it is lovely and clean and the staff are good” and “I love it, everyone is kind. The girls (staff) are very good”.

Another person said “I think it is very good here. They look after us well. My room is lovely and I have nothing to complain about at all”.

People told us that they were happy with their rooms. One person said “I love my room, it looks out onto the sea and it is very warm”.

We observed staff interacting and engaging with people in a warm positive way. One person said “The staff are lovely, I find I am in clover”.

A visitor told us that they were made welcome when they visited and that they felt their relative had the care and support they needed. They told us that the home was ‘excellent’. They said “I have nothing to criticise at all. It is very very good and I cannot fault it”.

A relative said “I am very pleased with it here”. Relatives told us they were kept informed about their relatives well being and that the home was always clean and smelled fresh.

Another relative said “It’s brilliant. You could not get anywhere better. (My relative) is safe here. They are happy and well looked after”.

A visiting professional told us “It is a very, very clean home. I do not see ‘care’ like this in any other homes”.

This inspection was carried out on 2 and 3 November 2015 and was unannounced.

St Brelades provides accommodation for up to 37 older ladies who are living with a dementia or Alzheimer’s and need support with their personal care. The service is a converted domestic property. Accommodation is arranged over three floors. Two stair lifts are available to assist the ladies to get to the upper floors. The service has 23 single bedrooms, and seven double bedrooms, which ladies can choose to share. Thirteen of the bedrooms have ensuite toilets. There were 36 ladies living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

St Brelades provides a service to ladies only and the manager employed only female care staff to meet their needs. Ladies were treated with dignity and respect at all times. For example, staff explained the care and support they would receive before they received it and asked them what they would like staff to do and when.

The manager provided strong leadership to the staff team and had oversight of all areas of the service. Staff were highly motivated and felt supported by the manager and other senior staff. The staff team shared the manager’s philosophy of care and worked to make sure that care was always provided to a good standard. Staff told us the manager was approachable and they were confident to raise any concerns they had with them. The manager had taken action to continually improve the service. Consultants had been employed to review and make recommendations to make sure the service was the best it could be.

There were enough staff, who knew the ladies well, to meet their needs at all times. Ladies needs had been considered when deciding how many staff were required on each shift. Staff had the time and skills to provide the care and support ladies needed. Staff were clear about their roles and responsibilities and worked as a team to meet the ladies’ needs.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were supported to provide good quality care and support. The manager had a very good knowledge of dementia and Alzheimer’s and its impact on the ladies at the service, she shared this with staff to develop their skills. A plan was in place to keep staff skills up to date. Most staff held recognised qualifications in care. Staff spoke to senior staff whenever they needed to discuss any concerns they had about the ladies. Plans were in place to hold more regular meetings to give staff the opportunity to discuss their role and practice.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the manager, senior staff or the local authority safeguarding team. Plans were in place to keep ladies safe in an emergency. Equipment was in place to evacuate ladies safely but staff did not know how to use it. Following the inspection the manager put plans in place to make sure all staff knew how to safely use the equipment.

Ladies’ needs had been assessed to identify the physical and mental care and support they required. Care and support was planned with ladies and their representatives to keep them safe and support them to be as independent as possible. Detailed guidance had not been provided to staff in some care plans about how to provide all areas of the care and support ladies needed, however they received consistent care as staff knew them well. An independent social worker had reviewed the care plans and was working with the manager and staff to make improvements in line with best practice recommendations.

The ladies received the medicines they needed to keep them safe and well. Action was taken to identify changes in their physical and mental health, including regular health checks and GP clinics. Ladies were supported by staff to receive the care they needed to keep them as safe and well as possible.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Arrangements were in place to check if ladies at risk of being deprived of their liberty and applications had been made to the authority where they were necessary.

Consent to care had been obtained from the ladies or those legally able to make decisions in their best interests. Ladies who had capacity were supported to make decisions and choices. The manager had recognised that processes were not in operation to assess if ladies were able to make decisions or to make decisions in their best interest. This had been discussed with the independent social worker and action was being taken to put systems into operation that met the requirements of the Mental Capacity Act 2005 (MCA).

The ladies were supported to participate in a wide variety of activities that they enjoyed. Possible risks to them had been identified and were managed to keep them as safe as possible, without restricting them. Ladies were supported to continue to attend activities outside of the service, such as attending church services.

Ladies told us they liked the food at St Brelades. They were offered a balanced diet that met their individual needs, including soft diets for ladies who had difficulty swallowing. A wide range of foods were on offer to the ladies each day and they were provided with frequent drinks to make sure they were hydrated.

The ladies and their representatives were confident to raise concerns and complaints they had about the service with the manager and staff and had received a satisfactory response.

The manager frequently worked on the floor with ladies and staff to check that the quality of the service was to the standard they required. Any shortfalls found were addressed quickly to prevent them from occurring again. Ladies and their relatives were asked about their experiences of the care and these were used to improve and develop the service.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place and dining rooms were being redecorated during our inspection. Appropriate equipment was provided to support the ladies to remain independent and keep them safe. Safety checks were completed regularly.

Accurate records were kept about the care and support ladies received and about the day to day running of the service and provided staff with the information they needed to provide safe and consistent care and support to the ladies.

We last inspected St Brelades in April 2014. At that time we found that the registered provider and manager were complying with the regulations.