The inspection took place on 11 January 2017 and was unannounced. We last inspected the service in April 2014 and found it was compliant with the regulations. There were no breaches at the time of the previous inspection in April 2014 which was done under the previous set of standards. The inspection was carried out by one adult social care inspector.

Strand House is a very small residential care home which is registered to provide personal care for up to eight people over the age of 65 years. It does not provide nursing care. The home has been run as a family business for the last 28 years. The provider, who was also the registered manager, lived at the premises with her husband, who was also the maintenance person.

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 the time of the inspection, there were four people using the service and three vacancies.

Strand House was warm, clean and welcoming and had a very calm, peaceful atmosphere. People living there said they were content and felt safe and happy. The service is located in a small village and was actively involved with village activities such as the local schools’ Harvest Festivals. Many relatives visited daily. They spoke highly of the care and support their relatives received at the service. ne person said, "Strand House is a lovely home. The staff are lovely … very caring and nothing is too much trouble.”

Strand House was decorated and maintained to a very high standard. The open plan kitchen dining room had the feel of a home kitchen, where people were able to see the food being prepared and talk to the cook when eating. This was also the registered manager’s own kitchen and she ate meals with people living there most days. This meant people could communicate directly with the registered manager and develop close relationships. People were also enabled to take part in activities such as cooking, baking and jam making.

Staff understood people's needs and supported people in a way which respected their wishes and preferred routine. People were protected because staff understood how to identify potential abuse and how to report this. Care and support was well planned to ensure every aspect of people's needs was met and any risks were identified. People's medicines were safely managed and people were supported to eat and drink a good range of healthy homemade food.

Staff recruitment processes ensured only staff who were suitable to work with vulnerable people were employed. New staff went through an induction programme. Staff felt valued and that they had sufficient training and support to do their job effectively. All staff were supported by having one to one supervisions and appraisals with the registered manager to help identify good practice and areas of learning.

The registered manager had a good understanding of the Mental Capacity Act 2005 and had systems in place to monitor capacity. All four residents had full capacity. She felt the staff could benefit from some refresher training in this legislation.

Staff were kind and compassionate towards people and had developed warm and caring relationships with them. Healthcare professionals supported people living at the service and the staff by regular visits. Staff supported and involved people and their families to express their views and make their own decisions, which staff acted on.

The registered manager operated well-established systems of quality assurance, including an effective complaints system, which ensured the home was well maintained. Records were kept up to date and people using the service and their families were fully involved in the care being delivered.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were six people living at Strand House. The summary is based on conversations with five people using the service, two staff supporting them and the registered manager, observation and records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the home environment was under regular review and kept in good order. Care workers were trained and supported to care for people safely. People's needs were assessed and their care planned, which took into account hazards to their safety. A health care professional said they had no concerns about the service at Strand House. The provider improved the safety of medicines management and record keeping, as indicated in their action plan following our last inspection.

Is the service caring?

We saw attentive, individual care provided. People were treated with respect, their independence promoted and their privacy protected. Our observations indicated a caring staff group and a nurturing environment.

Is the service effective?

We found people received a good standard of personal care. One person told us how their health had improved since they moved to Strand House. They said that their needs had been discussed with them and were being met. They said "I like it here."

Is the service responsive?

We found that people's health was promoted and issues responded to promptly, such as pain relief. Care workers were seen to respond to people's individual needs, such as assistance with eating and responding to people’s preferences. There was effective communication with the people using the service and their families.

A person's request to replace a vanity unit in a bedroom had been met. Another request, to move to a ground floor room was being arranged following decorating.

Is the service well led?

The owner/manager was in clear overall control of the home and led care workers by example. People said they were pleased with the standard of care provided. Care workers said they felt supported and their opinion was sought and listened to. Care workers said there was a very low staff turnover and staff morale was good. We found that care workers were enthusiastic about the service they provided.

There were seven people living at Strand House at the time of our inspection. We spoke with five people who lived at the home and a visitor. We also spoke with one care worker and the manager who was also one of the owners of the home.

All the people, but one, praised the home and the care workers. One person said “Wonderful, my family couldn’t have put me anywhere better”. Another person told us that the care workers “just can’t do enough for you”. A visitor said “the best place they can be, there’s nowhere better. Fantastic place”.

We found that people's consent had been obtained for care and treatment provided to them by the service.

People we spoke with were happy with the care provided at the home.

People had not been protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were cared for by staff who had been employed following the home's robust recruitment procedure.

People told us that they felt safe and knew what to do if they had concerns. One person said "I would feel very comfortable making a complaint if I ever had any concerns, but I've never had any". People told us that they would not hesitate to report any issues to any member of staff. One person said, "I am sure that if I did complain it wouldn't be ignored".

The home had not maintained accurate records which related to the care and treatment provided to each person who lived at the home.

We saw that staff interacted well with people who lived at the home. We saw that staff treated people with respect. For example, we heard staff speak to people in a respectful manner, using their preferred names. Staff responded to people's requests and listened to what they had to say. People appeared relaxed and comfortable in their interactions with staff. One person told us they felt "very safe, warm and comfortable".

We looked at the care records for three of the people who lived in the home to find out how their health and personal care needs had been assessed, and how the home planned to meet those needs. We saw evidence that care plans were regularly reviewed and updated as people's needs changed. We saw that when people's short term needs changed this was recorded so that staff knew what they needed to do to meet these needs.

One person we spoke with told us "I've got everything I need". Another person told us "I don't need much help, but they are there if I need them". One person told us staff "always teat me nicely, very good in all aspects". Another told us "only have to ring the bell and they (staff) come". We were also told the manager was "so kind and gentle, do anything for you".

We saw that medication was being stored safely. Medication was supplied to the home in a series of blister packs and stored in a locked metal cabinet. We saw that the medication storage areas were clean and free from a build up of excess stock.

During our visit on Friday 3 December 2010, we spoke with the 7 people who lived at the home, several of who were relatively independent. We also spoke with a visitor. The great majority were very positive about the home.

Comments we received from different people typically included “We’re very comfortable here”, “I haven’t been in any hotels where you get as good a service as you do in here - and I’ve been in a few”, “You get personal attention…there’s always someone about”, and, “Pat (Mrs Pigott) looks after us marvellously.”

People were satisfied with the care and support they received. There is a small stable, competent staff team, led by the registered provider who is very involved in the day-to-day running of the home and the support people receive. We found written care records were not always sufficiently detailed or up to date to ensure that care or support provided would continue to meet individuals’ needs and also ensure their safety. This included the matter of self-medication, where the home’s risk assessment was brief, for example.

People were not always aware of the care-related information held about them, with limited evidence in records of their involvement in identifying the support they wanted or needed. We also noted that staff were unclear about how to gain 'valid consent'. Whilst people currently living at the home felt they were listened to and able to make choices about their daily lives, this lack of clarity could affect people’s rights – both those with capacity to make decisions for themselves and anyone who lacks such capacity. The registered provider intends to look into further staff training, to address this point. Individuals we asked felt safe at the home, and everyone living there thought they would be taken seriously if they raised a complaint or made a suggestion.

The people we met told us the home’s catering, facilities and location suited them. They looked comfortable in their surroundings, most having their own property around them to personalise their room, etc. We found some risks to the wellbeing of people at the home relating to the environment and staff practices. These included aspects of fire safety measures, infection control, and very hot radiator surfaces. The home still has to formalise its planned response to possible emergency situations.