This unannounced comprehensive inspection took place on 3 April 2018 and was carried out by one adult social care inspector. We last inspected this home on 23 December 2015 when it was rated as ‘Good’ overall and in every key question.

Tracey House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tracey House is registered to accommodate up to 24 old people in one adapted building. Nursing care is not provided at Tracey House. This is provided by the community nursing service. At the time of this inspection in April 2018 there were 24 people living in the home.

Tracey House had a registered manager in place. 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.’

Tracey House was run with a firm purpose and a clear vision. People were held in high regard, had a good quality of life, had freedom to make choices and were supported to be independent. During our inspection we found each staff member at Tracey House, from the provider to the maintenance worker, displayed this purpose and vision.

People, relatives and external professionals praised the home and the staff’s caring attitudes. Comments received included, “I think their work is outstanding” and “I have always found a consistently high quality of professionalism and care at the home. One external professional stated, “I would have no hesitation in recommending the home to anyone, and would be very happy for any of my relatives to be resident at Tracey House.”

Staff treated people with respect and kindness. There was a low staff turnover at the home and this had enabled staff to build strong and meaningful relationships with people. The provider, registered manager and staff worked hard to ensure people’s self-esteem was promoted by acknowledging people’s skills, achievements and personalities. For example, one person’s relative had brought in some vegetables they had planted in their garden before moving into Tracey House. The cook had made soup for the evening meal with those vegetables and had named the dish after the person. Staff spent the day telling people about this dish and complimenting the person’s skills at gardening. This showed an admiration for this person’s talents and an acknowledgment of their accomplishments.

People were provided with enough high quality food to eat. The cook had attended a number of nutritional courses and food shows and had become the nutrition champion. In this role they had taken steps to improve people’s nutritional intake and create engaging activities around food to promote people’s enjoyment and wellbeing. They had introduced daily snack boxes to add additional calories to people’s diets, introduced packed lunch menus for when people had to attend appointments and had sought people’s feedback to tailor the menus to people’s preferences.

The provider and registered manager at Tracey House excelled in creating a culture where all staff members could provide outstanding care. The registered manager had ensured the ratio of staff to people was sufficient to enable staff to provide care that went above and beyond people’s everyday care needs. During our inspection we observed all different members of the staff team stopping and taking the time to speak with people and listening to what they said. People shared jokes and physical affection with staff who were calm, encouraging and humorous in their exchanges.

Staff worked hard to ensure people’s specific social and mental stimulation needs were met. Staff worked hard to continually improve on the activiti

Tracey House is registered to provide care for up to 24 older people. Nursing care is not provided at the home. Community nurses provide this service. This unannounced inspection took place on 17 and 23 December 2015, when there were 20 people living there.

The service was last inspected on 4 December 2013 when it met the requirements that were looked at.

A registered manager was employed at the 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.

Tracey House has been owned by the same family for over thirty years. The registered manager who is also a family member has managed the home for many years. During this time the service has consistently maintained a high standard of care, meeting all the relevant regulations during that time. People, staff and visitors told us they felt the fact the home was ‘family run’ was a major part of its success. There was a positive and welcoming atmosphere at the home.

Staff received training that helped them meet people’s needs, including moving and transferring and infection control. Newly appointed staff received a thorough induction and completed the Care Certificate. The certificate is an identified set of standards that care workers use in their daily work to enable them to provide compassionate, safe and high quality care and support. Staff received regular supervision and appraisals to discuss their work at the home.

People’s needs were met in a safe and timely way as there were enough staff available. Staff told us they thought there were more than enough staff to ensure they could spend time with people chatting individually. During the inspection there were five care staff, the assistant and registered managers a chef and a cleaner on duty. One person told us “Only have to ring my bell and someone comes”. One visitor told us “Staff are always around when you need them, and not when you don’t”.

People’s care plans contained details of how their needs were to be met. Staff had good knowledge of the people they supported and delivered care in a respectful and caring manner. Staff told us they had received training in respecting people and promoting dignity. All personal care was provided in private. Staff ensured people received care and support that was responsive to their needs. Staff knew people well and were able to describe their preferences. For example, staff told us about one person who had been in the armed forces and still liked their routines ‘regimented’. Staff told us that many people wanted to be independent and their job was to support them to maintain their independence, but be available if needed. One person told us staff “encourage everyone to use every ability they have and never give up”.

People could be involved in making decisions about their care if they chose. People told us staff regularly discussed their care with them, to ensure their needs continued to be met. One person said staff would say to them “This is what we said last time, any changes?”

There was a regular programme of activities available for people to participate in. Activities on offer included regular walks and trips out as well as visiting singers. Following suggestions from people a communal jigsaw was on ‘the go’ and people put pieces in when they passed by.

People were supported to maintain a healthy balanced diet. The chef told us that as soon as a small weight loss was identified they began to fortify foods. They told us they had recently completed a course on how to do this effectively at the local hospital.

There were choices for each meal and people told us the food was good. People were supported to receive ant health care services they may need. There were safe systems in place to man

There were 23 people living at Tracey House at the time of our inspection. We spoke with six people who lived at the home, two care workers, the deputy manager and one of the providers who was the manager of the home.

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

People who lived at the home told us they were well looked after and were happy. One person told us "It's very good here, all staff are good and very helpful. My room is kept beautifully clean and the food is good".

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. the service had an effective, robust recruitment procedure in place. One person had commented to the manager in a thank you card "I don't know what you do to your staff or where you get them, but they are just fabulous".

People told us that they felt safe and knew what to do if they had concerns. One person told us that they would feel comfortable making a complaint "but fortunately we don't have any complaints here". People told us that they would not hesitate to report any issues to any member of staff.

We talked with six people, three care staff and the manager. One person living at the home told us “I don’t think that I could be in a better place”. Another person said “I haven’t got anything but compliments for the place”. People said the service was supportive and understanding.

We saw that people's choices about their care were considered. This was supported by what people told us and what we saw in care records. One person said “The staff help me to get what ever I want”. We saw daily records kept for each person. We saw staff respected people's privacy and dignity. We saw staff respected equality and diversity. People were able to attend a communion service every week if they chose to.

We saw that people had access to a large outdoor area. People told us that they were supported to access the garden. People told us that they were supported to go out on small trips every week. We saw that people were playing board games, knitting, watching television and some people had use of computers in their rooms.

Staff told us that they felt supported by the manager. We saw that staff received training and regular supervision. Staff were able to describe different types of abuse and told us what they would do if they witnessed any abuse. People told us that they felt safe.

We saw that the home had been monitoring the quality of the service. The Registered Manager was able to explain how they monitor and manage incidents and accidents.