This inspection took place on 14 and 15 February 2017. The inspection was unannounced on day one and we told the registered provider we would be visiting on day two.

Vida Hall provides residential care for up to 70 people who may be living with dementia. It is purpose built and consists of a main reception area with four ‘houses’. Two of the houses provide nursing care and two provide residential care. At the time we visited 69 people lived at Vida Hall.

The home 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.

At the last inspection in November 2014 the service was rated outstanding. At this inspection we found the service was good.

We observed extremely positive interactions between people and staff. People were supported to live a full and stimulating life and innovative ways to engage with people and involve people in activities were sought. For example one person was supported to share the poetry they had written. This demonstrated staff had good relationships with people and they treated people with dignity and respect.

People’s feedback about the service was consistently high and people told us the care they received was, “Amazing” and “Nothing is too much trouble.”

Safe recruitment and selection procedures were followed. Staffing ratios were flexible and responsive to people’s changing needs and circumstances. This meant that people received attentive, timely care that met their needs. Staff told us that managers were supportive and they mentored and coached staff to enable them to provide compassionate, quality care.

There were systems and processes in place to protect people from the risk of harm. Staff knew about different types of abuse and were aware of action they should take if abuse was suspected.

There were inconsistencies in the recording and reporting systems. Measures were in place to reduce potential risks however people’s records did not contain a thorough monitoring of the outcome. Not all incidents of abuse and serious injury had been reported to the CQC as the law requires. We have dealt with this issue outside the inspection process.

Not all good practice in relation to medicines was in place and we have made a recommendation about the management of medicines.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Although we found some records required updating the policies and systems in the service support this practice.

People had a choice of healthy food and drinks and their preferences were taken into consideration to ensure they had the diet and menu of their choosing. People were supported to maintain good health and the service had good relationships with professionals who supported people to maintain their health.

People’s care plans were extremely person centred and written in a way to describe their care, and support needs. People, their relatives and professionals all told us the amount of effort and time the staff take to ensure everyone was involved to ensure a person received the support they wanted and needed.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Accidents and incidents were recorded appropriately and lessons were learnt following reviews of patterns and trends. The design of the building enabled people living with dementia to be independent and safe. For example, each house had an accessible outside space, either a balcony or a courtyard garden.

Effective leadership promoted a culture of learning and continuous improvement. The management team fostered mutual respect between staff at all levels. Manager

We undertook this unannounced inspection on 6 November 2014. The last inspection was completed on 19 August 2013 and the service was meeting the regulations we assessed.

Vida Hall provides accommodation for up to 70 people who live with a dementia related condition. It is purpose built and consists of a main reception area with four ‘houses’, which are named: Woodlands, Orchard View, The Glades and Meadow View. Each ‘house’ has a secure entry system, wide corridors with areas for people to sit in to enjoy the views, spacious communal areas with plenty of light and large bedrooms with en-suite facilities.

The service has a registered manager in place. A registered manager is a person who is registered with The Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. All the staff we spoke with said that the registered manager and registered provider were dedicated, supportive and approachable. They said whatever people needed was provided to ensure people had the best quality of life they could achieve.

People we spoke with were settled and contented. Relatives and friends visiting the home told us they only had positive experiences and praise for this service. Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively.

The registered provider, registered manager and all the staff we spoke with were passionate about providing a service that placed people and their families at the very heart of the service. This was confirmed with us by three health care professionals we spoke with and through speaking with relatives and visitors.

Staff told us that they would not like to work anywhere else. They received training in dementia care practices, for example NICE (National Institute for Clinical Health and Excellence) quality statement on dementia care, and current research on what ‘good’ dementia care looks like. This ensured they were very skilled at looking after people who had memory impairment. Staff we spoke with told us how they encouraged and supported people to make decisions for themselves, which ensured people were able to live the life they chose.

Staff had received training about how to ensure people’s rights were respected and how to safeguard people from abuse. They were able to describe the different types of abuse that may occur and said they would report any issues straight away. Staff told us how they were openly encouraged to raise any issues which were then reported to the local authority for them to consider under their safeguarding of vulnerable adults procedures. This helped to protect people.

Risk assessments and detailed care plans were in place. This helped staff to deliver the care and support that people needed. There were robust medication systems in place.

People were offered appropriate food and fluids to maintain their nutrition. The chef and catering staff took pride in serving appetising and nutritious food. A person we spoke with said, “The food is good.” another said “The food is delicious.” Those who required prompting or support to eat were assisted by patient and attentive staff which ensured that people’s nutritional needs were met.

A wide range of activities were available which people’s family and friends were invited to. Spontaneous activities took place, staff spent quality time with people to give them emotional support and comfort. Staff were seen reminiscing with people about their life, singing, discussing the newspaper headlines of the day or going for a walk with them. Entertainment was provided, we saw on the day of our inspection a musical concert was performed. This was seen to be enjoyed by everyone who attended.

Staffing levels were high to meet people’s needs. If people were upset or unwell and more staff were required, this was provided straight away to support people. Relatives of people who had been unwell said they were kept fully informed and said staff were allocated to their relatives to provide comfort and care. This was greatly appreciated by the relatives we spoke with.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Comprehensive arrangements were in place for carrying out pre-admission assessments. Comments from relatives included “It is fantastic” and “This is the first time in many, many years that I have felt safe leaving Y”.

We looked at people's care records and saw arrangements were in place to identify those people at a greater risk of poor nutrition and dehydration. Records about specific dietary requirements were prominently displayed in the kitchen area and staff demonstrated a good understanding about individuals’ specific needs.

We looked at the medicines records and stock for three people's controlled drugs and found these to be correct. We also checked the records and stock for a range of other medicines for six people. Records were complete and medicines could be accounted for.

We saw appropriate checks were undertaken before staff began work and a record kept to monitor the completion of the associated recruitment processes. The relatives we spoke with described staff in the following ways; “The staff are fantastic”, “I have never seen staff give anything but a smile. All staff members know the names of people living here” and "I have not found any member of staff who isn’t proactive and warm; even the directors are hands on.”

An effective complaints system was in place.