During a routine inspection

About the service: Badgers Holt is a residential care home that was providing personal and nursing care to 25 people aged 65 and over at the time of our inspection.

People’s experience of using this service:

At this inspection the service met the characteristics for a rating of "outstanding" in three of the five questions we inspected. Therefore, our overall rating for the service after this inspection was "outstanding".

At our last inspection in March 2017 we rated the effective domain as ‘Outstanding’. Our inspection findings, and the feedback received, at this inspection now supported a rating of ‘Good’.

People felt safe living at Badgers Holt and they were very much at the heart of the service. We received consistent positive feedback from people, their relatives and health professionals. People received excellent care that was based around their individual needs and that ensured care was personalised and responsive.

Staff working at Badgers Holt understood the needs of people using the service and supported people in an exceptionally personalised way. Staff knew people well and we saw that care was provided respectfully and sensitively, taking into account people’s different needs. The impact this had on people was outstanding and had resulted in people living an active life with choice evident throughout.

People received outstanding levels of care. Staff developed exceptionally positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in an individualised and compassionate way. People’s privacy and dignity was maintained at all times.

People were cared for by a motivated and well-trained staff team, who always put people first. Staff had the specialist knowledge and skills required to meet people’s needs.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe. People involved in the recruitment process and had an input in staff employed at the home.

The service developed and promoted community involvement within the home. Staff worked closely with the local college supporting new students into care which benefited the college and people at the home.

Rating at last inspection: At the last inspection the service was rated as outstanding. (Report published 03 April 2017).

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will follow up on this inspection as per our re-inspection programme, and through ongoing monitoring of information received about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

During a routine inspection

The inspection was unannounced and took place on 28 February 2017 and on 1 and 2 of March 2017.

Badger's Holt Care Home provides accommodation and support for up to 25 people. At the time of our inspection 24 people were using the service.

There was 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.

People received care and support in an exceptionally personalised way. Staff knew people extremely well, understood their needs and the way they communicated. Care was totally focused on people's wishes and preferences.

People received outstanding levels of care. Staff developed exceptionally positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in an individualised and compassionate way. People’s privacy and dignity was maintained at all times.

People's independence and wellbeing had been enhanced by improvements made in the internal and external environment of the home. Staff used their knowledge of best practice guidance to ensure the environment was suited to the needs of people including those living with dementia.

People, relatives and professionals consistently told us about the excellent care provided by well trained, committed staff who they said demonstrated outstanding levels of knowledge and skills. This had a very positive impact on people's health and wellbeing. People received outstanding effective care from staff who understood the needs of people living with dementia. This supported people’s decision making and allowed them to express their views from staff who understood them.

The provider had safe recruitment procedures in place. There were enough staff to meet people’s needs. Staffing levels were based on people’s individual needs and this made sure their personal care, social and emotional wellbeing needs were met. The skill mix of staff available in the home promoted a family and very homely environment.

The provider and registered manager used best practice guidance to drive improvement. Robust quality assurance systems were in place to ensure the homes environment was suitable to meet the needs of people who were living with dementia. Best practice guidance for each diagnosed condition had been implemented in people’s care plans and champions and lead roles were responsible for driving improvement.

People were supported to express their views and were involved in decision making about their care and were offered day to day choices. Staff sought people's consent for care and treatment and ensured they were supported to make as many decisions as possible. Staff confidently used the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, relatives, friends and relevant professionals were involved in best interest’s decision making.

People received end of life care to an exceptionally high standard and the staff had strong working relationships with external healthcare professionals.

People told us they felt safe at the home. Some people living with dementia were not able to tell us their experiences. We saw those people sought reassurance from staff and were relaxed with them. This indicated they felt comfortable and safe with staff. Relatives told us they felt their family members were safe at the home. Staff knew how to recognise any signs of abuse and how they could report any allegations.

Risks to people’s safety were assessed and managed to minimise risks. Staff followed any risk management plans in place for people. Medicines were managed safely and stored securely. People received their medicines as prescribed by thei

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was unannounced.

Badger Holt provides personal care and support for up to 25 people and has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The home provides care to a variety of people with different health needs including dementia and end of life care.

Staff working at Badgers Holt understood the needs of people and we saw care was provided with kindness and compassion. People, relatives and health and social care professionals told us they were very happy with the care and described the service as outstanding. One health care professional said: “If I ever have to go into care I want to come to this place. Almost everything is perfect. The home is so well managed and the staff are so caring”. People were supported to take part in activities they had chosen. One person said: “I can do whatever I want here, they always listen to me and I am extremely happy, the care they give is the best, I can’t fault anything”.

Staff were appropriately trained and skilled and provided care in a safe environment. They all received a thorough induction when they started work at Badgers Holt and fully understood their roles and responsibilities, as well as the values and philosophy of the home. They completed extensive training to ensure the care delivered to people was safe and effective.

The provider had employed skilled staff and took steps to make sure care was based on local and national best practice. Individual staff had taken special roles such as “Infection control” lead. Information regarding diagnosed conditions was documented in people’s care plans and discussions around risks to health and wellbeing were discussed each day.

The registered manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Each person and every relative told us they were continually asked for feedback and encouraged to voice their opinions about the quality of care provided.

There was a culture of respect, kindness and loyalty in the service. Interaction between staff and people was friendly and encouraging. People we spoke with consistently told us they had frequent opportunity to express their views with staff and management. Relatives told us the management was always available to help answer questions and provided opportunities to learn about particular conditions such as dementia. Professionals consistently told us the leadership in the home was outstanding and always displayed strong values when they visited people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We observed people’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. Each health care professional told us the staff were responsive to people’s changing health needs. One health care professional said: “They [the staff] always contact us if they are unsure or need advice”.

Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs.

During a routine inspection

Risks associated with the provision of care and support had been assessed, for example in relation to mobility and falls, nutrition and weight. The records showed that any concerns were followed up and that appropriate action was taken.

During our visit we inspected the storage and records of medicines held in the home. We saw that all medicines including controlled drugs were stored in a locked cabinet. A controlled drugs register was used for recording the administration of controlled drugs. This meant that drugs were stored safely and appropriately recorded.

Appropriate checks were undertaken before care workers began work. We looked at the personnel records for four care workers. These confirmed that they had been interviewed, that references had been requested and that the provider had completed appropriate background checks before they started work at the home.

The service had clear procedures in place to deal with any complaints or comments. One relative said "It's an excellent home, a brilliant home, it's first class". Another relative said "The staff are so caring, I couldn't recommend it highly enough".

During a routine inspection

During our visit we were able to speak to a variety of people about the service provided including, six residents, two visiting professionals, members of staff and two visiting relatives of a person living at the home. We made observations throughout the visit.

People who used the service were positive about the care they received at the home and all said they were always treated with respect. Each person we spoke to said they were very happy to be living at Badgers Holt. One person said they "considered themselves very fortunate to be here ".

People we spoke with told us that they had good relationships with staff and they " felt very safe " at the home. During the inspection we noted there was a calm and supportive atmosphere in the home and people went about their daily tasks in a relaxed and happy manner.

Each person living in the home had a plan of care that detailed their individual needs and wishes and addressed people's physical, social and emotional wellbeing.

People living in the home were cared for by an experienced and well supported team of staff who had received appropriate training.

People we spoke with said that they felt involved in the decision making in the home and that staff listened to them. We saw that people were included in home events and consulted about decisions at every level.

During an inspection in response to concerns

During our visit we spoke with people who told us that they were happy with the care they received at the home. They told us that members of staff were friendly and helpful.

People also told us that they liked the food and were happy with the choices they had for their meals. People told us that their rooms were cleaned regularly and they were happy that the home was kept clean.

During an inspection in response to concerns

During our visit we spoke with people who told us that they were happy with the care they received at the home. They told us that members of staff were friendly and helpful.

People also told us that they liked the food and were happy with the choices they had for their meals. People told us that their rooms were cleaned regularly and they were happy that the home was kept clean.