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Inspection carried out on 21 May 2019

During a routine inspection

About the service:

Dewar Close 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. Dewar Close accommodates up to 43 people across three separate households, each of which have separate adapted facilities.

What life is like for people using this service:

The management team and staff were exceptional in placing people at the heart of their service and home.

There was a clear culture that staff and managers looked at how the home could be continuously improved.

The provider and registered manger ensured their service was delivered according to their values. The home had a strong person centred and local community-based ethos.

The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated within the care home.

Respect and dignity were cornerstones of the values upheld by the staff and role modelled by the management team.

Staff and the service's management told us how important the services' shared values were to them, and how they were passionate about providing outstanding person-centred care to people when they needed it.

Innovative approaches such as assisted access to electronic records and feedback tools, provided people and their relatives options in shaping a personalised service, make decisions.

The registered manager went the extra mile to ensure people’s lives were enriched and worked in collaboration with leaders in dementia care, to ensure people received care that met their long-term needs.

People and their relatives were involved in choosing their care and support, from pre-admission to living in the home.

People received kind, responsive person-centred care from staff who were well trained, motivated and supported by a dedicated registered manager who led the staff team to provide the best care they could.

Staff were safely recruited, well trained and supported with personalised training programmes and 24 hour back up. Staff were aware of how to report any concerns about neglect or abuse and were confident they would be addressed. They felt they were listened to and were part of an organisation that cared for them and their wellbeing, as well as the people they were supporting.

Regular audits were carried out; people were asked their views in person and via questionnaires and changes were quickly made if issues were identified. The service learned from incidents, concerns or accidents to help prevent a reoccurrence.

People were supported safely, and risks regarding their care were assessed and met. Where this was a part of their care, people's medicines were administered safely and in accordance with the prescribing instructions.

The service was led by a registered manager and management team that were committed to improving people’s lives.

Rating at last inspection: The last comprehensive inspection report for Dewar Close was published in June 2016 and we gave an overall rating of Outstanding. At this inspection we found the service continued to be Outstanding in Responsive and Well Led.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Inspection carried out on 12 April 2016

During a routine inspection

The inspection took place on 12 and 13 April 2016 and was unannounced. The service was last inspected on 7 January 2014, when we found they were meeting the regulations.

The registered manager had been in post since April 2013. 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.

The service provides accommodation and personal care for up to 43 older people, who may have dementia. Thirty-six people were living at the home at the time of our inspection.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. Staff received training in the provider’s values and philosophy, which included, ‘play, make their day, be there and choose your attitude’. People were supported to maintain their purpose and pleasure in life. People’s right to lead a fulfilling life was enshrined in a charter of rights, which all staff understood and respected.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia care. The provider had researched and reflected on how an internationally recognised provider of excellence in dementia care provided care. They had re-modelled the home in accordance with current best practice principles, which included artefacts and different rooms designed to stimulate memories, provoke curiosity and to rest and relax.

The registered manager and staff participated in research projects aimed at improving the quality of care. Actions taken by the provider and planned improvements were focused on improving people’s quality of life, based on the research and experience of experts. People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences. The provider ensured people had the opportunity to share their views face-to-face, by telephone and by using the most up- to-date ‘on-line’ computer based methods.

People and relatives behaved as if the home were their own home. They maintained their preferred and familiar routines and habits, which made them content and relaxed. Staff took time to understand people’s life stories and supported and encouraged people to celebrate important personal and national events. People were supported take an active interest in the local community and to maintain their personal interests and hobbies.

The provider employed a team of exercise and activity co-ordinators who were dedicated to supporting people to make the most of each day. The group activity sessions were effective and the positive impact on people’s moods was visible. People and staff shared the moment of fun together, which developed trust and positive relationships. Healthcare professionals and external agencies commented on the rapport between people and staff and the ‘lovely’ feeling that their rapport created across the home.

People planned their own care, with the support of their relatives and staff, to ensure their care plans matched their individual needs, abilities and preferences, from their personal perspective. Care staff showed insight and understanding in caring for people, because they understood people’s individual motivations and responses.

Staff were attentive to people’s appetites, moods and behaviours and were proactive in implementing individual strategies to minimise people’s anxiety. Staff ensured people obtained advice and support from healthcare professionals to minimise the risks of poor health.

All the staff were involved in monitoring the quality of the service, which included regular checks of people

Inspection carried out on 7 January 2014

During a themed inspection looking at Dementia Services

Thirty eight people lived at the home at the time of our inspection. Not everyone had a diagnosis of dementia, but many of the people were not able to tell us about how they were cared for and supported because of their complex needs. A relative commented, “I have always found the care to have been of good quality and the staff and managers very helpful.”

We observed how people were cared for and supported. We saw that staff interacted positively with people. When staff offered people drinks and snacks, they took the opportunity to chat with them about a topic that the person was clearly interested in.

The layout of the rooms and corridors provided plenty of small, homely spaces with armchairs, books and an old fashioned radio for people to relax in. On the day of our visit people took part in several organised activities. We saw that a lot of people liked to just sit and chat with each other and care staff.

The three care staff we spoke with told us they liked working at the home. They told us they were trained in dementia care. They said, “We learnt about the different aspects of dementia so we could understand the different conditions, forms and impacts” and “It explained the effect on the brain and I got to understand people better so I can respond more effectively.”

The provider’s quality monitoring system included asking people, their relatives, staff and other health professionals what they thought about the service. The provider took action to improve the quality of the service.

Inspection carried out on 24 May 2012

During a routine inspection

We carried out this review to check on the care and welfare of people using this service. We talked with the registered manager and the care manager, three care staff employed by the service, four people who lived at the home and one relative about the quality of care. Everyone we spoke with said they were very happy living at the home. One person said, "Really this is a lovely home, I have never been refused anything and they help me whatever I do".

Lots of the people who lived at the home could not talk to us directly about their care because of their dementia, but we saw that people were relaxed and moved freely around the home. We saw that staff were observant and anticipated people's needs and that people responded positively to staff engaging with them.

People told us they could choose how to spend their day and where they had their meals. We saw that some people chose to sit in the quiet lounge and watch television or chat to their friends and that other people chose to sit in the larger living areas where they could engage in day to day domestic tasks and craft activities or sit in the adjoining garden.

One relative we spoke with said, "Staff listen to M, they never brush her off, they interact and make her feel positive about herself". One person who lived at the home said, "The staff are very good, they always knock at my door". One member of staff said, "My job is about building relationships with people, so they start to trust you".

We found that the provider had a system for monitoring the quality of the service which included checking that care and support were delivered according to the care plans and asking people who received care what they thought about it. We saw that when people raised issues about any aspect of the quality of care and support that staff were involved in agreeing how to improve it. Three people we talked with told us they had, “Nothing to complain about".

Reports under our old system of regulation (including those from before CQC was created)