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Inspection carried out on 27 February 2018

During a routine inspection

The Check 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. The Check House is registered to provide personal and nursing care. They provide care and support for older people living with frailty and for people living with dementia. The Check House accommodates 57 people in one adapted building which has been extended since our last inspection, which means there is additional communal space.

At our last inspection on December 2015, we rated the service as good overall, with requires improvement in the question linked to effective care. At this inspection we found evidence to support the continued rating of good in three key questions and outstanding in two key questions. From our on-going monitoring of the service there was no evidence that demonstrated serious risks or concerns.

There was a registered manager working at the home. A registered manager is a person who has registered with the CQC 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.

There was a firm commitment to provide a creative array of activities to support people’s emotional and mental well-being. These enabled people to learn new skills. Staff recognised the importance of people's past lives, their interests and preferences, as well as providing them with an opportunity to be involved in new experiences. The contribution of pets to enhance people’s well-being was recognised; there were two house cats and several people had moved to the home with their dogs.

People had access to diverse activities and events both at the home and in the community, including dance therapy and physiotherapy. Examples included tea dances with a dance group, flower arranging, cake making and regular trips out in the service’s mini-bus to local places of interest such as cafes, museums, garden centres and the seafront. People were supported to have regular walks around the local area. People living with dementia were as involved with community activities as much as everyone else.

People living at and visiting the home praised the high standard of the food and its presentation. Catering staff worked alongside care staff to find food to meet people’s preferences and choices. They worked as a team with the outcome for the person at the forefront of their minds, discussing how to make choice meaningful for people living with dementia. Written feedback on an independent review website scored the home very highly recognising the “incredible caring staff”, the range of activities and the “very attentive care, both personal and medical”.

There was an on-going investment in the environment which reflected research and best practice to promote people’s independence and connection with their surroundings. The provider and registered manager recognised the effectiveness of the use of colour and contrast to ensure the adaptation, design and decoration of the environment was enabling, stimulating and suited to the needs of people living with dementia. Research influenced their decisions in how people were supported to navigate their way around the home.

People’s relationships and life experiences were respected and celebrated. This knowledge enabled staff to help people consider their wishes for their end of life care. Staff held a strong sense of pride in connection with the quality of end of life care. Staff knew people and who and what was important to them and significant events in their lives.

The registered manager acted as a strong role model for all the staff team and was accessible to people living, working and visiting the home. A visitor commented “Someone is always on hand if a

Inspection carried out on 26 and 29 October 2015

During a routine inspection

The inspection took place on 26 and 29 October 2015 and was unannounced. We last visited the service in December 2013 and found the service was compliant with the standards inspected and no breaches of regulations were found.

The Check House is registered to provide accommodation for 49 people who require personal care and nursing and specialises in the care of people living with dementia. 49 people lived at the service when we visited. Staff were deployed to work in teams across the three areas of home, known as Ruskin, Main, and Rosetti and there were shared communal areas on the ground floor.

The service had a registered manager. 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 had a clinical lead nurse who provided nursing leadership and advice to the registered manager and monitored nursing practice.

Staff were trained and knew how to manage people whose behaviours challenged the service, although care plans on managing this lacked detailed instructions for staff. This lack of detail in care plans about how to manage this increased the risks for others and staff, particularly for staff less familiar with the person and how to manage these behaviours.

Staff identified people at risk of malnutrition and dehydration and had detailed care plans in place about how to support those people. However, their food and fluid records were not accurate or detailed enough about their nutrition and hydration, although we observed those people were supported to eat and drink regularly. By the second day of the inspection, the registered manager had taken action to make improvements. 

People were supported to receive ongoing health care support. Staff were knowledgeable about people’s care and treatment needs. People were seen regularly by their local GP, and had regular health appointments such as with the dentist, optician, and chiropodist. The local community mental health team supported staff with some people’s mental health needs and gave us positive feedback about staff skills.

Staff were kind and compassionate towards people, they had warm and caring relationships with them. The service was organised around people’s needs by staff who knew each person, about their life and what mattered to them. People’s views were actively sought, listened to and acted on.

People and relatives felt safe at the home, and risks for people such as from falls and choking due to swallowing difficulties were well managed. People were supported to remain active, and be as independent as possible. Hand rails, and other specialist equipment were available to help residents move around the home independently. The home had a physiotherapist that supported people to remain mobile by providing advice about equipment and exercise plans. Regular exercise and fitness classes were held.

People and relatives were consulted and involved in developing and reviewing care plans. Care records were regularly reviewed and updated as people’s needs changed. Most people were assisted to maintain their interests and hobbies and to try new things, through a varied programme of activities. They were supported to access their local community regularly. However, for people who remained in their rooms through choice or for health reasons, there was less evidence of how they were supported with their interests and hobbies, or to interact with people and avoid isolation.

Repairs and maintenance of the building and equipment were regularly undertaken. A new boiler had recently been installed although we identified some rooms where the water in hand wash basins was slightly hotter than recommended by the health and safety executive. We discussed this with the provider and registered manager, who immediately risk assessed these areas to identify further steps to reduce risks. They arranged for thermostatically controlled valves to be fitted to those rooms.

The culture of the home was open and friendly. There was clear leadership from the registered manager, and staff had delegated roles and responsibilities. The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. Where there were concerns or complaints, these were investigated and positive action taken. The provider participated in good practice initiatives such as Dignity in Care to encourage high standards of care and to keep staff up to date with practice. There was evidence of continuous improvements being made in response to feedback and the findings of audits.

We found one breach of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 11 December 2013

During a routine inspection

Our inspection was unannounced and lasted approximately eight hours. During this visit, we inspected five outcome areas; all five were compliant. This included an outcome linked to consent to treatment and care as there was a compliance action made on the last inspection.

We spoke with nine people living at The Check House about their experiences of living at the home. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We also spoke with four staff members and the manager. We looked at a selection of care records, as well as staff training records, and we checked to see how complaints were managed.

We saw people looking relaxed and at ease with staff and each other. When people felt anxious or unhappy, staff were quick to recognise the need to change their approach, such as sitting with them to reassure them. There were a range of activities taking place during our visit, which included aromatherapy and physiotherapy.

People told us they were happy living at The Check House. People�s privacy and dignity was respected by staff. Staff practice showed they knew to gain people�s consent when they provided with support with care. People�s health and well-being was assessed, and care was provided in a way that suited people's individual needs. There was a training programme in place and the manager addressed complaints in a robust manner and ensured lessons were learnt from concerns.

Inspection carried out on 19 July 2012

During a routine inspection

At the time of this inspection there were 48 people living at The Check House. We met with or saw the majority of people who lived at the home. We spent time speaking in depth with seven people who lived there as well as speaking with two relatives, and eight members of staff, including the manager and company representative. We also spoke with health and social care professionals who supported people living at the service, including a GP, a nurse specialist and care manager.

A number of people that lived at this service had a dementia type illness and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection). This involved us observing three people who used the service for a period of at least one hour and recording their experiences at regular intervals. This included people's mood, and how they interacted with staff members, other people who use services, and the environment. It helped us to gain an understanding of people�s general well-being. Some people using the service were able to tell us their views.

We observed that staff treated people with respect at all times during our visit. We saw that staff were responsive, friendly and considerate when supporting people. We saw that, where possible, staff promoted independence and choice for people.

The people we spoke with told us they were happy with the care and support provided to them. One person told us, �I am very happy here. The staff are very good, they help me�. Other comments included, �I am well cared for. The staff are lovely girls�, �I have everything I need here�, and �I am very happy with everything here�. Those people who were able told us that they felt safe at the home and knew who to speak with should they have any concerns.

People told us the food was good; one person said, �The food is delicious�. Another told us, �The food is out of this world�. People also told us that the home was �always clean and fresh�. One person said, �The cleaners work very hard. My room is always clean�. We found that all communal areas and private bedrooms were clean and tidy and well maintained.

Visiting relatives told us they were happy with the care and support their family member received at The Check House. One person told us, �It is wonderful here. I can�t speak highly enough of the staff�. Another relative told us, �I have no worries or concerns about the care that X is getting here�.

Visiting professionals spoke highly of the care and support delivered to people at the home. They told us that the home makes appropriate referrals to them and that good communication had been established between outside professionals and staff within the home. One health professional told us, �There are very high standards here; very professional�. Another visiting professional told us, �The care staff are very good, on the ball. I have seen real improvements over the past two years�. A third professional told us, �We have no concerns about The Check House. They are creative with the activities; the staff are responsive, competent and understand complex issues��

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