The shift: Karen Poulter, care home manager of Red Oaks in Henfield

Karen Poulter was on the morning medication round — a cupboard on wheels full of pills and medicine for the residents of the Red Oaks care home. It is a complicated business: four pills in the morning for this man, then three at lunch and tea; two twice a day for that woman; eight pills and a medicine for that resident — for arthritis, gout, heart problems and, of course, dementia.

Betty, 94, squinted in the sunlight of the kitchen as a member of staff gave her a bowl of cereal. “Would you like sugar on your Rice Krispies, Betty?”

“I bet you she knows Betty takes sugar on her Rice Krispies,” Mrs Poulter said. “She could have just put sugar on but Betty has been given the chance to make a decision.”

Being given autonomy over little things can make all the difference when you have dementia.

“Am I in school?” Betty asked. “No, you’re in Red Oaks,” Mrs Poulter said. She explained that Betty’s son moved her into the care home so that she could be safe and near his family.

“Why isn’t he living with his daughter?” Betty asked. “He does live with his daughter.” “What am I, then?” “You’re not his daughter.” “I thought we were talking about my father. Have I got a dad?” “Not any more, Betty.” “Oh. That’s not fair, is it?” She looked sad. “Where am I now?” “You’re in Red Oaks. We’re looking after you.” “What is Red Oaks?”

In the Lavender wing, which cares for 18 residents with dementia, a Singer sewing machine, clothes from the 1930s and antique watering cans are spread around tables. Some residents sat in their rooms, some ate breakfast in bed, others made their way slowly towards communal areas.

Routines are kept as flexible as possible. “They don’t mean anything to people who can’t remember. So if somebody wakes up at 3am and wants breakfast, that we know it’s 3am is irrelevant,” Mrs Poulter said.

There are many poor care homes for the elderly in Britain. Red Oaks in Henfield, West Sussex, which is owned by Barchester Care Homes, is not one of them. The nine staff on the Lavender wing are dedicated, cheerful and long-serving. “Every day when I drive in, I look forward to it. The people here have got so much to offer,” Mrs Poulter said. If the residents have no family, “we become their family”, she added.

After a pre-lunch sherry we put on bibs and ate prawn cocktail, beef casserole and sponge cake with custard. The residents stared at me in wonder trying to place me.

“Just ignore them,” Harriet, a well-spoken woman, muttered. “They are all crazy.” She put some food carefully aside for the animals in the zoo. “Should I be telling her about this?” she asked Mrs Poulter when she noticed my note-taking, “about the zoo?”

The Alzheimer’s Society predicts that there will be one million people with dementia in Britain by 2025. Mrs Poulter said people should judge a care home by what they feel, see and hear — and they should visit their relatives regularly. “I would only have to open the front door to know if it was somewhere I wanted my relative to be.”

Ellen’s daughter visits every day. While Mrs Poulter cleaned Ellen’s ulcers her daughter removed bits of tissue paper from the mouths of stuffed dogs. Ellen, a great-grandmother, loves dogs. There are 15 in the room in all sizes and colours. “Trouble is she feeds them,” her daughter said. “This one has had jelly, liver and marzipan.”

“To her they are real,” Mrs Poulter said. “It gives her something to look after, a sense of worth.”

I read to Harriet, 89. She looked calm and dreamy but it was disconcerting to read to someone without being sure that they could remember what had happened at the top of the page.

Harriet has a form of dementia called lewy body. She can be lucid for some time but will then suffer an hallucination. We talked about her sons, marriage and work as a nurse — salary £76 a year.

Mrs Poulter came in. “We’ve been talking about my life,” Harriet said. “I can’t imagine why she’s interested — oh look! The puppies!”

We stared at a spot on the ceiling. “All those puppies! Up there!” She turned sadly to her carer. “Am I seeing things again?”

Care home manager

Name Karen Poulter

Age 46

Hours 40 to 45 a week including some nights

Annual earnings £40,000

Length of service Five years

Training General nurse, registered mental nurse

Family Married with two children

Best part of the job The fascinating people

Worst part Dealing with funding applications

Cost of a place at the home £900 to £1,200 a week