This inspection took place on 16 and 17 February 2017 and was unannounced. The home provides accommodation and personal care for up to 18 people, including people living with dementia. There were 17 people living at the home when we visited. Accommodation was spread over two floors, connected by a passenger lift and stairwells. There was a good choice of communal spaces where people were able to socialise and some bedrooms had en-suite facilities.

The provider is registered as an individual. Although they are not required to have a registered manager, the current manager had applied to be registered with CQC. 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 our last inspection, in January 2016, we identified breaches of two regulations. Risks to people were not always managed effectively and recruitment practices were not always safe. At this inspection, we found action had been taken and the provider was meeting these regulations.

Legislation designed to protect people’s freedom was being followed and staff sought verbal consent from people before providing care and support. However, assessments of people’s capacity to make decisions, and decisions made on their behalf, had not been recorded in accordance with legislation. We have made a recommendation about this.

People’s needs were met by staff who were skilled and suitably trained. New staff completed a comprehensive induction programme and all staff were suitably supported in their roles. Training records were not well organised, and some staff training needed to be refreshed, but the manager took action to address this following the inspection.

People were protected from harm in a way that supported them and respected their independence. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Staffing levels had recently been increased and there were enough staff to meet people’s needs. Appropriate recruitment processes helped ensure only suitable staff were employed.

There were appropriate arrangements in place for the safe handling, storage and disposal of medicines.

People praised the standard of care delivered and the quality of the meals. Their dietary needs were met and they received appropriate support to eat and drink enough. People were supported to access healthcare services when needed and to attend hospital appointments.

People were cared for with kindness and compassion. Staff interacted with them in a positive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals.

Staff protected people’s privacy and encouraged them to remain as independent as possible. They involved people in the care planning process and kept family members up to date with any changes to their relative’s needs.

People were encouraged to make choices about every aspect of their daily lives. They received personalised care and support that met their needs. Care plans provided staff with detailed information about how they should support people in an individualised way. Staff responded promptly when people’s needs changed.

People had access to a range of suitable activities. There was an appropriate complaints procedure in place and people knew how to make a complaint. The provider sought and acted on feedback from people.

People and their families felt the home was run well. The provider was actively involved in running the service and there was a clear management structure in place. Staff were happy in their work and felt supported by the provider and the manager. They had created a calm, relaxed and homely environment for people.

There was an open and tra

We spoke with nine of the 17 people who were living at the home. They were all extremely happy with the care they received. One person told us “the staff are first class, absolutely wonderful”. Another said “the staff are so patient, I listen to them when they are helping a person with dementia and they take so much time explaining things to them”. We met other people and observed some of their care and staff interactions in communal areas. We also spoke with four visitors. Again they were very positive about the home. One said “mother has blossomed here, the staff really care”.

We spoke with all staff on duty including the registered manager. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff said they had completed lots of training and had sufficient time to meet people’s needs. Staff were aware of people’s needs and how these should be met.

We observed staff, who were courteous and respectful of people's views and offered choices. The care we observed corresponded with care plans and risk assessments viewed. The home was clean and there were systems in place to manage infection control risks. There were also systems in place to monitor the quality of the service provided.

We spoke with one visitor and eight people who lived at the home. We met other people who lived at the home including those in their bedrooms but only had short conversations with them. We also spent some time in the home’s communal areas observing people and the way they were cared for.

We spoke with health and social care professionals who regularly visited the home. They were complimentary about the way the service met people’s needs.

Everyone we spoke with confirmed that people’s privacy and dignity were maintained at all times and that people were able to make day to day decisions such as what time they got up and how and where they spent their time. We observed that people were enjoying their lunch time meal. People told us meals were good and that alternatives were provided.

People said that they had no concerns about how their personal care needs were met. They also told us that if they were unwell then staff would contact a doctor for them. We were told that staff were available when people needed them and knew what care they required. People said staff gave them their medications when they needed them.

People and relatives said that if they had any concerns or complaints they would raise these with the manager. Nobody had any concerns when we spoke with them.

This inspection took place on 5 and 6 January 2016 and was unannounced. The home provides accommodation for up to 18 people, including some people living with dementia care needs. There were 17 people living at the home when we visited. The home was based on two floors; there was a good choice of communal spaces where people were able to socialise and some bedrooms had en-suite facilities.

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’s safety was compromised as the risks to their health and safety were not always managed appropriately and action had not always been taken to reduce the level of risk. This included the risks of one person choking on their food and the risk of two people having repeated falls. Accidents records were not organised and there was no process in place to identify trends.

Clear recruitment procedures were in place, but these were not always followed. Reference had not been obtained for a staff member who had recently been employed and full employment histories were not always obtained to check staff were suitable to work with the people they supported.

Staff sought consent from people before providing care. However, they had not protected one person’s rights as their freedom was being restricted and staff had made decisions on their behalf without following the relevant legislation.

Most people received personalised care from staff who understood and met their needs. Care plans provided detailed information about how they wished to receive care and support although some information in them had not been personalised to the individual. Records relating to continence care did not always contain sufficient information.

People were usually involved in planning the care and support they received, but this was not consistent and people were not involved in reviews of their care.

Effective systems were not in place to assess, monitor and improve aspects of the service, such as infection control, the management of falls and staff training. There was a Duty of Candour policy in place, but this was not always followed. The provider sought and acted on feedback from people, although the results of satisfaction surveys were not analysed or used to identify improvements.

People liked living at the home. Relatives felt it was run well and said they would recommend it to others. There were strong links with the community and the provider promoted a positive culture. Staff understood their roles, were motivated and worked well as a team.

People told us they felt safe. Staff had the knowledge and confidence to keep people safe through procedures they understood well. There were sufficient numbers of suitably trained and experienced staff to ensure people’s needs were met. New staff received induction, training and support from experienced members of staff. Staff felt supported by the provider and the registered manager, felt valued and said they were listened to.

People were treated with kindness and compassion and staff showed concern for people’s wellbeing. Their privacy was protected and staff treated them with dignity and respect.

Medicines were managed safely and people received their medicines when required. Risks posed by the environment were managed effectively and people were supported to take risks that helped them retain their independence.

People were offered varied and nutritious meals. They were given appropriate support when needed and their intake was monitored. People were supported to access healthcare services when needed to stay healthy and there were good working relations with healthcare professionals.

Staff responded to people’s change needs. People were empowered to make choices about how they lived their lives and had access to a range of activities.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.