The inspection took place over two days on the 17 and 20 January 2017 and the first day was unannounced.

The service provides accommodation with both personal and nursing care for up to 38 people and is located within a detached property in a residential area of Christleton close to local amenities. The service is based in two units: Birchwood is in the main house and Greenwood in the extension. Access to Greenwood is via the outside court yard. At the time of our visit there were 36 people using the service.

The previous inspection took place on the and we found that there was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. On this return visit, we found that improvements has been made to meet all of the relevant requirements.

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 told us the staff were kind, caring and treated them well. Staff had time for people and treated them with respect. People received care in a dignified manner that protected their privacy and promoted their independence.

Staff knew people well and responded to their wishes promptly. People had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis. People's care plans were very detailed and which meant that staff were able deliver a personalised support.

The service worked with other healthcare professionals to ensure people's health and wellbeing needs were met. People received prompt medical and wellbeing services and staff assisted them to ensure that any recommendations in relation to their health were met.

A range of activities were on offer for people to participate in if they wished. People were given the opportunity to maintain links with their local community and to attend events outside of the service.

People received their medication safely and action taken to minimise any risk to a persons health and wellbeing.People were protected from the risk of abuse as staff could demonstrate they understood what constituted potential abuse or poor care. Staff knew how to report any concerns and they felt confident the service would address these appropriately.

Staff had been employed following appropriate recruitment checks that ensured they were safe to work in health and social care. We saw that staff recruited had the right values and skills to work with people who used the service. Staff rotas showed that the staffing remained at a levels required to ensure all peoples needs were met and helped to keep people safe.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us they worked as part of a team and that the service was fantastic place to work. Staff said they felt supported, that morale was good and they were very happy in their work. Staff received the training and on-going support that they required to be confident and competent in their roles.

People had confidence in the management team and met them on a regular basis. People who used the service and staff reported that the manager was approachable, supportive and available as required. People felt listened to and told us they had confidence that any concerns they may have would be addressed.

The registered provider and the registered manager continuously assessed and monitored the quality of the service, including obtaining feedback from people who used the service and their relatives. Records showed

The inspection took place on 8 and 11 February 2016 and the first day was unannounced.

The service provides accommodation with both personal and nursing care for up to 38 people and is located within a detached property in a residential area of Christleton close to local amenities. The service is based in two units: Birchwood is in the main house and Greenwood in the extension. Access to Greenwood is via the outside court yard. At the time of our visit there were 34 people using the service.

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.

We found that there was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Care records gave basic information about a person’s needs and how they wished their support to be delivered. However, they were not all personalised to give a real picture of a person’s wishes, preferences and personal history. Care Plans and risk assessments were not always updated in a timely manner to reflect significant changes in need and to direct staff in managing certain aspects of a person’s care. This meant that staff who were unfamiliar with people at the service would not know how their support needed to be delivered .We found that records in relation to the assessment and treatment of pressure ulcers and the monitoring of weight were not accurate and up to date. This meant that there was a risk that a person may not receive the care that they required.

People told us that the building was clean, warm and comfortable. People and their relatives made positive comments about the care received and were complimentary about the food. They said that the care staff and the registered manager were always available and would have no hesitation in going to them with worries and concerns. Observations indicated that people were happy at the service and there were warm and friendly interactions with staff. Staff knew the people that they supported well and could tell us about their support needs.

Where people were not able to indicate what they wanted, staff knew them well enough to anticipate their needs. The requirements of the Mental Capacity Act 2005 were met and staff helped people to express themselves and to seek consent. People told us that they were given choices, allowed to take risks and staff included them in decision making. Applications had been made under the Deprivation of Liberty Safeguards where it was felt a person’s liberty was being restricted or deprived.

People told us that staff came to them when they called but sometimes they felt that they had to wait longer than they would like. People and relatives were concerned that staff were, “Busier than ever.” We found that the dependency levels of people who used the service had increased and the registered provider had recently taken steps to increase the staff on duty.

Staff were aware what was required in order to keep people safe and they were confident to report matters of concern. People received care and support from staff that had been through robust recruitment procedures to ensure that they were of suitable character to work in this setting. Staff also underwent an induction programme to equip them with the appropriate knowledge and skills to support people. Staff received on-going training and support to ensure that they remained competent and confident to carry out their roles.

The registered manager and registered provider ensured that audits were carried out on a regular basis in order to monitor the quality, safety and effectiveness of the service. They responded in a timely manner to any complaint