This inspection took place on 25 and 26 January 2017 and was unannounced. Cedar Falls Care Home provides accommodation and personal care to up to 39 people. At the time of the inspection there were 33 older people living at the service. Most people were living with dementia and some people were living with mental health problems.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

At our last inspection carried out 18 March 2016 we asked the provider to make improvements to identifying and managing risks to people, medicine management, understanding and application of The Mental Capacity Act 2005 (MCA), the design and decoration of the service, quality assurance systems did not drive improvements and Closed Circuit Television cameras (CCTV) were in operation without the correct legal procedures having been followed. During this inspection, we found the provider has taken appropriate action to make the required improvements.

People were safe. Staff understood how to identify abuse and take appropriate action and could support people to manage risks to their safety. There was sufficient staff to keep people safe and the registered manager had systems in place to ensure staff were recruited safely. Medicines were stored, administered and managed safely. Staff supported people to have their prescribed medicines when they needed them.

People were supported by staff that had the required skills and knowledge. Staff could describe how they used the training to develop their practice. People had a choice of meals. Staff understood how to support people to manage nutritional and hydration risks. People were supported to maintain their health and wellbeing. Staff were able to access a range of health professionals as required to support people with their care.

People had good relationships with staff. Staff understood people’s needs and took time to get to know them. People could make decisions and choices about their care and support and were supported by staff to decide about all aspects of their care. Staff made sure people’s privacy was protected. They treated people with respect and maintained their dignity.

Staff understood people’s needs and preferences. They could describe in detail peoples wishes, likes and dislikes. Staff ensured people were involved in planning their care and support and involved other people where appropriate. People had access to activities and were supported to pursue their individual interests. People knew how to raise a concern or complaint and the provider had a system in place to ensure all complaints were appropriately investigated and responded to. Complaints were used as an opportunity to learn and improve the service.

People told us they had good relationships with the management team. People and staff were involved in developing the service. Staff were supported by the registered manager. Staff told us they received support to help them understand their role and provide effective support to people. The registered manager had systems in place to monitor the quality of service people received. The systems were used to drive improvements.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A person who lived there said to us "The staff are very obliging, nothing is too much trouble." A family member said "I go to bed at night and sleep well because I know they are looking after my relative."

Staff records demonstrated that mandatory training was up to date and that staff were trained sufficiently to meet the needs of people who lived there. Staff had received specialised one-to-one training in the care of people with dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Relatives told us that they were happy with the care that was delivered and that people's needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and told us that they were satisfied with the standard of the training.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff took into account the complex needs of people when planning activities so that they could take part safely. A person who lived there told us that living there was very positive with "excellent staff." Staff said that they were very happy with the level of professional and emotional support they received from the management team.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences and interests and lifestyle passports/social histories were used to help staff understand each person's personality and emotional state. People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff had a good understanding of the ethos of the home and robust quality assurance processes were in place. A relative told us that the manager had an open-door policy and that they had never had an issue but that they would feel confident in approaching the manager if there was a problem. Food was prepared freshly on site by catering staff who were trained to be able to meet the complex nutritional needs of people. Staff told us that they were clear about their roles and responsibilities and that management support was of a high standard and helped them to do their job effectively.

We carried out this inspection to review the care of people who used the service. In order to target our inspections effectively we gather information about services. This may include information from people who use services, family members and staff.

The people living at the home and visitors we spoke with were generally complimentary of the staff and the care provided at the home. One person said: “I am very, very happy here”. We saw that staff were available to support people with their care needs. Medication was dispensed to people as prescribed by a clinician.

Generally the staff we spoke with said they felt supported. An induction was available for new staff to ensure they had the necessary knowledge prior to starting work. We saw that there was a training matrix in place which recorded the training undertaken by staff, this included safeguard training (protecting vulnerable adults). We saw that there were some gaps in the training that staff had received.

There were systems in place for the registered manager and the provider to monitor the quality of the service provided at Cedar Falls.

This inspection took place on 1 and 2 December 2015 and was unannounced. At the last inspection completed on 29 October 2014 the provider was found to be meeting all legal requirements.

Cedar Falls Care Home is a residential home that provides accommodation and personal care to up to 39 people. At the time of the inspection there were 36 older people living at the service. Most people were living with dementia and some people were living with mental health problems.

The service is required to have a registered manager. There was a registered manager in place at the time of the inspection. 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 were not always protected as potential risks had not always been identified and managed. People were happy with the management of their medicines and they received them as prescribed. However, we found that medicines were not always stored safely and accurate records had not always been maintained.

People told us that they felt safe living at the service. Staff could describe how they would recognise and report any signs of abuse towards people. We found that not all incidents of concern were recorded and reported by staff to the registered manager. People were protected from potential harm by robust recruitment processes that ensured staff members were appropriate to work in a care setting.

People’s rights were not always protected through the effective use of the Mental Capacity Act 2005. Decisions about people’s care were not always made in line with this Act. The provider had not always considered people’s needs in the design and decoration of the environment.

People told us that they enjoyed the food and drink that was available to them. We saw that people’s day to day health needs were met and people were supported to see healthcare professionals.

People told us that they felt staff had the required skills to support them effectively. Staff told us that they felt well supported in their roles and they had access to training to enable them to support people well.

People told us that they liked the care staff and we saw positive interactions between staff and people living at the service. People told us that they were supported to make choices and to be independent. People’s privacy and dignity was respected and protected. People were also encouraged to maintain relationships that were important to them.

People told us that they were involved in their care planning. People were happy with the activities and leisure opportunities available to them. People were able to complain if required and felt that their views were listened to. We saw that the provider took appropriate action where complaints were received.

People were not supported by robust quality assurance systems that ensured issues were identified in the service and managed effectively. We found that Closed Circuit Television cameras (CCTV) were in operation with the correct legal procedures having been followed. We have made a recommendation about this.

People spoke highly of the management team and told us that they felt managers were approachable and listened to them.  Staff told us that managers were supportive and enabled them to perform in their roles.  We saw that staff and people living at the service were involved in the development of the service.  Improvements had been made as a result of feedback received from people.