This unannounced comprehensive inspection took place on 13 January 2017. We last carried out an inspection of this service in February 2016 and identified that the service required improvement.

Cestria House provides accommodation and personal care for up to 24 older people. Care is provided to older people, some of whom are living with dementia or dementia related conditions. At the time of our inspection there were 21 people living at the home.

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.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what staff should do if they had concerns about the practice of a colleague.

There was sufficient staff to meet people’s needs. They were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff had developed good relationships with people and communicated in a warm and friendly manner. They demonstrated good communication skills in relation to supporting people who lived with dementia. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had. The registered manager understood the importance of acknowledging and improving areas of poor practice identified in complaints.

There was a wide range of activities available both within and outside of the home. People were able to access their local communities and enjoy the amenities.

The home was well led by a registered manager who had a vision for the future of the service. A quality assurance system was in place that was utilised to improve the service.

This was an unannounced inspection carried out on 17 and 19 February 2016.

We last inspected Cestria House on 12 September 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

Cestria House provides accommodation and personal care for up to 24 older people. Care is provided to older people, some of whom are living with dementia or dementia related conditions. Nursing care is not provided.

A registered manager was 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 said they were safe and staff were kind and approachable. There were sufficient staff to support people. We had concerns that robust arrangements were not in place to reduce the risk of fire as a person smoked in their bedroom.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Systems were in place for people to receive their medicines in a safe way. However, we have made a recommendation about the management of medicines.

The environment was mostly well-maintained but some areas required attention.

People had access to health care professionals to make sure they received appropriate care and treatment. However, we had concerns peoples’ privacy and dignity was not respected as we observed some people's treatment took place in the lounge.

Cestria House was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Best interest decisions were not always made appropriately on behalf of some people, when they were unable to give consent to their care and treatment.

Appropriate training was provided and staff were supervised and supported.

Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected by Cestria House staff.

There were a variety of activities, outings and entertainment available for people.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided, however they had not identified the issues during their audits that we noted during the inspection.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

We found that all staff had received mandatory emergency first aid training and the provider now monitored training requirements appropriately.

Training records held by the registered manager, were accurate and up to date and showed when certain training had been completed, needed to be refreshed and when future training had been arranged.

We saw the premises were suitable, safe and well maintained.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person told us, “I definitely feel safe here and I am very well looked after.” A relative told us, “I feel X is very well looked after and cared for; she is safe here.” Another relative said, “We have no issues or concerns about her being here. We are happy that she is safe and secure.”

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. 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. One person commented, “There’s always enough staff on to look after people.” One relative told us, “There’s absolutely no problem with staffing. There is always plenty of staff about and I’ve never felt that they have even been understaffed.”

The building was well maintained, secure and other appropriate measures were in place to ensure the security of the premises.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us, “The care is good and everything is fine here. The staff are very good, especially at night; they are always coming in to check on you.” Another person told us, “I am very well looked after and cared for; I have no complaints on that score. The staff are very conscientious and the domestic staff are meticulous about their cleaning.” A relative told us, “They have good communication skills and that is important, especially for people with dementia.” Another relative said, “I find the staff try hard and it’s great to see them make sure people are not left isolated. They never seem rushed and are patient and spend one to one time with people.”

We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development, appraisal and supervision. However, we found that one area of staff training was not up to date and the provider did not always monitor training requirements appropriately. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and training arrangements.

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. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “The staff are very patient and caring; very much so.” Another person said, “The staff are nice, kind and caring.” Relative’s comments included said, “Overall, we are very happy with his care. He is happy and content here, the staff do a grand job and they are all very caring,” and, “They treat her nicely and genuinely seem very caring and it’s obvious that they want to do their job.”

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed monthly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

We saw the provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that one complaint had been received by the service within the 12 months. We saw that the complaint had been recorded, investigated and resolved to the satisfaction of the complainant. We also noted that three compliments had been received by the service within the last 12 months.

We saw the service had policies and procedures in place in relation to the safeguarding of adults. This meant that people were safeguarded as required and the provider was able to respond appropriately to any potential allegations of abuse.

Is the service well-led?

The service had a registered manager in post and the provider had in place, systems to monitor the quality of the service people received.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People and their relatives were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Both staff, people who used the service and their relatives said communication was good. One relative told us, “Kathy is a good leader, very helpful and approachable. We have regular reviews about her care and anything raised, or minor issues, have been sorted. Kathy runs a nice ship here. It may not have a lot of fancy bells and whistles, but the care is really good.”

Staff received regular supervision and appraisal and told us they felt supported by the management team. A member of the management team was available on call for advice and support and in case of emergencies.