This inspection took place on 10 & 17 May 2016 and was unannounced. At our previous inspection on 10 February 2014 the provider was not meeting all the regulations that we checked. We asked the provider to make improvements around staffing, as people were not always supervised appropriately. At this inspection we found that improvements had been made.

Coleridge House provides residential care for up to 40 older people, living with dementia and or a physical disability, or sensory impairment. There are bedrooms on the ground and first floors. It is split into three units each with its own lounge and dining area. The service has a high dependency unit (Chestnut), which provides care for people living with dementia and two low dependency units (Maple and Willow). There were 32 people living at the service at the time of our inspection.

There was no active registered manager in post. There was a manager recently appointed at the service who was covering this position. The provider confirmed that the manger would be applying to become the registered manager. The home is required to have a registered manager in post. 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 and associated Regulations about how the service is run.

People we spoke with said they felt safe at Coleridge House. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe.

Safe systems were in place to manage people’s medicines and medicines were stored safely. Risk assessments and care plans were kept up to date. Staff had the relevant information on how to minimise identified risks to ensure people were supported in a safe way.

Staffing levels were monitored to ensure people’s needs were met. The provider’s recruitment procedures ensured suitable staff were employed to work with people who used the service. Staff received training to meet the needs of people living at the service and received supervision, to support and develop their skills.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. However mental capacity assessments had not been completed. Deprivation of Liberty Safeguards (DoLS) applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions.

People were not always given choices with regard to food and drink preferences and appropriate support when needed. People were supported to maintain good health and to access health care services as required.

Staff were caring in their approach and had a good understanding of people’s likes, dislikes and preferences. Staff supported people to maintain their dignity. People were supported to maintain and develop their social interests. People felt confident that they could raise any concerns with the managers.

There were processes in place for people and their relatives to express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

Staff felt supported by the management team. The leadership and management of the service and its governance systems ensured consistency in the care being provided.

We spoke with five people who used the service and two people’s visitors. People using the service and their visitors told us they were happy with the care they received and spoke highly of the staff that supported them. Comments included, “I wouldn’t want to move from here, it’s lovely.” And “All of the staff are very nice, very approachable.”

People told us they enjoyed the meals provided. Comments included, “The meals are very good here.” And “The food is very nice and there is always a choice.” People’s nutritional support needs were monitored appropriately to ensure they were effectively met.

We checked the medication practices and saw that people received their medication as prescribed and in a safe way.

The support plans and risk assessments seen reflected the care that was given.

We spoke with four care workers, one senior carer, the registered manager and the assistant manager of the high dependency unit. We found that sufficient numbers of staff were available within the high dependency unit. However we identified that the staffing levels in the two low dependency units were at a minimum level with one care worker on duty in each unit. This meant there was the possibility that people’s needs could not always be met effectively.

Processes were in place to ensure the services and care provided were monitored and improved upon where needed.

We spoke to five people living in the home. They spoke positively about the staff team respecting their privacy and maintaining their dignity. People told us that staff were supportive and caring. One person said "I can’t praise them enough, they really do care”.

We found that people were receiving the care and treatment that they needed in line with their care plans.

The staff working at the home were recruited safely. All of the staff we talked with spoke positively about working at the home.

We found that the provider had systems in place to assess and monitor the standards at the home and action plans showed that they address items that came to their attention.

Meetings had been held with the people who lived at the home and they were asked for their opinion on the services they received.

People told us the routine was relaxed and flexible. People were able to stay in their rooms or use communal areas as they wished. They also told us on occasions they thought there weren’t enough staff on duty. They told us sometimes they had to wait for care workers to answer the call bell, and they only had one bath a week. However people did think that their needs were being met by care workers.

People told us care workers were good, and they would help them when needed. One person said, “The carers will do anything for us, above and beyond their duties.” People told us they felt safe and had not seen any care practice that gave them cause for concern.

People told us 'residents meetings' were held on a regular basis. People said they were able to raise issues at these meetings, and they felt listened to. People told us that that most recent meeting had been to discuss the preparations for the Christmas period.