This inspection took place on the 24 October 2016 and was unannounced.

The service is a residential home that offers care without nursing to a maximum of 30 older people living with dementia. At the time of our inspection there were 26 people living in the service.

There was 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.

Prior to this inspection the service was last inspected on 14 December 2015 and was found to require improvement with four breaches of the regulations. At the previous inspection we found the Safe domain was inadequate with an unsafe environment, a lack of reviews of people’s risk assessments and unsafe recruitment processes. There was a limited variety of activities for people and care plans did not contain all the necessary information. The governance of the service required improvement as records were not kept up to date and the concerns had not been identified by the management team during auditing.

During this inspection we found there had been an improvement and most areas of concern had been addressed by the service who had worked in partnership with the local authority to improve the quality of care.

The service had adequate staffing to meet the support needs of people living at the service and staff had received training and supervision sessions to support them in their role. The service had systems in place for the safe recruitment of staff but had not renewed some disclosure and barring service checks for many years in line with good practice.

People told us they felt safe at the service. Staff had received training in safeguarding adults and knew how to report abuse. However the senior staff were unaware of their responsibility to report grade three and four pressure ulcers as a safeguarding adult concern to the appropriate authorities. Senior staff explained they had believed this to be the responsibility of the district nurses only. Following our visit the senior staff reported pressure ulcers appropriately.

The environment was much improved, the garden area was well maintained and had been fenced to stop access to the stream. Previously stored items that were a fire hazard had been removed or stored in a safe manner. The interior of the service was now well maintained and repairs had been completed.

There were now risk assessments to keep people safe from harm and these had been reviewed to reflect any changes in circumstances.

There were robust systems in place for the safe administration and storage of medicines and staff were knowledgeable about people’s health support needs and knew what the medicines prescribed for people were for.

The staff supported people’s rights under the Mental Capacity Act 2005 by asking their permission before supporting them. Mental capacity assessments and best interest decisions were recorded and when appropriate the service had made Deprivation of Liberty Safeguards applications to the statutory body.

People were supported to eat well and remain hydrated and were supported with their dietary requirements.

Staff were caring and respectful to people and there was now a variety of activities to entertain and engage people throughout the day.

People’s care plans were person centred and contained relevant information to tell staff how people wished to be supported. Care plans and associated documents were updated on a regular basis. Records including daily notes were complete and did not contain gaps.

The service had systems of auditing in place to check the quality of the support provided and relatives were asked to feedback their views at care plan review meetings and in yearly surveys.

The inspection took place on the 14 December 2015 it was an unannounced inspection. The previous inspection took place on the 28 June 2013 when the service met the standards inspected.

The service is a residential home that offers care without nursing to a maximum of 30 older people living with dementia. At the time of our inspection there were 26 people living in the service.

There was 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.

The deputy manager was responsible for the day to day running of the home supported by two assistant managers. We found the service staff numbers could meet people’s needs but not all staff files examined contained all the recruitment checks.

We found the staff to be caring and knowledgeable about the people living in the service. Staff members demonstrated they understood people’s dignity and privacy support needs.

We found robust systems in place for the administration of medicines.

Staff referred people in a timely manner for support from health care professionals and we found good partnership working. However people’s files showed some health check recordings were inconsistent. We found staff had received training in most relevant areas. Staff received supervision but this was only twice a year and we thought this could be increased to be more effective. We found some individual and group activities for people took place, but these were limited and people who remained in their bed rooms did not have individualised activity plans to engage them.

Staff asked people about how they wished to be cared for and staff demonstrated a good knowledge of people’s support needs. The service gave people a choice of meals and was supporting people to eat healthily and remain hydrated.

We found that the environment had not been risk assessed to take into account all hazards in the premises and grounds. Equipment was not stored appropriately in a safe manner. We found people had individual risk assessments but we found gaps in reviewing these risk assessments

We four found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We made a recommendation regarding the frequency and content of supervision for staff.

You can see what action we told the provider to take at the back of the full version of the report.

The staff were aware of people's dignity and privacy. They told us they would always knock before entering someone's room, keep bathroom doors shut and never discuss people's care in public.

Staff treated people well, we witnessed staff chatting, laughing with and reassuring people. Staff understood people's needs. One person said "the staff call me by the name I like when they greet me.".

We spoke with six people in the home, all of those who were able to understand their medication did. One person said "I have my medication in the morning I know the colour of the tablet and what it's for." Medicines were prescribed and given to people appropriately.

We talked to people who lived in the home all believed enough staff were on each shift to provide for all their needs, one person told us " we have lots of staff here, just look you can see them all, just shout or wave they will come and help."

The home completes a satisfaction survey each year, the results showed that people and their relatives were all positive and happy about the service they received. One person said "my room gets cleaned, my bed is comfortable and it's nice and warm."

During this inspection we spoke with six people who use the service and two visitors. People told us that they were satisfied with the care provided and they indicated that their care needs had been met. They stated they had been treated with respect and dignity. Their views can be summarised by the following comment, “I feel safe here and the staff are very nice. They take good care of me.”

We noted that people appeared comfortable and well cared for. Staff were supervising and assisting people. Comprehensive assessments had been carried out and care plans had been prepared for people. Care provided had been carefully monitored. The healthcare needs of people had been attended to.

People indicated that staff were capable and able to care effectively for them. We saw that staff worked well as a team and knowledgeable regarding the needs of people. There were arrangements to ensure that staff received supervision and support from the manager and senior staff.

The premises were clean and essential safety inspections had been carried out. Some maintenance issues were noted in the bedrooms. However, the provider took prompt action to rectify them.

People who use the service and their relatives expressed satisfaction with the care provided and they indicated that the care needs of people who use the service had been attended to. They spoke highly of staff and stated that staff had treated them with respect and dignity. Their views can be summarised by the following comments :

"Staff are wonderful. They take good care of me.”

“I am very impressed by the standard of care in the home.” (relative)

We observed that people who use the service appeared comfortable and well cared for. Assessments of their needs had been carried out and detailed plans of care had been prepared for people who use the service. These had been prepared with the agreement of people who use the service or their representatives and signed by them.

Staff were observed to be interacting regularly with people who use the service and gently encouraging them to participate in various activities. The staff training records indicated that staff had been given the necessary essential training.

The service had consulted and asked people who use the service and their representatives about their views. The results of a recent survey were available in the office. The feedback received was on the whole positive. The manager reassured us that suggestions for improving the service provided would be followed up.