We inspected Fairby Grange on Monday 27 March 2017. Fairby Grange provides care, support and accommodation for a maximum of 27 older people some of whom lie with dementia. The service provides both permanent and respite place. There were 21 people living at the service at the time of our inspection.

There was no registered manager in post at time of inspection. The registered provider had an acting manager in post that was going through the processes of becoming registered with the Care Quality Commission. 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.

At our previous inspection on 14 March 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities). These breaches were in relation to assessing individual risk of people living at the service, understanding of the Mental Capacity Act 2005 and appropriate records and quality monitoring systems. At this inspection, improvements had been made and the service was compliant with all regulations.

The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The acting manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and tidy.

Medicines were stored securely and safely administered by staff who had received appropriate training to do so.

There was sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

Mental capacity assessments were being carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. However, we found that one area had been missed. We have made a recommendation about this in our report.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were referred to health care professionals when needed. People’s records showed that appropriate referrals were being made to GP’s, speech and language therapists, dentists and chiropodists.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.

People were being supported to have a nutritious diet that met their needs. People were supported to eat by suitably trained staff.

Relatives spoke positively about staff. Staff communicated with people in ways that were understood when providing support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overheard.

People had complete freedom of choice on how they wanted to live their lives. Staff supported people to make choices and understood the importance of this.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Records showed that outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback through resident meetings and yearly surveys.

The acting manager was approachable and supportive and took an active role in the day-to-day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately.

The inspection was carried out on 14 March 2016 by three inspectors. It was an unannounced inspection. The service provides personal care and accommodation for a maximum of 27 older people some of whom live with dementia. The service provides both permanent and respite places. There were 24 people living at the service at the time of our inspection.

There was 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 2008 and associated Regulations about how the service is run.

The registered manager was supported by a senior care staff to ensure the daily management of the service. The registered provider was present in the service most days during the week and was involved in the day to day management of the service.

This was the first inspection of the service under the provider’s registration, however the registered manager had continued to manage the service during the transition from the previous ownership to the current.

The registered provider had not ensured that risks to individuals were appropriately assessed and minimised, for example the risk of developing pressure wounds, malnourishment and falls. However, staff were responsive to changes in people’s needs and made referrals to health professionals as needed.

The registered provider had not ensured that staff and the registered manager fully understood and adhered to the principles of the Mental Capacity Act.

The registered provider did not have effective systems in operation for checking and improving the quality of the service. They had not identified shortfalls found in this inspection, for example in relation to managing risks and meeting the requirements of the Mental Capacity Act.

Generally staff promoted a person centred culture in the service, but some of the language that staff used reflected a culture that focussed on getting tasks completed more than a person centred culture. Staff referred to ‘doing’ people when they were talking about who they were going to assist with personal care and ‘feeding’ people rather than supporting them with their meals. The registered provider had spoken with staff about the use of appropriate language in a team meeting, but this had not ensured the required improvements.

The registered provider had not ensured accurate and complete records were maintained in respect of the running of the service.

Staff were trained in recognising the signs of abuse and knew how to refer to the local authority if they had any concerns. Systems were in place to protect people from abuse. Staff showed they understood the need to meet the emotional needs of people living with dementia as well as their physical needs.

There were enough staff employed, with the right skills and experience, to meet people’s needs. The registered provider ensured appropriate checks were made before new staff started work to ensure they were suitable to care for people.

People’s medicines were managed so that they received them safely. People had their health needs met by a team of health care professionals. Staff supported people to access the care they needed. Staff took necessary precautions to reduce the risk of people acquiring an infection in the service. We made a recommendation about the access arrangements for the laundry room.

The premises were clean, safe and well maintained and suitable for the needs of the people that lived in the service. The registered provider had given some consideration to the specific needs of people who live with dementia. Signs had been fitted providing people with guidance to bathrooms and living spaces and people had been supported to choose a picture for their bedroom door that would help them recognise their room. Risks within the premises had been assessed