The inspection took place on 5 and 6 December 2016 was unannounced. We had last inspected Hadrian House in November 2015 and found breaches of legal requirements in relation to staffing and meeting people’s nutritional needs. At this inspection we judged the necessary improvements to meet legal requirements had been implemented and we have changed our rating of the service.

Hadrian House provides personal care for up to 63 older people, including people with dementia related conditions. Nursing care is not provided at the home. At the time of our inspection there were 54 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.

The service had established systems for preventing abuse and responding to any safeguarding concerns. Risks to people’s safety and welfare were assessed and appropriately managed. People and their relatives told us they felt care was provided safely.

The home was clean, comfortable and free from hazards. Safety checks were conducted and the accommodation was well-maintained. There were plans to further enhance parts of the building, with an emphasis on creating a more dementia-friendly environment.

New staff were checked and vetted to ensure their suitability in working with vulnerable people. Sufficient staff were employed to provide continuity of care and we found that staffing was now much better organised. The staff team received regular training and supervision that enabled them to carry out their roles effectively.

People were supported to receive their medicines as prescribed. The service worked in a co-ordinated way with external professionals to support people’s health and well-being. Improvements had been made around mealtime arrangements, the food provided and the help that people required with eating and drinking.

The service worked within the principles of mental capacity law to make sure people’s rights were protected. Relatives were involved in decision-making and, where needed, independent advocacy was arranged. People and their representatives were given information and support and were encouraged to be involved in care planning.

Staff understood the needs and preferences of the people they cared for. We observed they were kind, caring and had a good rapport with people and their families. People confirmed that staff respected their privacy and dignity.

Personalised care plans had been devised that guided staff on meeting people’s identified needs. Social stimulation had greatly improved and people now had access to a range of activities and events.

Measures were in place for obtaining people’s opinions about the service and feedback was acted on. Any complaints made were properly investigated and responded to.

Staff received appropriate leadership and support. Structured methods were used to monitor the service’s standards. The registered manager believed in working inclusively and was open to people, their families and staff influencing the quality of the service.

We found that action had been taken to improve the ways that staff who worked at the home were supported. Suitable arrangements were now in place to support staff in their professional development and enable them to deliver care safely and to an appropriate standard.

People told us what it was like to live at this home and described how they were

treated by staff and their involvement in making choices about their care. They

also told us about the quality and choice of food and drink available. This was

because this inspection was part of a themed inspection programme to assess

whether older people living in care homes are treated with dignity and respect

and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.People told us they were treated well by the staff and they felt their independence and rights were respected.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

These are some of the things other people said to us;

“If I have any worries, I just have a word with my carer or senior staff members”.

“I can leave and enter the home within reason, as long as I let staff know where I am, and if I will be back for meals”

“The place is always clean and tidy and smells fresh”

The inspection took place on 3 and 5 November 2015 and was unannounced. This means the provider did not know we were coming. We last inspected Hadrian House in October 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

Hadrian House provides personal care for up to 63 older people, including people with dementia related conditions. Nursing care is not provided at the home. At the time of our inspection there were 56 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.

We found that risks to personal safety were assessed and managed to prevent people from coming to harm. Relatives told us they felt their family members cared for safely. Staff had a good awareness of their responsibilities to safeguard people from abuse and knew how to report any concerns about poor or unsafe care.

New staff were properly recruited to ensure they were suitable to work with vulnerable people.

On occasions, the numbers of staff and the ways that staff were allocated affected the consistency of the service that people received.

People were supported to receive health care services, maintain their health and to take their prescribed medicines safely. People’s nutritional needs were assessed and monitored. However, menus were not being followed, mealtimes were disorganised, and people did not always receive the support they needed with eating.

Staff were given training and supervision to help them meet people’s needs. Staff told us they felt well supported in their roles and personal development.

People living with dementia were cared for effectively, though a dementia-friendly environment had not yet been fully developed. We have made a recommendation about enhancing the environment. People’s rights under mental capacity law were understood. Formal processes were undertaken when people lacked capacity to make important decisions about their care and treatment.

Staff were caring and respectful in their approach and provided people with dignified care. All staff we spoke with had a good understanding of people’s preferences and how they wished their individual care to be given.

People had personalised care plans drawn up for meeting their needs. Care was adjusted in response to changes in needs and when other professionals gave advice. People and their families were involved in decisions about care planning and in reviewing care and support. Any complaints about the service were appropriately responded to and thoroughly investigated.

Limited activities had been made available to meet people’s social needs whilst a new activities co-ordinator was being appointed. We have made a recommendation about providing regular social stimulation.

The registered manager provided leadership within the home and was committed to promoting an open and inclusive culture. Checks and audits of different areas of the service were conducted to make sure standards were being met. Action plans were in place for making improvements to the quality of the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing and meeting people’s nutritional needs. You can see what action we told the provider to take at the back of the full version of this report.