This inspection took place on 23 May 2017 and was unannounced.

Littlefair is registered to provide accommodation with personal care and support for up to 41 older people. At the time of this inspection there were 28 older people, some of whom were living with dementia. The service is a large purpose built property spread over three floors with a well maintained garden and accessible patio area.

The home 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 was last inspected on the 10 August 2016, where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in medicines were not always managed safely or recorded correctly, people were not always supported to eat and drink safely and their requirements were not always recorded or respected, care plans were not all up to date so staff did not always have the most up to date information on how people needed to be supported and there were no formal supervision arrangements for the acting manager and limited oversight of the management of the service by the provider. The service received an overall rating of 'Requires Improvement', and after our inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

The majority of care plans we examined had been updated and improvement had been made since the last inspection. Staff told us they found care plans to be detailed with people’s support and care needs. However, although care staff told us they felt they were aware of people’s current care needs, care plans did not always fully demonstrate the areas that had been discussed as part of the review. We have identified this as an area of practice that needs improvement.

People told us they felt safe living at the service. Comments from people included “Oh yes, I’ve felt safe and there’s always someone around, so I think there are enough staff”, “Yes, I feel safe here and everything here is alright”. People were protected from the risk of abuse because staff understood how to identify and report it. Staff had access to guidance to help them identify abuse and respond in line with the providers policy and procedures if it occurred. One member of staff told us “If we have a concern about the safety of a resident, it is reported to one of the managers. It would always be looking into”.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “The food’s quite good, plenty to eat and you get choice and we get tea and coffee all day”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable leisure and social activities.

People and relatives found staff to be kind and caring and the care t

This inspection took place on 10 August 2016 and was unannounced.

Littlefair is registered to provide accommodation with personal care and support for up to 41 older people. At the time of this inspection there were 35 older people, some of whom were living with dementia. The home is a large purpose built property spread over three floors with a well maintained garden and accessible patio area.

The service did not have 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 previous registered manager had recently left. The provider had an acting manager in place while recruiting a new registered manager.

The home was currently in a transitional period due to new management and staff that had recently left. People had variable experiences because of this and we found areas for improvement.

Medicines were not always managed safely and recorded correctly The provider had not ensured care and treatment had been delivered in a safe way, medicines and risks to people had not been managed safely.

The provider had not ensured peoples nutrition and hydration needs were documented correctly and guidance for staff was insufficient to support people to eat and drink safely. People were not always supported to eat and drink safely and their needs and preferences were not always recorded or respected.

People had their needs assessed and care plans devised to inform staff of their care and support needs. People told us that they were involved in their care and could make their thoughts and suggestions known. However Our findings in relation to the quality and detail of the guidance in the care plans were mixed.

Although people and staff told us they had meetings, people and staff felt that they had not been kept up to date fully on the changes that had been taking place at the home. People were concerned why some staff had left with little or no explanations. One person told us “They should have a meeting with us and tell us what’s going on”.

There were no formal supervision arrangements for the acting manager and limited oversight of the management of the home by the provider.

The experiences of people were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. One person told us “I’m amazed how caring they all are, even the younger ones that you might think wouldn’t be that interested”. Another person said “They’re always happy to see me in the mornings and have a smiley happy face for me”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

We found staffing levels were consistent over time with the provider using permanent and bank staff. The majority of people felt there was enough staff to meet their needs. One person told us “Most of the time yes there is enough staff, sometimes I wait a little longer for them to come when I call my bell but they are busy and always come to me”. The provider was also currently recruiting more staff.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. One member of staff told us "Any concerns I had like if I noticed someone’s mood had changed or any marks on their body, I would report straight away no hesitation”.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. Staff were aware of the legislative requirements in relation to