The inspection was carried out over two days on 5 and 9 January 2017. On 5 January the inspection was unannounced. We returned to complete the inspection on the 9 January 2017, this visit was announced.

The home provided accommodation and personal care for up to 44 older people who are living with dementia. The accommodation was provided over two floors and in a linked detached eight bedroomed annex. The accommodation was spacious and modern. Four of the bedrooms in the annex were double rooms. A lift was available to take people between floors. There were 33 people living in the home when we inspected.

There had not been a registered manager employed at the home since 17 February 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The provider was still in the process of recruiting a suitable manager and had kept us informed of the recruitment process they had undertaken. In the absence of a registered manager the provider’s director of care and operations was in day-to-day charge of the home.

At the previous inspection on 4 December 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to the deployment of staff and the recruitment of staff. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in the Regulations we had identified. At this inspection we checked they had implemented the changes.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The director of care and operations understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

At the time of this inspection there were only four people living in the annex. Since our last inspection, the provider had implemented a system of staff management in the annex, which ensured there was at least one member of staff in the annex at all times. People’s experience of home had been affected by the changes to the managers, especially around staffing levels. The provider had taken action to address this and was recruiting to vacant staff posts. There were systems in place to assess the people’s needs and areas of risk. However, it was not clear how this information was used to deploy staff in the right numbers, places and times in the home to meet those needs. We have made a recommendation about this.

Activities, both group and individual were available to people, but there was not a suitably qualified and experienced activities co-ordinator in post who understood how to plan activities for people living with dementia. We have made a recommendation about this.

Recruitment policies were in place and now included information about any gaps in employment candidates for jobs may have. The recruitment policy reflected best practice and the law in relation to pre-employment checks.

People felt safe and staff understood their responsibilities to protect people living with dementia. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority, and followed the safeguarding processes.

The director of care and operations and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and mana

The inspection was carried out on 4 December 2015 and was unannounced.

The service provided accommodation and personal care for older people who are living with dementia. The accommodation was provided over two floors and in a linked detached ten-bedded annex. A lift was available to take people between floors. There were 42 people living in the service when we inspected.

There was a registered manager employed at the service. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

There were systems in place to assess the levels of staff needed to meet people’s needs. However, we found that staffing levels had not kept pace with the levels of care people needed as their dementia deteriorated and their needs changed. This had resulted in people who needed more supervision to keep them and others safe were being exposed to potential harm as staff were not always available in the annex.

Recruitment policies were in place. The policy reflected best practice and the law in relation to pre-employment checks. However, the registered manager had not always applied the policy when new staff were recruited to work in the service.

People felt safe and staff understood their responsibilities to protect people living with dementia. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by staff to protect people from harm.

There were policies and a procedure in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

People and their relatives described a service that was welcoming and friendly. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

The registered manager involved people in planning their care by assessing their needs when they first moved in. People were consistently asked if they were happy with the care they received. Staff knew people well and people had been asked about who they were and about their life experiences. This helped staff deliver care to people as individuals.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk in the service was assessed and the steps to be taken to minimise them were understood by staff.

Managers ensured that they had planned for foreseeable emergencies, so that should they happen people’s care needs would continue to be met. The premises and equipment in the service were well maintained.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. The actions taken were fed back to people.

People felt that the service was well led. They told us that managers were approachable and listened to their views. The registered manager of the service and other senior managers provided good leadership. The provider and registered manager developed business plans to improve the service. This was reflected in the positive feedback given about staff by the people who experienced care from them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.