We inspected Quinton Gardens on 27 September 2017 and this inspection was unannounced. At the last inspection on 1 September 2015 the service was rated Good. At this inspection, the service continues to be rated Good, however we rated well led as requires improvement. This was because there was no registered manager in post, a rating poster was not displayed and people’s privacy was comprised by the use of CCTV because people and their relatives, had not been consulted with.

Quinton Gardens is divided into three separate floors and provides personal and nursing care for up to 35 people, including people living with dementia and physical disabilities. There were 35 people living at the home when we inspected the service.

A requirement of the service’s registration is that they 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was no registered manager in post. The registered manager had left the service on 15 September 2017. The provider had decided to take this role on themselves, and had applied to become the registered manager at the home.

Care and nursing staff received training in safeguarding adults and understood the correct procedure to follow if they had concerns. They were confident if they raised concerns with the managers and provider, these would be investigated.

People had been consulted about their end of life wishes. People’s care plans showed people’s wishes about who they wanted to be with them at this time and the medical interventions they had agreed to.

People received their medicines safely from care and nursing staff who were trained and assessed as competent. Medicines were stored safely and administered as prescribed, however, further support from pharmacists was needed when people’s medicines were given to them covertly.

People were supported to access healthcare from a range of professionals to help maintain their health and welfare.

The provider and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The management team had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make specific decisions for themselves. However during our inspection visit we found the provider used CCTV to monitor people and visitors within communal areas of the home. There was no consultation with people regardless of their capacity, and we were told it was installed to limit the opportunity for some people to leave the home unnoticed. Following our inspection visit, the provider told us the system would not be used, until other areas had been explored and if then required, people would be consulted with and risk assessments put in place.

There were enough staff to care for people safely and effectively. All necessary employment checks had been completed before new staff started work at the home to make sure, as far as was possible, they were safe to work with the people who lived there.

People were supported by a consistent staff team that knew them well. Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity when providing their care and support. Staff promoted people to be as independent as possible.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited

This inspection took place on 1 September 2015 and was unannounced.

Quinton Gardens is a three storey residential home which provides care to older people including people who are living with dementia. Quinton Gardens is registered to provide care for 35 people and at the time of our inspection, there were 31people living at Quinton Gardens.

At the time of our inspection a registered manager was not in post although the provider had arranged for two deputy managers to manage the home in the interim. The provider had appointed a manager who planned to start the end of September 2015. 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 and associated Regulations about how the service is run.

People were well cared for and safe living at Quinton Gardens. Staff were respectful, kind and empathetic to people. Staff protected people’s privacy and dignity when they provided care and staff asked people for their consent before any care or support was provided.

Care plans contained relevant information for staff to help them provide the individual care and treatment people required. Care records reflected people’s wishes and how they preferred their care to be delivered. Risk assessments provided information for staff to keep people safe and were reviewed to ensure they continued to protect people from risk.

People received their medicines when required. Staff were trained to administer medicines and had been assessed as competent, which meant people received their medicines from suitably trained and experienced staff.

The provider had effective recruitment procedures that helped protect people. All the necessary checks had been completed on potential staff before a decision was made to employ them at the home.

Staff understood the need to respect people’s choices and decisions. Assessments had been made and reviewed for people who lacked mental capacity to make certain decisions. Where people did not have capacity, decisions had been taken in ‘their best interests’ with the involvement of family members and appropriate health care professionals.

The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS). The registered manager had contacted the local authority and submitted applications to make sure people’s freedoms and liberties were not restricted unnecessarily. At the time of this inspection, seven applications had been authorised under DoLS.

Staff were caring and compassionate in their approach to people. People chose how they spent their time so they retained independence in making day to day decisions about their everyday life. Staff encouraged relatives to maintain an active role in providing support to their family member.

A variety of activities were provided for people living in the home that promoted their health and wellbeing. Improvements were being made to increase the opportunities for people who wanted more time involved in activities on a one to one basis.

There was an audit system that identified and improved the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People were satisfied with the service they received and if they suggested improvements, these were acted upon. People’s concerns were listened to and supported by the provider and staff who responded in a timely way.