The inspection took place on 16 and 19 January 2017 and was unannounced. Rotherbank is registered to provide accommodation and support to 21 people; it does not provide nursing care. At the time of the inspection there were 18 people living there.

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. Although the registered manager visited regularly, the day to day management of the service was carried out by the manager; in addition there was a trainee manager and a deputy manager.

People told us they felt safe and well supported. Staff had undergone safeguarding training and understood their role in relation to safeguarding and the actions they should take to keep people safe from the risk of abuse.

People’s records demonstrated that risks to them as individuals in relation to their care had been assessed and managed safely overall. However, there was a lack of clear guidance in relation to blood sugar monitoring for people’s diabetes care. Although the manager took prompt action to address this, it will take time to embed this into practice and for the provider to be able to demonstrate staff have followed the revised guidance over time.

People told us there were always staff available when needed and that they had the time to support them in the way they liked. No agency staff were used at the service to ensure people received continuity of care, which is important for people living with dementia. People were safe because the provider applied robust recruitment policies and procedures.

The registered manager had not ensured they had consistently followed good practice guidance in relation to the storage, usage and recording of people’s medicines. The manager took prompt action to rectify these issues for people. However, it will take time for the registered manager to embed the changes that were made during the inspection in relation to medicines safety.

The registered manager had not ensured that all staff followed infection control guidance in relation to their nails. This placed people at potential risk from acquiring a skin flap and some staff’s nails were not hygienic. The registered manager has taken relevant action to ensure all staff meet regulatory requirements to ensure people’s safety, however, this needs to be embedded over time.

People said that staff appeared to be well trained and knew what they were doing and supported them in the manner they liked. New staff underwent an induction to prepare them for their role and all staff received regular supervision. Staff were required to undertake a range of training identified by the provider as necessary in order to meet people’s needs. Staff were supported to undertake professional qualifications in social care.

People told us staff always sought their consent before they provided their care, medication and support. Staff were able to demonstrate how the Mental Capacity Act (MCA) applied to their day to day work with people. Where people were subject to the Deprivation of Liberty Safeguards (DoLS) legal requirements had been met.

People said the food was good. Risks to people associated with their eating and drinking had been assessed and relevant measures taken to manage these effectively for them.

Staff supported people to access a range of healthcare services to ensure they could maintain good health.

People said that the staff were caring and supported them the way they liked. Staff were observed to interact with people in a kind and caring manner. Staff received relevant information about people to enable them to form a relationship with them.

People told us they were able to do what they wished and that staff respected their wi