The inspection visit took place on 16 May 2017 which was unannounced and we returned announced on 17 May 2017.

Salford House is a residential home which provides care over two floors to older people including people who are living with dementia.

Salford House is registered to provide care for 25 people. At the time of our inspection visit there were 21 people living at the home which increased to 22 because of a new admission.

At the last inspection, the service was rated good overall, however effective was rated as requires improvement. We found improvements were made to the effectiveness of the service and at this inspection we found the service remained Good overall.

There was a registered manager at the home. 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.

People and relatives were complimentary and satisfied with the quality of care provided. People were supported to remain as independent as possible so they could live their lives as they wanted. People made choices about what they wanted to do for themselves and how they wanted to spend their time. People were supported to maintain important relationships with family and friendly relationships had been built between some people in the home.

People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes.

Care plans contained detailed and supportive information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing the care provided to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people were minimised. Staff understood people’s individual needs and abilities which meant they provided care in a way that helped keep people safe. Staff received essential and regular training to meet people’s needs, and effectively used their skills, knowledge and experience to support people.

People’s care and support was provided by a caring and consistent staff team and there were enough trained and experienced staff to be responsive to meet their needs. People told us they enjoyed and felt safe living at Salford House. Relatives were complimentary of the support given to their family members and relatives were kept informed about important changes.

Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support when they were involved in making some decisions. Staff always gained people’s consent before they provided care and support.

People were supported and encouraged to pursue hobbies and leisure activities and people said they enjoyed the variety.

People received meals and drinks that met their individual dietary requirements. Anyone identified at risk of malnutrition or dehydration, were monitored and if concerns were identified, advice was sought and followed.

People’s feedback was sought by completing surveys and the visibility and access of staff and management made people feel they could voice any concerns or complaints. The registered manager had an ‘open door’ for people, relatives, staff and visitors to the home which reduced complaints escalating.

The registered manager’s systems were effective to monitor and drive improveme

We spoke with three people who lived at Salford House about their experiences of the service. We observed the care that was given to people during our inspection. We spoke with a range of staff including the manager.

This is a summary of what we found-

Is the service safe?

People told us they felt safe and secure.

Staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

We inspected the staff rotas. These showed there was sufficient staff on duty to meet people’s needs throughout the day. People received a consistent and safe level of support.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us, "It is nice here; everything is in the right place." Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this and care staff responded promptly to people's requests. People told us, "The staff come very quickly" and "Staff come and check I'm okay."

Is the service responsive?

People’s needs had been assessed before they moved into the home. We found records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. We found that the manager worked with other health professionals, such as GPs, to ensure people's care needs were met.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. We found the manager undertook a number of checks on the home to ensure people's needs were met.

We spoke with three people who lived at Salford House about their experiences of the service. We also spoke with three relatives about their family member's experiences of the service. We observed the care that was given to people during our inspection. We also spoke with a range of staff including the registered manager.

People and relatives told us consent was sought regarding the planning and carrying out of care. They told us that the care that was discussed with them matched the care that was being provided. They also told us consent was obtained throughout the day before any support was provided to people.

We saw that the care plans were person centred and reflected people’s individual needs. We found the members of staff supported people as detailed within their care plans. We noted staff were compassionate and caring when supporting people.

People we spoke with told us that staff were friendly and supported their needs well. We saw staff knew what people's care needs were and how they needed to be supported.

We noted the home was clean and there was a cleaning schedule which staff followed. We saw checks were made to review the cleanliness of the home.

We spoke with staff who told us they were supported by the management team. They also told us that training was provided which was specific to meet people's support needs.

We found the service was well led and had systems in place to monitor the quality of service being provided.

We have returned to Salford House to determine the progress the provider has made against the compliance action set by the Care Quality Commission following their visit on the 30 October 2012. During the visit we spoke with the registered manager and four care workers.

From the discussions held with the staff and the staff training attendance information we saw it was evident that the registered manager and deputy manager have implemented strict guidance for staff in relation to staff attendance at training sessions provided through the home. This was evident as staff training records now show that the majority of training sessions have been attended by the majority of staff. The exceptions being those staff who either on long term sick leave or maternity leave. Conversations held with individual care staff also confirmed that they had in recent months attended a lot of training which had been provided through the home.

During the inspection we spoke with the registered manager, deputy manager, one care worker and five people using the service. People who used the service told us they liked living at the home. Some comments were: ‘’Lovely living here’’ and ‘’Everybody is so friendly; they will get things for you’’.

We saw systems in place allowing people to communicate their experiences of the home and the care they had received. We were told that people had been involved in changes made to the home's environment and that people's opinions had been taken into account.

People told us they enjoyed the food. People said they had a choice of meal options and they could access sufficient drinks. During the lunch time we observed that the food looked nutritious, was well presented and people had been given a choice of soft drinks to have with their meal. People were seen to enjoy the meals.

We saw people's needs had been assessed, risks identified and personalised plans of care developed for each person. There was evidence of support by healthcare professionals to ensure people's ongoing healthcare needs were met.

We saw staff training records showing there had been minimal staff attendance at the trainings provided by the home during 2012. The manager told us she had not taken any action in relation to staff non-attendance at training sessions.

We have asked the provider to note that not all people's records were complete on the day of the inspection.

This inspection took place on 17 and 18 March 2015 and was unannounced.

Salford House is a two storey residential home which provides care to older people including people who are living with dementia. Salford House is registered to provide care for 25 people. At the time of our inspection there were 20 people living at Salford House.

There was a registered manager in post at the time of our inspection. 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.

All of the people we spoke with told us they felt well cared for and felt safe living at Salford House. People told us staff were respectful and kind towards them and we saw staff were caring to people throughout our visit. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent, before any care was given.

Care plans contained accurate and relevant information for staff to help them provide the individual care and treatment people required. We saw examples of care records that reflected people’s wishes. We found people received care and support from staff who had the knowledge and expertise to care for people.

People told us they received their medicines when required. Staff who administered medicines were trained and experienced, so that people received these safely.

There was a thorough system to recruit staff suitable to work at the home and staff demonstrated a good awareness of the importance of keeping people safe. Staff understood their responsibilities for reporting any concerns regarding potential abuse.

Staff understood about consent and respected decisions people made about their daily lives.

Assessments had not been completed to determine people’s varying capacity to make certain decisions so we could not always be confident people understood what they were consenting to. The registered manager assured us that capacity assessments would be completed where people’s capacity varied to ensure any decisions were taken in ‘their best interest’. This would make sure the provider’s responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) was met. The registered manager was not aware of a Supreme Court judgement made in 2014 for DoLS and how this could result in people being restricted in how they lived their lives.

Regular checks were completed by the registered manager and provider to identify and improve the quality of service people received. These checks and audits helped ensure actions had been taken that led to improvements. People told us they were pleased with the service they received. If anyone had concerns, these were listened to and the registered manager and staff responded in a timely way to people’s satisfaction.