This inspection took place on 18 July 2016 and was unannounced. At our last inspection in April 2013 the service was meeting the regulations of the Health and Social Care Act 2008.

Stanford House provides accommodation for up to 10 people who require personal care. On the day of our inspection there were seven people living at the home and one person was in hospital. People who lived at the home were elderly and had needs associated with old age and dementia.

There was a registered manager in post and she was present during 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.

People told us they felt safe at the home, and staff had received training to ensure they knew how to recognise and report concerns. We found risks to people were managed in a way to keep them safe. There was sufficient staff to support people and meet their needs. People received their medicines safely and as they had been prescribed.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People received care and support from staff that knew their individual needs, and recognised when these changed. Staff were supported through regular supervision, and told us that if they had any concerns for people’s well-being they were able to get advice from senior staff or the registered manager.

People were encouraged to be independent and their privacy and dignity was respected. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health. People knew how to make a complaint and were confident that their complaint would be fully investigated and action taken if necessary.

People described the registered manager as approachable and they said they felt the service was well managed. Arrangements were in place to assess and monitor the quality of the service, so that improvements could be made. The management of the home was open and transparent.

We spoke with the nine people living at the home, the manager and two care staff. One person living there told us, "This is a really lovely home, and I consider it my home”.

We saw people were treated with respect, and were encouraged to do things for themselves so protecting their independence and self esteem. People told us staff respected their privacy when supporting them with personal care.

People told us they enjoyed their own interests and hobbies, and entertainment brought into the home.

We saw people were supported to eat and drink enough, and arrangements were in place to identify risks of weight loss.

The management of risks associated with people's mobility and skin care, had improved. Staff were aware of the importance of ensuring people's needs were re assessed when their dependency increased. This meant there was enough equipment to promote the safety and comfort of people.

Staffing levels were sufficient to manage people’s needs. Everyone we spoke with was confident if they had any complaints these would be managed without delay. We found improvements in people’s care records; these were up to date and included accurate information about how risks to people’s health should be managed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional. We spoke with eight people who live there home, two relatives, the manager and three staff. We looked at the care records for three people to see how their needs should be met.

Some of the people who live there were not able to talk directly with us because of their health conditions. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person told us, "The staff are wonderful, they treat us really well, look after us." Another person said, "Although they are busy, they would never ignore us, they always ask how we are, and always come when we ask". This meant people were treated with respect and dignity.

The needs of some people had changed and this impacted on how much choice they had, for example, when they ate, or when they had the assistance they needed with their personal care.

We saw that people spent large periods of time without staff being present, and for some people this left them at risk of falling.

Everyone told us the food was really good, and that they had enough to eat. People confirmed alternatives were offered, and that they did not have to wait for food to be served.

People appeared comfortable in their surroundings and were not hesitant about asking staff to help them.

Gaps in care records and observation of the care practice showed people did not always receive safe care. The assessment process and management of risks associated with people’s mobility, nutrition, and skin care, was not consistent. This indicated that staff were not aware of the importance of ensuring that people's personal needs were met and was part of protecting people from harm.

We spoke with two people using the service about the availability of staff. Both commented staff were 'busy' and that some people were 'poorly' which impacted on the time staff spent with them. We found the service was understaffed and that staffing levels were not sufficient to meet the needs of all of the people, safely.

We saw that people had to wait for assistance because there were not enough staff. This affected how well their choices could be respected for such things as getting up from bed and what activities were available. We saw staff did not use the training they had to support people in a safe way.

We spoke with one person using the service about their records. They thought told us they were confident staff recorded accurate information about their needs; this was because the staff knew what support they needed. We found records were not up to date and not accurate so people were at risk of receiving inappropriate care. People's care records were not secured which could mean people's records were not confidential.

We talked with three people who lived at the home, four visitors and two staff. People told us that they liked living at the home because it felt like their own home and that the staff were kind and thoughtful. We saw one person happily stroking the cat sat on their lap, another person was talking with their visitors and other people watched television and talked with staff. A visiting relative said, "It is lovely here, M likes it, and we don’t have to worry about M when we are not here".

People who lived at the home told us the food was very good and they could choose what they wanted. We saw that two people had a late breakfast and staff explained that was because some people do not like to get up early. We saw that the registered manager sat and had lunch with the people who lived at the house. We saw that people were relaxed and enjoyed their mealtime as a social event. This meant that care reflected people's needs and preferences.

We found that some people had lived at the home for a long time and knew each other very well. We saw that they were happy in each others company. We saw that everyone who lived at the home was individually dressed according to their own taste. People we talked with told us the hairdresser comes every week and that staff help them care for their nails.

We saw kind and genuinely affectionate interactions between staff and people who live at the home. We saw positive encouragement given by staff to maintain people's mobility and positive intellectual stimulation through conversation, both one-to-one and in groups. One person who lived at the home said to us, "I have no complaints, I wouldn’t change a thing".