This inspection took place on 7 March 2017 and it was unannounced.

The Headington Care home is registered to provide accommodation for up to 60 older people living with dementia who require nursing or personal care. At the time of the inspection there were 59 people living at the service.

There was a registered manager in post. 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 registered manager worked closely with the deputy manager.

At the last inspection on 27 January 2016, we asked the provider to take action to make improvements and ensure staff were deployed effectively during meal times, staff engaged with people meaningfully and offered person centred care and ensured people received meaningful activities and stimulation. At this inspection on 7 March 2017, we found these actions had been completed. However, we still have some concerns.

People had varied dining experiences. Some people were not always supported in a timely manner during meal times. Some staff prioritised other tasks to supporting people having meals.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard people and protect their health and well-being. People received their medicine as prescribed. There were systems in place to manage safe administration and storage of medicines.

The Headington Care home had enough suitably qualified and experienced staff to meet people's needs. People told us they were attended to without unnecessary delay. The provider had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where risks to people had been identified, risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff received adequate training and support to carry out their roles effectively. People felt supported by competent staff that benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they cared for.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and applied its principles in their work. Where people were thought to lack capacity to make certain decisions, assessments had been completed in line with the principles of MCA. The registered manager and staff understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.

Staff treated people with kindness, compassion and respect and promoted people’s independence and right to privacy. People received quality care that was personalised to meet their needs.

People were supported to maintain their health and were referred for specialist advice as required. Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way.

Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People were actively involved with the local community. People were encouraged and supported to engage with services and events outside of the home. Staff supported and encouraged people to engage with a variety of activities and entertainments available within the home. Activities were struc

We inspected this service on 27 January 2016. This was an unannounced inspection. The Headington Care home is registered to provide accommodation for up to 60 older people living with dementia who require personal care. At the time of the inspection there were 58 people living at the service.

There was a registered manager in post. 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 registered manager worked closely with the area manager.

People who were supported by the service felt safe. The staff had a clear understanding on how to safeguard the people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines. There were enough suitably qualified and experienced staff to meet people needs. However, staff were not always deployed effectively. People had a range of individualised risk assessments in place to keep them safe and to help them maintain their independence. Where required, staff involved a range of other professionals in people’s care. Staff were quick to identify and alert other professionals when people’s needs changed.

People received care from staff who understood their needs. Staff received adequate training and support to carry out their roles effectively. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People were supported to have their nutritional needs met, however, the dining experience varied. People were not always given choices and some did not receive their meals on time. We observed people during lunch time and saw people being supported with meals.

There was a calm, warm and friendly atmosphere at the service. Every member of staff we spoke with was motivated and inspired to give kind and compassionate care. Staff knew the people they cared for and what was important to them. Staff appreciated people’s unique life histories and understood how these could influence the way people wanted to be cared for. People's choices and wishes were respected and recorded in their care records.

People did not always have access to activities and stimulation from staff in the home. Activities were not always structured to people's interests. Relatives told us there wasn't always much to do. However, other people told us they were happy. We discussed these concerns with the registered manager, deputy manager and area manager who informed us a new activity co-ordinator’s post had been advertised, and staff were to receive coaching on dementia care and activities.

Where people had received end of life care, staff had taken actions to ensure people would have as dignified and comfortable death as possible. End of life care was provided in a compassionate way. Staff had also identified they needed more training in this area and the manager was arranging it.

People felt supported by competent staff. Staff benefitted from regular supervision (one to one meetings with their line manager) and team meetings to help them meet the needs of the people they were caring for.

The manager informed us of all notifiable incidents. The service had good quality assurances in place, however, these were not always used effectively. The manager had a clear plan to develop and improve the home. Staff spoke positively about the management and direction they had from the manager. The service had systems to enable people to provide feedback on the support they received.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to

We spoke with eight people, nine care staff and five people’s relatives. We also spoke with a visiting professional and reviewed seven care files. At the time of our inspection there were 60 people living at the home.

All the people we spoke with were complimentary about their care, one person said, “they are fantastic, they know what they are doing and what we need” another person said, “Its brilliant, I am well cared for and understood”. One person’s relative told us, “staff are wonderful, very dedicated and caring, they get to know each individual by meeting as a team when somebody new comes”.

We observed that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We also saw in care files that people, or family members on their behalf, gave consent for care they received and in line with best interest decision making guidance.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Where people were at risk of malnutrition or pressure damage the service responded by taking action to reduce the risk of harm. For example, the service worked with a Speech and Language therapist (SALT), dietician and memory nurse to plan care and treatment for people at risk of these issues.

People were protected from the risks of inadequate nutrition and dehydration. We found that where people had specific dietary requirements these were recorded in the kitchen and the chef was aware. People had a wide and varied range of food and drink to choose from. Recommendations from the SALT stated that one person at risk of malnutrition needed their food to be fortified. We observed this happening and the kitchen staff were aware.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. Staff told us they felt supported and that they received regular supervision and annual appraisals. Staff also told us they received regular and adequate professional development.

The provider had an effective system to regularly assess and monitor the quality of service that people received. We saw satisfaction surveys from people and their families, we also saw minutes from monthly relative meetings where we saw actions being captured and taken in response to views sought.

At the time of the inspection there were 60 people living at the home. All were suffering from advanced stages of dementia and consequently there were some difficulties in engaging directly with people who used the service. However, we did manage to speak to two people who said they were very happy living in the home. We also spoke with three relatives who were able to give a lot of useful information regarding the quality of care in the service, and they were all very positive about this.

We were able to observe the way staff interacted with the people who used the service and they all did this in a professional and sensitive manner. We were provided with evidence that showed that people were provided with a wide range of activities, and, with the assistant of relatives, were able to exercise choice in a range of areas including menus, worship and social activities.

Through their relatives, people who used the service were able to provide feedback to the provider on a regular basis, and any concerns or complaints raised were acted upon in a timely manner.

We were shown copies of peoples’ care plan and other documentation relating to their care and wellbeing, and these were all complete and had been reviewed on a regular basis. We were also provided with evidence which showed that there were sufficient staff, who were properly trained and qualified, to provide a good quality of service.