Waxham House is registered to provide accommodation with personal care for up to 20 people who have needs associated with increased age and physical disabilities. At the time of our inspection there were 19 people living in the home. The service is set over three floors and has a range of communal areas for people to use, including a communal lounge, quiet lounge and dining area.

At the last inspection on 17 & 24 November 2015, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way. They were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

There were sufficient numbers of staff on duty to support people with their assessed needs and provide care to people in a relaxed and unhurried manner.

The registered provider and registered manager followed safe and robust recruitment procedures. Staff were appropriately trained to meet the needs of the people using the service. Staff were supervised in their roles and received an annual appraisal to aide their personal development.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

Care plans were individualised and person centred. Plans were reviewed regularly to ensure planned care was current and up to date. People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through questionnaires. They were also supported to raise complaints should they wish to.

People’s families told us they felt the home was well-led and were positive about the registered manager and provider who understood their roles and responsibilities. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There were systems in place to monitor quality and safety of the home provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We carried out a focused inspection on 28 August 2015 to check whether action had been taken following our last inspection. At that inspection we found serious concerns around the safe care and treatment of people living in the home. This report only covers our findings in relation to this topic.

We undertook an unannounced comprehensive inspection at Waxham House on 18, 20, and 25 March 2015 at which breaches of regulation were found. You can read the report from our last

comprehensive inspection, by selecting the 'all reports' link for ‘Waxham House’ on our website at www.cqc.org.uk.

Waxham House is registered to provide accommodation for persons requiring nursing or personal care. Waxham House is a residential care home for up to 20 people. At the time of our inspection 17 people were living at Waxham House some of whom had physical disabilities or were living with a diagnosis of dementia. The home did not have a registered manager.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 2008 and associated Regulations about how the service is run.

Risks to people’s health and wellbeing were assessed and mitigating action was taken to reduce the risk. Medicines were managed safely and people received their medicines appropriately. The home was clean and action had been taken to ensure infection prevention and control measures were in place.

We spoke with four people who use the service and five care staff. People we spoke with were happy with the level of care they received in the home. One person told us “I can’t fault them. Night or day, they are brilliant”. Care records showed people received the care they had been assessed as requiring.

Infection control procedures were in place. Staff knew what measures to take to ensure people were protected from the risk of infection.

Quality assurance systems were in place. Audits were carried out frequently, and issues identified were addressed. Staff received supervision regularly and areas of concern were identified and acted on. Measures were in place to ensure standards of care were maintained.

During this inspection we spoke with four people who used the service and three visitors. We also spoke with three members of staff and the manager. People told us staff discussed their care and support with them. One person said staff “couldn’t do enough” for them. All the people we spoke with were complimentary about the care they received. A visitor told us they “can’t fault” the service.

We observed that staff communicated well with people. Staff promoted a friendly and caring environment. Effective recruitment procedures were in place to ensure staff had undergone the relevant checks before commencing their employment.

The building was fit for purpose and well maintained. We saw that a complaints policy was in place and that complaints received were handled in line with the policy.

People we spoke with were very happy with where they were living and stated that their needs were being met. People said that if they had any problems they would raise these with the manager or staff. They had no concerns or complaints when we visited.

People said staff were friendly and available when they needed them. People said staff knew how to look after them. People also said that staff did not change often and knew their names and individual likes and dislikes.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about the home.

The inspection was carried out on 17 and 24 November 2015 and was unannounced. At our last comprehensive inspection in March 2015 we found several breaches of regulation. In August 2015 we found the provider had made significant improvements to the care provided in the home.

Waxham House is registered to provide accommodation for persons requiring nursing or personal care. The home can accommodate up to 20 people. At the time of our inspection 17 people were living at Waxham House some of whom have physical disabilities or are living with dementia.

After the comprehensive inspection in March 2015, CQC took enforcement action because improvements were needed to ensure the safety and well-being of people living at the home. We issued a warning notice in relation to the safe care and treatment of people living at Waxham House. We inspected again in August 2015 and found improvements had been made to comply with the requirements of the warning notice. In relation to the other breaches of regulation identified in March 2015 we received action plans from the provider stating what they would do to meet the legal requirements to improve their service.

The service did not 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 2008 and associated Regulations about how the service is run. The provider was in the process of making an application to CQC to be registered as the manager.

At Waxham House care is provided on three floors. A lift and a stair lift are available for people to access the rooms on the upper floors. A dining room, lounge and conservatory are located on the ground floor. The garden was well maintained and people had access to the outside areas.

Care provided at Waxham House was safe. Risks to people’s health and wellbeing were assessed and managed well. There were sufficient staff to care for people safely and staff ensured people had the equipment and support they required. People’s care plans were up to date and staff were familiar with people’s individual needs and preferences.

Staff had been trained to safeguard people in their care. They were aware of what constituted abuse and were confident to report their concerns. They said the management team would take prompt action. People received their medicines safely and staff took care to make sure people were as comfortable as possible and received pain relief appropriately. The home was clean. Procedures were in place to protect people from the risk and spread of infection.

People spoke positively about the choice and quality of the meals served to them. Staff supported people to eat where this was needed. They did this in a manner that helped people to maintain their independence as much as possible. Staff ensured people gave their consent before providing care. People made choices on a daily basis and staff respected people’s right to make decisions for themselves. People contributed to the improvement of the service provided by making suggestions which the provider put into action.

Staff respected people’s privacy and took care to help them maintain their dignity. Appropriate action was taken when staff were concerned about a person’s health and medical help was sought quickly when needed. People were supported to access specialist health care if this was required.

Staff felt supported to carry out their role. They had completed a range of relevant training. Staff had access to advice and guidance from the provider and the management team and received supervision regularly. Staff meetings were arranged regularly and staff were able to discuss any concerns. The meetings also provided an opportunity for the provider to update staff on changes in the home. Staff took personal responsibility for the care they provided and had developed positive relationships with the people they cared for.

The provider had a range of quality assurance measures in place. When areas for improvement were identified these were acted on promptly to improve the service people received. The values of privacy, dignity and respect were promoted in the home and observed in the way staff provided care to people.