The inspection took place on 18 April 2017 and was unannounced.

Winifred Dell Care Centre provides accommodation and personal care for up to 76 older people who may also have dementia. Care is provided in four units over two floors. At the time of our visit there were 69 people living in the service. The service does not provide nursing care.

A new manager was in post who had applied to become registered.. 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.

At our previous inspection we found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not always minimise the risk of falls for people. At this inspection we found the service had improved how risks were assessed, reviewed and managed. There were robust systems in place to assess and manage risks to people. Risk assessments were regularly reviewed and evaluated to ensure they remained relevant. Staff demonstrated a good awareness of the individual risks to people and how to manage them.

People were protected by the service’s approach to safeguarding and whistleblowing. Staff were aware of the different types of abuse and action to take if abuse was suspected.

People who used the service told us that they felt safe, could raise concerns if they needed to and were listened to by staff.

Checks of the building, equipment and maintenance systems were regularly undertaken to ensure people’s health and safety was protected.

There were sufficient numbers of staff that had been safely recruited to meet people’s needs.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Only staff who had received training and been checked to ensure they were competent administered medicines.

Staff received on going training and regular supervision and appraisals to support them to carry out their duties and responsibilities effectively.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity that were of a high quality had been undertaken when required and appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority.

People were supported to have enough to eat and drink that met their preferences and any dietary or health requirements. However people living with dementia were not always adequately supported to make their own decision about what they would like to eat. We made a recommendation that the provider refer to best practice guidance on supporting people with dementia to make choices at mealtimes.

People were supported to maintain good health and wellbeing. The service was good at involving external healthcare professionals and obtaining advice and guidance when needed from specialists such as, the community nurse, dietician and GP.

Independence was promoted and people were treated with kindness, dignity and respect by staff who listened to them and knew them well.

Assessments were undertaken to identify people’s care and support needs. People’s care and support plans were regularly reviewed with people and their relatives. Care records contained up to date information about the care and support needed and included information about people’s likes, dislikes and personal choices.

There was a wide range of activities and events available for people to participate in. People were supported to access the community and provided with varied opportunities for social interaction.

The provider had a system in place for responding to people’s concerns and complaints. Any issues were investigated and dealt with appropriately by the manage

The inspection took place on 3 May 2016 and was unannounced.

Winifred Dell Care Centre provides accommodation and personal care for up to 76 older people who may also have dementia. Care is provided in four units over two floors. At the time of our visit there were 70 people living in the service. The service does not provide nursing care.

A registered manager was in post at the service. 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.

During our inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff did not always minimise risk for people who were at risk of falls. Staff did not always analyse the reason why people fell or make necessary changes to the support being provided in order to keep people safe. You can see what action we told the registered person to take at the end of the full version of this report.

Whilst there was adequate staffing in some of the units, staffing on other units was insufficient to meet people's needs. In particular, where people with complex needs were visiting for a short term stay, staffing levels were not always increased as required.

The provider had systems in place to check the quality of the service, however these were not being used effectively to minimise risk and highlight areas of concern in the support people were receiving.

There was an open culture where people and staff felt able to express their views. Staff were enthusiastic about their work.

People were protected from the risk of abuse. There were appropriate arrangements in place for medication to be stored and administered safely.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. People were enabled to make their own decisions about the service they received. Staff followed processes in place to ensure decisions were made in people’s best interest, involving family and outside professionals as appropriate.

People's nutritional needs were well met. Alternatives were offered where required, and drinks and snacks were available throughout the day. People's food and liquid intake was recorded and monitored.

People were supported to maintain good health and wellbeing and to access relevant health and social care professionals.

People were treated with kindness, dignity and respect by staff who knew them well. People knew who to complain to and the manager responded to people’s concerns.

Care plans and risk assessments were person centred and provided guidance for staff about how best to work with people to meet their needs. Staff supported people to lead meaningful lives and to maintain links with the outside community.

At our last inspection on 9 July 2013 we found that people who used the service were not always respected and treated with dignity. We also found that people’s needs were not being met in a way that promoted their care and welfare. The provider gave us an action plan which stated how they planned to make the changes required to meet the essential standards.

At our inspection on 22 October 2013 we found that improvements had been made. We observed people as they were spoken with respectfully and with kindness. When a person spoke or asked a question, they were answered appropriately. For example, a person asked if they could have a cup of tea and a member of staff, who was on the other side of the room, turned round and said, “Of course, the kettle is on and then I’ll brew another pot.” We then saw the member of staff bring a freshly made pot of tea and offer it to the person.

We saw that care needs were being met in accordance with people’s care plans. People we spoke with told us that the service had improved. One person told us, staff members were, “… always respectful…”

The service had systems in place in relation to safeguarding people from abuse and staff were aware of this. However, we noted that there were a number of safeguarding investigations currently on-going. We looked at staffing at the service and found that the manager had ensured shifts were covered and that the staff were working as an effective team.

As part of our inspection we observed practice that showed us that people were not always respected and dignity was not promoted. We saw that at times people would direct questions to staff members who did not answer appropriately or at times, did not answer at all. For example, one person said, “I’d like another piece of toast.” However, this was not responded to, and extra toast was not brought to them.

At our inspection on 30 April 2013 we found that the service was not meeting the individual care needs of people. At our inspection on 9 July 2013 we found that there were still areas of improvement required.

At our inspection on 30 April 2013 we found that due to the staffing structure, the service was not able to meet people’s needs appropriately and in an acceptable time frame. This caused anxiety amongst people living at the home and impacted on their care needs. At our inspection on 9 July 2013 we found that the service had rearranged the layout of the unit and reorganised the way staff were distributed. We saw that the people who lived at the home were much more relaxed.

On our visit on 30 April 2013 we looked at five people’s care plans. We saw that they all had assessments of their needs in place and any medical history was highlighted. We spoke with a visiting health professional who told us, “The care they give is very good."

During our inspection we looked at how people’s nutritional needs were being met. We found that any dietary requirements and preferences had been identified in the care plans and had then been communicated to the chef.

We looked at medication management which included looking at the medication administration records (MAR charts). We found that all medication was recorded and stored appropriately.

We looked at staffing at the service as concerns had been passed to the Care Quality Commission regarding the number of skilled and trained staff available to meet the needs of people who used the service.

The service completed monthly audits and surveys which generated action plans to improve the service.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. The people we observed were alert and took part in conversations with care workers. The staff showed that they recognised each person’s individuality and they encouraged them to engage in conversation about their activities.

Care plans contained clear information on how the people communicated their needs, and the measures that staff should take to meet those needs appropriately.

A new manager had started work at the home during the week of our inspection. They had qualifications and experience of managing services providing dementia care, and they discussed measures to further improve the quality of dementia care.

The provider notified us of six safeguarding referrals to the local safeguarding authority between August and November 2012. There was evidence that the provider had taken the appropriate action by immediately informing the relevant authorities and following their own procedures for responding to these concerns.

We also had concerns about the safety of people in the home following notifications of four unobserved falls resulting in fractures during the same period. We saw evidence that the provider had investigated and addressed the increased incidence of falls in the home.

We used a number of different methods to help us understand the experiences of people using the service, because many of the people using the service had complex needs which meant they were not able to tell us their experiences.

The people who we spoke with told us that they enjoyed the social activities in the home. They said that they were consulted about the choices they wished to make, for example for their choices of meals, and the support that they needed with personal care. One person told us that they had chosen to stay in bed for the day because they felt unwell. We spoke with the relatives of two people, who told us that they thought that the home was very good, and that staff treated people with dignity and respect. People told us that the staff treated them well. The people who we spoke with and visiting relatives told us that the food provided was very good.

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. We observed some good interactions by the staff, spending time with individuals and assisting and encouraging them to take drinks. They supported and encouraged people to engage in activities such as knitting and making a collage.

Everyone who we spoke with told us that staff were always available to speak to if they had any concerns. One visiting relative told us that they had raised a concern about the availability of staff to help with personal care, and that they had received a satisfactory verbal response from a senior carer.

Visitors with whom we spoke told us that their relatives were happy with the food provided at Winifred Dell. They told us that if there was anything that people didn’t like the chef would prepare something additional for them. One person told us how pleased they were that their relative had gained weight since moving into the home.

Visitors with whom we spoke told us that they would be confident to take any concerns to the registered manager. One person told us they had total confidence in the process but had never needed to make a complaint. Another relative told us they had tried to raise a complaint with a care manager on one unit in the home however they felt they had not been listened to.

Relatives of people living at the home confirmed they were invited to meetings and that they felt they could effectively influence the quality of service their relatives receive.

People with whom we spoke told us they were happy living in Winifred Dell and they were satisfied with the care and support they received. People told us they enjoyed the food, they said it was very good and plentiful.

We received positive comments from relatives of people who use the service about how well people are cared for in Winifred Dell. One relative with whom we spoke said “It is definitely a lot better here now, staffing levels have improved.”

Relatives of people living in Winifred Dell with whom we spoke felt confident that any concerns they had would be dealt with appropriately. One person told us “If I have any concerns I just go straight to the management, they sort it straight away” and “They have always been very responsive when we have raised issues.”

Health professionals we spoke with as part of this review told us they had noted considerable improvements in the service provided for the people living in Winifred Dell in recent months. They told us that communication had improved and that this led to increased confidence that people would be cared for safely.