We inspected this service on 31 October 2016. This was an unannounced inspection. At our previous inspection on the 19 October 2015 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding managing environmental and individual risks to people, the deployment of staff, guidance for staff in relation to the management of medicines and notifying us of incidents and events that affected people using the service. In other areas the service was meeting the regulations that we checked but we asked the provider to make some improvements. Such as the staff recruitment checks, the staff’s understanding of the deprivation of liberty safeguards and the activities and social stimulation available to people, The provider sent us a report in November 2015 explaining the actions they had and were taking to improve. At this inspection, we found improvements had been made, but further improvements were needed.

The service was registered to provide accommodation and personal care for up to 27 older people that were living with dementia. At the time of our inspection there were 19 people using the service.

There was no 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 2008 and associated Regulations about how the service is run. A new manager was due to commence employment the day after our inspection visit. The provider has confirmed since our visit that the new manager is now in post and has begun the process of registering with us. The new manager was being supported by the deputy manager who has been overseeing the management of the home with support from the provider.

Staff understood about the deprivation of liberty safeguards and how to protect people’s rights but were unaware of any legal restrictions on people’s freedom and liberty to ensure these restrictions were followed.

The recruitment checks undertaken had been improved. Staff spoken with and records seen demonstrated that all of the required checks were undertaken before staff commenced employment.

Improvements were seen in the assessments in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. There were enough staff on duty to support people and people received their medicines in safe way. The provider had ensured that environmental risks were managed safely.

Improvements were seen in the support provided to staff and the staffs understanding of people’s needs. People were supported by staff that understood their needs because they received training, support and supervision. People were supported to make their own decisions because staff understood the importance of gaining people’s consent and enabling them to make their own decisions whenever possible. Improvements had been made to enhance the social and therapeutic opportunities for people. An activities person had commenced employment and was in the process of gathering information from people regarding their interests. The provider understood their responsibilities around registration with us and notified us of events as required.

People felt safe and staff had received training to ensure they knew how to report any concerns. People were supported to maintain a diet that met their dietary requirements and preferences and support from health professionals was requested and available when needed. People had established positive relationships with the staff team. Staff treated people in a kind and caring way. People were encouraged to be

We inspected this service on 19 October 2015. The inspection was unannounced. At our previous inspection in March 2013, the service was meeting the regulations that we checked. The service provides accommodation and personal care for up to 27 older people that were living with dementia. There were 25 people living at the home on the day of our inspection.

There was no 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 2008 and associated Regulations about how the service is run.

Although the provider determined the staffing levels on an assessment of people’s needs, they had not taken into consideration the deployment of staff or additional tasks that staff were responsible for. This led to insufficient staff being available to meet people’s individual needs. Staff had knowledge about people’s care and support needs but guidance was not always in place or followed to support staff in meeting people’s needs in a safe way. Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm but staff were not clear on the external organisations they could report to. Medicines were managed safely but guidance was not in place to ensure that staff knew what to do when people refused to take their medicine. Protocols where not in place for staff to follow regarding as required medicines, to ensure people were given these medicines as and when needed. The provider had not undertaken thorough recruitment checks to ensure the staff employed were suitable to support people.

Staff received training to meet the needs of people living in the home, but we found staff’s lack of understanding in some areas of training meant it could not be implemented into their practice. Staff supervision, which may have identified areas where staff needed further support to develop their skills, were not consistently taking place. The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity in certain areas, capacity assessments had been completed to show how people were supported to make those decisions. People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach, but the main interaction with people was focussed on offering support or completing a care task. Staff we spoke with had a good understanding of people’s likes, dislikes and preferences. People felt confident they could raise any concerns with the manager. There were processes in place for people to express their views and opinions about the home. There were systems in place to monitor the quality of the service but the manager had not been provided with the time to undertake these. This meant they had not identified some of the areas of concern we found during our inspection visits.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection to check on the care and welfare of people using the service. The inspection was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with six people using the service, seven members of staff and the registered manager.

People using the service told us they were happy living at the home and they were well looked after. Staff spoke respectfully to people and offered choices about how they wanted to be supported and what they wanted to do. People told us they could choose how to spend their time including what time they got up in the morning.

The staffing provided had been reviewed and people told us when they needed support or assistance there was sufficient staff available to support them. One person told us, “The staff always come when we need them and they’re always around.”

Where people were not able to make decisions, capacity assessments were now completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

We carried out this visit to speak with the registered manager about the concerns that had been identified with the staffing provided during the night. The registered manager had provided us with information about the needs of people using the service and staff rosters before our inspection. We used this information to help us to make a judgement about whether there were sufficient staff on duty during the night to meet people's needs.

We judged that staffing needed to be reviewed to ensure people were safe and their assessed needs could be met.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

During our inspection we spoke with seven people using the service, two health care professionals, seven members of staff and the registered manager and provider.

We saw that staff treated people with respect and dignity. People told us that choices had been offered and their views had been taken into consideration. One person said, “There’s always something happening, but it’s up to us what we do. We don’t get pushed into things.”

We saw people's needs had been assessed by a range of health professionals including doctors and community nurses. This meant that people's health care needs had been monitored and met.

People using the service told us they were happy living at the home and they were well looked after. They said if they had any concerns they would discuss them with members of staff or the manager. One person told us, “I’ve never regretted choosing here, the staff are wonderful and can never do enough for you.”

Where people were not able to make decisions, capacity assessments had not been completed. Information about consultation with other significant people had not been recorded to demonstrate why decisions had been made. This meant people could not be confident decisions had been made in their best interest.

Information we hold about the home showed us that we needed to undertake a monitoring visit, in order to update our records, and to establish that people's needs were being met. We concentrated on finding out how the care was provided and looked at the quality of the service, including making sure there were enough staff available to meet people’s needs.

We saw that the staff were kind, respectful and polite. They gave support in ways that respected people's dignity and privacy for example, we saw and heard the staff knocking on bedroom doors and waiting before entering. We observed the staff listened to people and spent time with them, talking and carrying out activities, as well as providing care.

People spoken with told us they felt the staff treated them well and respected them. They commented that they received support from regular staff, which promoted consistency.

The home was warm and welcoming. We saw that communal areas had been decorated for Christmas and there was a festive feel around the home. We spoke with seven people living at the home, visiting family and friends and some of the staff members. Some of their comments included, “The staff are kind, the food is good.” “All the staff are really nice.” “This is my home, I love it here.” “The activities are really good, they get me going.”

A visitor informed us, “The home has a good reputation, the staff are very helpful and I am always made to feel welcome.”