We carried out a fully comprehensive inspection at Adelaide House Care Home on the 30 June and the 18 July., The location was previously known as, Clare House Care Home (Walton on Thames,) until July 2017. The inspection was unannounced and partly out of hours, starting at 6am on the 30 June.

The last inspection took place on 21 July 2016 before BUPA (The provider) changed their legal entity to BUPA Care Homes Limited. At that inspection although the home was rated as providing good care, we suggested improving the way staff were informed about people’s medical needs and how activities were organised to meet everyone’s needs. At this inspection people had more choice of individual activity and staff were well informed about their needs.

The home provides accommodation, personal and nursing care and treatment of disease, disorder or injury for up to 30 older people some of who may be living with dementia. At the time of this inspection there were 24 people using the service.

On both days of our visits 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 greeted us at 06.00 on the first day as they had been at the home since 04.30 carrying out checks to ensure people were receiving the care they needed at night.

There were enough nursing and care staff during the day and at night to meet people’s needs. However, we discussed with the registered manager and provider how they could adjust staff working times to provide care at the times people preferred. This was most relevant in the mornings when staff were busier and may not have been able to assist everyone to get up when they wanted to, but people were receiving personal care within a reasonable time. The registered manager was going to review this and make improvements.

There were systems in place to protect people from the risk of fire, or from leaving the building unnoticed. Staff had been trained and all fire doors had an alarm to alert staff if they opened.

The risks people may have been exposed to had been assessed and staff knew what actions to take to minimise them. This included for nutritional risk, skin integrity, mobility and health. People who had capacity to make their own decisions were enabled to do so. Those who may lack capacity to make important decisions had been assessed and where needed, best interest decisions had been made. Deprivation of liberty applications had been submitted to the local authority. This meant people had their rights protected from unreasonable or unlawful restrictions.

People had their medicines as prescribed and these were stored and administered safely. People had their health care needs met by competent nurses who requested health care advice or treatment as required.

People liked the food and said there was plenty to eat and drink of their choice. The chef and staff knew peoples nutritional needs and risks and met these.

People were cared for by staff that showed they had compassion for each person. They knew people well and interacted with kindness and affection. People’s privacy, confidentiality and dignity were maintained.

Visitors were welcomed and included in the home. People’s rooms were individual and they contained personal belongings that mattered to them. The home was adapted to help people living with dementia find their way, with signage and colours. People had the equipment they needed to remain as independent as possible.

Staff responded to people’s needs but there is a need to improve how staff offer people a choice of baths or showers and how often. There was already action taken by day two of the inspection following our feedback to the registered mana