This inspection took place on the 8 November 2017 and was unannounced.

Allendale House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and personal care for a maximum of 20 older people, some of whom may be living with dementia. It is located close to the centre of the market town of Hedon, in the East Riding of Yorkshire, and within walking distance of shops, leisure and health services. At the time of our inspection there were 16 people using the service.

We last carried out a comprehensive inspection of this service on 25 August 2015. At the last inspection we rated the service overall Good with requires improvement for the key question "Is the service safe."

We recommended the registered provider ensured people always received their medication safely according to the policy, which should include information on administering medicines safely, and whenever possible in private to maintain peoples’ dignity. At this inspection we found improvements had been made. We found the service remained Good overall.

At the time of our inspection the service did not have a registered manager. The manager in post was in the process of applying to become the registered manager and an application to register with the Care Quality Commission had been submitted in October 2017. 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.

Recruitment processes were safe and staffing levels were sufficient to meet people’s needs.

Staff knew how to keep people safe and understood their duty to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm.

There were systems in place to ensure people’s medicines were safely managed. We found people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received food and drink according to their needs and were also supported by health and social care professionals when required.

We observed positive interactions between people and staff. People told us staff were kind and caring towards them and the care they received was good.

Each person had a care plan that was suitably detailed to ensure they were at the centre of their care. People's care and support was kept under review and, where appropriate, they were involved in decisions about their care.

People told us they were happy with the activities organised at the service. People were aware of how to raise any concerns they had.

There were effective systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being.

Further information is in the detailed findings below.

This inspection took place on 25 August 2015 and was an unannounced inspection. We previously visited the service on 23 February 2015 and we found that the registered provider did not meet the regulations we assessed. The service was in breach of four regulations in relation to cleanliness and infection control, nutrition, staffing levels, records and monitoring of quality performance.

Allendale House is located close to the centre of the market town of Hedon and within walking distance of shops, leisure and health services. It is a relatively short walk to access local public transport. The home is owned by an individual and registered for up to 20 people.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager registered by the Care Quality Commission (CQC); 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.

We found that people were protected from the risks of harm or abuse because staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Risk assessments were in place to protect people from being harmed unnecessarily.

Staff had been employed following the home’s recruitment and selection policies.

We saw that there were sufficient numbers of staff on duty to meet people’s needs.

Medicines were administered safely by trained staff and the arrangements for ordering, storage and recording were sufficient. However the service was not always handling medication according to policy or guidelines on infection control or affording people that used the service privacy and dignity when taking it. Medication policy or guidelines should include information on administering medicines safely.

The staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

We found that people were given adequate nutrition and their health care was monitored. While the premises were suitable for older people we had recommended at the last inspection that the provider accessed best practice guidance for supporting people with dementia needs. We could see efforts had been made to make areas of the home more dementia friendly. The service had made changes that were required such as toilets, bathrooms, laundry and carpets.

People spoken with said the staff were caring and they were happy with the care they received.

People were treated with respect and dignity by the staff. There had been no formal complaints made to the service during the previous twelve months but there were systems in place to manage complaints if they were received.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include people’s preferences, likes and dislikes. People who used the service received additional care and treatment from health care professionals based in the community.

Staff told us that the service was well led. The quality audits undertaken by the service were designed to identify any areas of improvement that would improve safety and the care provided to people who lived at the home.

The inspection took place on 23 February 2015 and was unannounced. The service was last inspected on 20 June 2013 and we found that all of the areas assessed were met.

Allendale House is located close to the centre of the market town of Hedon and within walking distance of shops, leisure and health services. It is a relatively short walk to access local public transport. The home is owned by an individual and registered to accommodate up to 20 older people. It provides support for people with needs associated with old age and/or dementia.

There was a registered manager in post at the time of the visit. 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.

We found that there were not enough staff to support people with the meeting of their needs, records required improvement, control of infection was not adequate, people’s dietary needs were not effectively met and the quality assurance systems were not effective. You can see what action we told the provider to take at the back of the full version of the report.

We made recommendations about best practice for people with dementia needs and regarding the principles of the Mental Capacity Act 2005 (MCA).

Staff were aware of and had received training in the safeguarding of vulnerable people from harm. Risk assessments were in place which supported people to live their lives whilst being protected from harm. However, we saw these required improvements.

Staff were recruited through procedures which helped to make sure they were suitable to work with vulnerable people.

Systems were in place to support people with receiving their medication although minor improvements were required with this.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the MCA legislation which is designed to ensure that the human rights of people who may lack capacity to make decisions are protected. Although staff had received training in this some improvements were required in practice.

Staff had received training to help them with their role and systems were in place to makes sure peoples physical health needs were met.

There had been no changes to the environment to support people with dementia needs.

People were supported by a care planning system which helped identify their needs and provide information to staff so the correct support could be provided. Improvement was needed to this to ensure peoples choices and wishes were fully recorded.

People were treated with dignity and respect and systems were in place for people to be consulted or to raise concerns. However, the quality assurance systems required improvement to ensure people were consulted effectively.

Staff told us they felt able to raise concerns to the manager. We were told that no complaints had been raised with the home by staff or people who lived there.

We asked the manager to review a concern with medication and to forward this to CQC. This was not received.

We undertook this inspection to review areas of non compliance found at the previous visit.

We found that actions had been taken to address the non compliance and this included replacing damaged tiles in the lounge and kitchen, repairing the bath and a radiator, adding new flooring to the laundry room and updating some records in the home.

People we spoke with were happy with the home and felt they could raise any concerns. However some people felt that staff were too rushed to spend time with them and staff also felt they did not spend enough time talking with people.

We found that people continued to be supported through a care planning process which included supporting people with risk assessments and in accessing health professionals.

We found that recruitment practices had improved and that paperwork had been updated to ensure that it contained the correct and up to date information.

People who lived in the home told us “All I can say is they are very good”, and “You get a choice on various things, mostly food and activities. There is something to do everyday for example, bingo or a quiz”.

When asked about their care they said “If I ask them for anything they do it” and all confirmed they all felt safe living in the home.

Staff told us how they asked people about options for their care before they supported anyone and we saw that people were supported on the whole through a care planning process that identified their needs and preferences.

We saw that there were systems in place to support people with safeguarding issues or to raise concerns. Staff demonstrated a good knowledge of these systems.

Some areas of the premises required attention in order to ensure that the regulations were met and not all of the recruitment processes were to the required standard. Gaps in some of the records in the home required action to be taken.

We spoke with people using the service and they told us they could make choices about aspects of their lives. They said, “I like it here, it’s lovely”, “I can have a bath when I want to”, “I have everything I need” and “I love it here, when it was my 100th birthday we had a party.”

We spoke with a family member regarding the care and support offered by the home and they told us, “The care is very good” and “Staff are friendly and they listen to complaints”.

People said they were well cared for and saw a range of health care professionals as required. We spoke with a visiting health care professional and they told us they had no concerns about the home and commented, “Staff are always approachable and they listen to direction and advice.”

People told us they liked the meals and the quality of the food was, “Very good”, “The food is good and they do something else if you don’t like it” and “The food is marvellous.”

People told us the staff were supportive and they felt safe in the home.

People told us the environment was comfortable and homely but sometimes cold and commented, “I have everything I need”, “I like my room, but it’s a bit cold” and “The heating needs sorting out.”

People were very complimentary about the staff team and commented, “The staff are great”, “They are lovely” and “The staff are nice.”

People told us they knew how to make a complaint and that their views were listened to. Some comments included; “I have no complaints” and “The manager would sort it out.”