.This inspection took place on 2 October 2018 and was unannounced.

Allonsfield House is a care home without nursing that provides a service for up to 42 older people living with dementia and/or a physical disability. On the day of our inspection visit there were 31 people living in the service. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection

After the last inspection on 29 August and 4 September 2017, we asked the provider to take action to make improvements to staffing levels and their governance procedure and we have seen a degree of improvement at this inspection. However this has not been as timely as it should have been and we were unable to assess that this had been embedded and effective over time. This report shows areas for further development.

People told us they felt safe living in the service and when receiving care and support. Our previous inspection had found that improvements were needed in staffing levels. At this inspection we found that this had improved but in some instances, there were still not sufficient staff to support people in a personalised way and a peak times of need.

Care files included a range of risk assessments such as moving and handling, nutrition and continence. These were regularly reviewed and updated according to people’s needs. However, we found that reporting of incidents was inconsistent which meant that risks to people were not being effectively monitored.

People were protected by the provider's recruitment processes. Safe recruitment practices were followed before new staff were employed to work with people. Required checks were made to ensure staff were of good character and suitable for their role.

People received effective health care and support. Medicines were stored and handled correctly and safely. There were infection control appropriate policies and procedures in place.

The service was not always working within the Mental Capacity Act 2005 (MCA). Where people had Deprivation of Liberty Safeguard applications authorised by the relevant authority these were not kept under the review. We found one which had expired. There was a lack of understanding of the decision-making process using relevant legislation and guidance. We have made a recommendation referring the service to the guidance available on the MCA and the decision making process.

Some of the building interior decoration had become shabby and tired. Decoration in the unit which specialised in supporting those living with dementia was not always appropriate. This had been recognised and there were plans in place to improve these areas. However, there were no firm timescales in place to achieve these improvements. Internally the service was clean and hygienic.

There were two new activities co-ordinators in post with plans in place to improve the experience of people with more person-centred activities. However, these plans were still being developed with some people still feeling disengaged with activities.

A range of audits were carried out by managers in the service. Whilst the provider told us that these were used to drive improvement we found that they were not always effective in identifying and addressing deficiencies at an early stage and taking immediate action.

The service used an integrated electronic care planning system. This had been introduced prior to our last inspection and we found staff understanding of the system required improvement. At this inspection we found this had improved and staff recorded day to day activities on the system. However, there was still inconsistencies with how some information was put into the system.

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

This inspection took place on 29 August and 4 September 2017. The previous inspection in September 2015 had rated the service as Good. However, this inspection identified areas where the service needs to improve.

The service provides care and support for up to 42 people. On the dates of our inspection there were 40 people living in the service, some of who are living with dementia. It is divided into two units Allonsfield and Ashfield.

The service is required as a condition of registration to have a registered manager. On the dates of our inspection there was not a manager registered with the CQC in post. There was a manager who had applied to register. 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.

There were not always the number of staff on duty that the service had assessed as necessary to support people safely and effectively. This included the number of night staff and staff with a specialist role, for example activities staff.

Staff training was not effectively monitored to ensure staff had received the required training and that training was up to date. Staff had not all received effective training in areas in which the service provided care, for example, dementia care. Staff received supervision sessions where they could discuss concerns or development needs.

Staff had received training in keeping people safe from abuse and were confident they would be able to identify and respond to any concerns.

The provider had invested in a new care planning system. This was computer based with care staff inputting information via a smart phone. The amount of time it would take for care plans to be put onto the computer and for staff to become competent in the system had not been effectively assessed by the provider. This has resulted in care plans which did not always contain full information about the care to be provided and staff not being able to fully access information on the system.

Appropriate checks were carried out before staff started providing care to ensure they were suitable for the role.

Medicines were managed safely to ensure that people received their medicines as prescribed. The service did not comply with the Mental Capacity Act when administering covert medicines, that is when disguised in food.

People had mixed views on the quality of the food provided. Care plans contained information on people’s nutritional needs.

People were supported to maintain good health and access other healthcare professionals.

Staff respected people’s privacy and dignity when providing care and support. However, as an organisation dignity was not promoted with linen being old and tired and a lack of crockery.

The service did not have a planned programme of meaningful activities either for people as individuals or for the service as a whole.

The manager and the provider carried out a variety of audits. However, these had not always identified areas of concern. Where the audits had identified shortfalls action to address these had not always been put in place.

Allonsfield House provides accommodation and personal care for up to 42 older people, some living with dementia.

There were 39 people living in the service when we inspected on 30 September 2015. This was an unannounced inspection.

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.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included risk assessments and management plans in respect of individuals’ safety and the environment, including equipment.

Staff received training and support in relation to their jobs, and tasks required to meet the needs of the people who used the service. Staff were attentive when people needed assistance or support and responded when people needed assistance. Robust and safe recruitment procedures ensured staff who worked at the service were suitable to care for vulnerable adults.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

People, or their representatives, contributed to the development of plans of care. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with changes to the law regarding the Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring, respectful and professional manner.

People’s nutritional needs were being assessed and met. Where concerns were identified about, for example a person’s food intake, the home had a clear system for monitoring peoples weight, and making referrals for specialist advice and support. People were also supported to see, when needed, other health and social care professionals to make sure they received appropriate care and treatment.

A complaints procedure was in place. People’s comments, concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

There was an open and empowering culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were addressed promptly. As a result the quality of the service continued to improve.

We talked with six people who used the service to gain their views and experiences about the service they were provided with. They told us their needs were met and staff treated them well. One person told us, “The staff are great, very accommodating and kind. I like it here.” Another person said, “I make the most of it. It’s not quite home but it is getting there. I have made friends since I came. People are nice here and the staff are good.”

People we spoke with confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, “They (staff) are good. They tell me when it is time to take my medication and are quick to call the doctor if they think someone is poorly. They don’t hang about. They got the doctor in the other day for me. I wouldn’t have bothered as it was one of those things, an off day. But, they (staff) don’t take a chance; shows they care.”

We looked at five people’s care records. The records showed that people's needs were assessed and care and treatment was planned in line with their individual care plan. We saw evidence in the care records that people received safe and coordinated care, treatment and support where more than one provider was involved.

People said they were given a variety of meals that were, “Very pleasant and well cooked,” and, “Always appetising.” One person said, “The food is nice. I enjoy what we have. There is plenty of choice and they (staff) are not stingy with the portions.”

We looked at staff records and spoke with four members of staff who told us they were being appropriately supervised and supported. Staff were knowledgeable about the people they supported and how to meet their needs.

During our inspection we saw that staff interacted with people in a caring, respectful and professional manner.

The people we spoke with told us that they were well looked after. One person told us, “The staff are so willing and kind. They give us every support.” Another person said, “Sometimes I tell them about something and they do it.” People using the service or their families were invited to review the care plans every six months. Relatives told the service that they found this helpful and informative. One said, “One of the staff has given me some information on dementia.”

Care plans held information on all aspects of a person’s care needs. We saw some examples of clear guidance to staff on how to support people with specific needs. Some plans could have been more person-centred.

The service had demonstrated that it raised safeguarding concerns in the correct way and dealt with them appropriately. Relatives had commented in a recent survey that their family members were well looked after, and any problems were sorted out promptly.

Staff were praised by people using the service and their relatives. One person told us, “Staff are always willing to listen.” Another said, “I feel I can always ask questions if I am unsure. Nothing is too much trouble.”

The service used several ways of monitoring the quality of care, especially the care of those living with dementia. The provider had introduced a project to improve staff knowledge about supporting those people. Care practices were audited regularly to ensure people received dignified and respectful care.

The 2010 residents' quality questionnaire report demonstrates that overall people are satisfied or very satisfied with the quality of their experience at Allonsfield House.

People with whom we spoke during our visit on 18 January 2011 were very positive about their experience at the home and told us that their needs are met appropriately. They told us that the bedrooms are warm and comfortable with adequate storage and privacy. One lady said that her bedroom walls were too thin and she could hear her neighbour's radio, which we brought to the attention of the manager

The 2010 family questionnaire was completed by 16 respondents who overall were very positive about the premises, meals, care and management, being satisfied or very satisfied throughout.

A log of comments we examined confirmed that families are very complimentary about the activities that are provided within the home, stating that people at the home enjoy them and derive real benefits.