We carried out an unannounced comprehensive inspection on 1 December 2016. Angels (Stratton House) provides care and accommodation for up to 24 people. The majority of people at this service have dementia or mental health needs. There were 21 people using the service on the day of our inspection.

We last inspected the service in November 2014, at that inspection the service was meeting all of the regulations inspected. However we made two recommendations to the provider regarding reviewing the Mental Capacity Act 2005 to make sure best interests decisions were being carried out and recorded appropriately. Also to explore the relevant guidance on how to make communication systems used by people living with dementia more ‘dementia friendly’. At this inspection we found the provider had taken action to improve these areas significantly.

There was a registered manager. 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 is also registered as the registered manager at a second location under a different legal entity. They delegated day to day clinical responsibility to two deputy managers who were nurses.

Relatives and staff gave us positive feedback about the management team. They said they were open, friendly and welcoming. They were happy to approach them if they had a concern and were confident that actions would be taken if required. The registered manager was very visible at the service and had an open door policy. They promoted a strong, caring and supportive approach to staff and put a high emphasis on staff training and increasing their knowledge.

The registered manager ensured there were sufficient numbers of suitable staff to keep people safe and meet their needs.

The provider demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. They had made appropriate applications for people they had assessed that required to be deprived of their liberty to the local authority DoLS team.

People were supported by staff who had the required recruitment checks in place and were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were supported to eat and drink enough and maintain a balanced diet. People and visitors were positive about the food at the service. People were seen to be enjoying the food they received during the inspection.

People received their prescribed medicines on time and in a safe way. Visitors said staff treated their relative with dignity and respect at all times in a caring and compassionate way.

People were supported to follow their interests and take part in social activities. A designated activities coordinator was employed by the provider. They ensured each person at the service had the opportunity to take part in activities and social events which were of an interest to them.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were person centred and people where able and their families had been involved in their development. Staff were very good at ensuring people where able were involved in making deci

This unannounced inspection was carried out by one inspector on the 9 October 2014.

Angels (Stratton House) Limited provides accommodation and nursing or personal care to up to 24 older people. The care home specialises in the care of people living with dementia.

There is 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 and associated Regulations about how the service is run.

The registered manager was supported by a deputy manager and a clinical lead. This gave clear lines of accountability and ensured senior staff were always available to people who lived at the home, staff and visitors.

People received care and support which met their needs and took account of their likes and dislikes. Staff working at the home had an understanding of up to date guidance about how to support people to make decisions. However some improvements were needed to make sure documentation gave clear evidence of how decisions had been made when someone lacked the capacity to make a decision for themselves.

Improvements were also needed to make sure that information available in the home was appropriate to the needs of people living with dementia. This included information about how to make a complaint, activities and social events.

People received care that was personalised to their needs and preferences. One person said “They seem happy for me to live as I choose. They couldn’t do more for me but also they let me be myself.”

There was a warm and welcoming atmosphere in the home. Throughout the day we saw staff interacted with people in a friendly and kind manner. Many people we spoke with commented on the kindness of the staff who supported them. There were adequate numbers of staff to make sure people received care and support in a timely manner. We saw people who requested assistance were responded to promptly.

People were safe at the home because staff understood how to recognise and report any signs of abuse. Staff were confident that any allegations would be taken seriously and action would be taken to make sure people were protected.

Staff worked in accordance with the risk assessments that were in place to make sure people were able to take part in activities and their chosen routines with minimum risk to themselves or others.

People were very complimentary about the food. Comments included: “Food here is excellent” and “The food is good, there’s always a choice and there’s always cake and biscuits as well, You won’t starve here.” Throughout the day we saw people were offered plenty of hot beverages and everyone had access to cold drinks. At lunchtime we saw people received the support they required to eat and drink.

There were systems in place to monitor the quality of the service provided and plan on-going improvements. The home took part in local and national initiatives designed to develop and share good practice.

We observed care and support being delivered to people who used the service with dignity and respect. People we spoke with told us that "the staff were marvellous".

We spoke with two relatives who told us that they could visit when they liked, nothing was too much trouble and the manager kept them up to date with changes to their relative's welfare.

We saw that best interests meetings had been called when relevant and also the Deprivation of Liberties procedure had been used properly when it was needed. This meant that decisions about peoples care, treatment and support were taken by people who knew them well.

We observed the medication administration system which was very clear and accurate. This meant that people had received the right medication at the right time.

We spoke with staff about the support they received and they told us that they thought that management were very supportive to them. We saw records which showed us that supervision and training occurred on a regular basis.

We saw a monthly auditing system which showed us that people's views were taken into account when delivering care, treatment and support. This system also reassured us that matters such as health and safety and case files were well managed.

This inspection was carried out following concerns that had been raised with us. The report will not detail specifically what the concerns were due to confidentiality. However, the areas of concern were about how the home was maintained to keep it safe, prevention procedures to reduce the risk of infection and how the home was run after changing from residential to nursing. We found no evidence to substantiate the concerns that were raised to us.

This inspection took place from late afternoon until late evening. During our visit we spoke with both day and night staff including three nurses, two carers and one of the cooks. We also reviewed three care records that described people’s individual needs in the home.

We were told all people who lived in the home had some form of memory loss or dementia. We carried out a short observation to help us understand whether people’s needs were being met. This was because some people were unable to tell us their full experience of what it was like to live in the home. This showed interaction from staff towards people who lived in the home was positive. We noted that when staff had assisted a person, this was done respectfully and at a comfortable pace for the person.

One person spoken with told us they thought “staff were very kind, helpful in everyway, they help me to wash and dress myself”.

Many of the people living at Stratton House are unable to fully express themselves verbally but all appeared content in their environment. People appeared comfortable with the staff who supported them on the day of the visit.

People spoke highly of the staff, one person said that they were “kind and thoughtful” another said “they know what our needs are and are always happy to help.”

People said that if they had any worries or concerns they would feel comfortable to talk with the manager or a member of staff.

Everyone asked said that they liked the food in the home and that there was always plenty to eat. The main meal of the day was observed and it appeared to be enjoyed by most people.

One person said, “We are very comfortable and get everything we need.”

People said that they were always treated with respect and that support was never rushed.

One person living at the home said “I’ve no complaints, they treat you like a human being – with respect.”