This inspection was unannounced and took place on 8 December 2016. The service was registered to provide accommodation for up to 20 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection, 16 people were using the service.

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.

At our last inspection on 21 December 2015, we told the provider to make improvements in relation to levels of staffing available to meet people’s needs and keep them safe. The provider sent us a report on 13 February 2016 explaining the actions they would take to improve. At this inspection, we found the required improvements had been made. There were enough staff available to meet people’s needs and keep them safe.

We had also told the provider to make improvements to ensure the way they checked the quality of the service was more effective. Again, we found that the necessary improvements had been made. There was a programme of audits in place that were effective in driving continuous improvement.

Staff gained people’s consent before support was given. However, when people were unable to make decisions about their care, the provider had not assessed their capacity regarding this and was not able to show why decisions made on behalf of people were in their best interests.

People were safe and protected from harm and abuse. Staff were knowledgeable in safeguarding people and the provider referred any incidents as needed. Risks to people were assessed, managed and reviewed to minimise potential harm. People’s medicines were managed safely by staff who were trained to do this. The provider had safe recruitment processes in place.

Staff were equipped with the knowledge and skills needed to carry out their roles. People were supported to maintain a balanced diet and enabled to maintain good health. When people were not able to make decision about their care and were being restricted, the provider ensured this was authorised legally.

People were supported by staff who were respectful and kind towards them. Staff knew people well and cared for people in a dignified manner. People’s privacy was respected and their independence promoted. Visitors were made to feel welcome.

People were involved in the assessment and planning of their care. The service responded to people’s changing needs and people received support that was individual to them. Staff knew about people’s needs and preferences. There were opportunities for people to participate in activities they enjoyed. People knew how to raise any concerns or issues and the provider acted on this.

There was a positive culture within the home and staff felt supported by the management team.

This unannounced inspection took place on 21 December 2015.

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.

At our last inspection on the 13 and 15 August 2013 we found the provider was not meeting all of the standards we inspected. At that time we had concerns about the care and welfare of people, the arrangements for safeguarding people from harm and the way staff were supported to fulfil their role. The provider submitted an action plan to us detailing how they would achieve the required improvements. At this inspection, we saw that the required improvements had been made. We identified some concerns about the number of staff available to meet people’s needs and the reporting of safeguarding concerns.

Staff knew how to protect people from harm but had not recognised that some incidents should have been reported to the local safeguarding authority, to ensure people were fully protected. The number of staff available was not determined by the needs of people and we found that at times there were insufficient staff to care for people safely. The registered manager was monitoring the quality of the service but was not identifying trends and patterns in incidents.

People were provided with a choice of suitable food and were encouraged to take adequate fluids to support their health. People’s health and wellbeing needs were regularly monitored and when necessary people received additional support from health care professionals.

Staff received support to improve their skills and knowledge to care for people. People were happy with the management of the home and staff felt well supported.

We saw that people were routinely asked for their consent before their care was provided. When people lacked the capacity to make decisions for themselves we saw that staff supported them in line with the requirements of the Mental Capacity Act 2005.

People were treated kindly by staff and their rights to privacy and dignity were recognised and maintained. Staff recognised people’s individuality and provided care which met their preferences. People were encouraged and supported to maintain the relationships which were important to them.

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

We found that arrangements had been put in place to gain and review consent from people who lacked the capacity to make certain decisions, and to show that decisions were made in their best interests.

We spoke with ten people who use the service and three relatives.

Not everyone we spoke with was able to share their views about the service. People able to share their views told us they were happy with the care and support they received, and felt that their needs were being met.

People told us they enjoyed their meals, which included a choice of foods. One person said ’’I can't fault the meals; I have put on weight since I came here.’’ Another person said ‘’the meals were appetising and included foods they liked.’’

People said that they received their medicines at the times they needed them.

People said they liked the staff that supported them and felt that they get the help they needed as there was usually enough staff on duty.

Relatives we spoke with said they were happy with the care and support their family member received, and felt involved in decisions about their care and treatment. One relative told us ‘’my family member couldn’t be better looked after. The staff are kind and thoughtful and they keep me informed of any changes.’’ Another relative said ’’the home has a good team of staff and I have no concerns about the care or service.’’

We spoke to eight people who used the service, five relatives, and seven members of staff. Most people were unable to share their experiences with us. Those that could said they were happy with the care and service they received, and felt that their care needs were being met. They felt listened to and had a say in how the home is run. One person told us ‘'I can’t fault the care I receive’’. Another person said ‘’the staff team are great; they look after us very well’'. People said they get the help they need as there is generally enough staff on duty.

One relative told us that ‘'the care and support my family member receives is excellent’’. ‘' Another relative said ‘’staff are caring and friendly; nothing is too much trouble’’.

People considered that their privacy, dignity and independence are respected.

We spoke with ten people who used the service and two relatives.

People able to express their views said they were happy with the care they received, and felt that their needs were being met. One person told us "the staff are helpful and caring. The home is suburb; nothing is too much trouble’’. Another person told us ‘’I am happy living here; I spend my day doing what I want to do and go to bed and get up when I want’’.

People told us that they received the support they needed as there were usually enough staff on duty. They also said that they felt that the daily routines were flexible, taking into account their wishes. However we found that some routines were not set around individual needs.

People able to express their views said that they felt safe and able to raise concerns with staff if they were unhappy with their care or the service. We found that senior staff were not aware of local safeguarding procedures, to protect people against the risk of abuse.

Relatives we spoke with told us they were satisfied with the care and support their family member received, and felt involved in decisions about their care and treatment.

People said that they liked the staff that supported them. We found that arrangements were not in place to ensure that all staff received appropriate training, supervision and appraisal to carry out their work effectively.