This inspection took place on the 6 September 2017 and was unannounced. We last inspected Broadwindsor House on 9 and 12 November 2014. At that inspection we rated that inspection overall Good with requires improvement for the key question “Is the service responsive”. We recommended that the provider consider current best practice for how more opportunities can be offered for people to follow individual interests and socialise and how the environment needed to be changed to support people living with dementia. At this inspection we found improvement had been made.

Broadwindsor House provides accommodation for up to 21 people, at the time of the inspection there were 15 people living there. People need support with their personal care. The home provides support for mainly older people, including 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 2008 and associated Regulations about how the service is run. The registered manager was well qualified and had the experience needed to carry out their role. Relatives told us they found them open and approachable. Relatives we spoke with all said they were very happy with the care provided at Broadwindsor House and would recommend the service.

People remained safe at the home. People told us there were adequate numbers of suitable staff to meet their needs. People received care promptly when they asked for help. Staff told us they were able to take time with people and call bells were answered promptly.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely.

Care plans included MCA assessments and clearly stated if the person had capacity to agree and give consent. Where representation was required the correct procedures had been followed.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe.

Staff had attended training in safeguarding people and had access to the organisation’s policies on safeguarding people and whistle blowing. People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people effectively. Staff were positive about their training opportunities, one member of staff told us, “My training is good, it has changed my practice. For example I now look more closely at people skin when I am helping them to ensure there are no marks that might need more cream”.

People’s nutritional and hydration needs were assessed and monitored to make sure they received a diet in line with their needs and wishes. Where concerns were identified, staff sought support from professionals.

People were supported to access external health professionals, when required, to maintain their health and wellbeing. Health professionals visited the home on a regular basis. Documentation was updated to reflect the outcomes of professional visits and appointments.

People had access to dedicated activities. Activities took place three afternoons a week. Staff supported people with activities in the mornings or by supporting people with their chosen activity such as a daily walk around the grounds. One visitor told us, “I now expect to come into the home and see the staff team interacting with people”.

There was a clear management structure. The registered manager was supported by a deputy manager who staff told us were supportive and approachable. There were systems in place for monitoring the quality of the service

During our inspection we spoke with three people who lived in the home, and observed people taking lunch. We also observed people who were involved in a quiz and a sing-along activity in the afternoon. We spoke with two visiting relatives and a district nurse who was on a professional visit at the home.

Two people who lived at the home told us that they understood the care choices available them, and could have their views taken into account in the way their care was delivered. A person said, "They are very good at asking you about things."

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person’s relative told us, "I am aware that my father has a care plan." We saw that people's care was regularly reviewed and their personal information was held securely.

We saw that the home had taken steps to ensure that people were protected from abuse and that their human rights were respected and upheld. A person told us, “I feel safe here.” Another person told us, “The people here are friendly and get on well together.”

We viewed a selection of staff records, and saw that relevant checks had been carried out when the home employed staff.

The home had appropriate systems in place to ensure that people’s comments and complaints were listened to and acted on effectively. A person told us, "Staff take concerns seriously, they do listen."

Our inspection of 7 June 2012 found that staff had not received appropriate training in the identification of people at risk of malnutrition. The provider wrote to us on 7 August 2012 and told us that staff had received appropriate training. We carried out an inspection on 25 September 2012 and found that appropriate training had not been delivered. We served a warning notice which required compliance with the standard by 12 November 2012.

During the inspection on 25 September 2012, we saw that although the service was conducting some audits, the audits of care plans had not identified that the Malnutrition Universal Screening Tool (MUST) was not being used appropriately by staff. The information recorded on people’s MUST documents was not clear and people may have been at risk of malnutrition that was not identified or acted upon. We also saw that people’s medical records had not been completed correctly and that people may not have received care or treatment in line with their wishes.

During this inspection, we found that all staff currently employed by the home had completed training in the identification of people at risk of malnutrition and in the use of MUST. A new audit system of the MUST had been implemented and this demonstrated that people’s risk of malnutrition was recorded clearly. The home had consulted with relevant GP’s and Do Not Attempt Resuscitation (DNAR) orders had been reviewed so that people’s care would be in line with their wishes.

We spoke with people who use the service and they told us that “the food was very tasty” and that their lunch was “first class”. We spoke to one person who told us “I like it here.” At our last visit in June 2012 we were concerned that people’s nutritional needs were not being assessed properly and that some people had lost weight. When we visited this time, we found that people had gained weight although some information in care plans still contained inaccurate and incomplete information. We found that staff still had not had relevant training to identify if a person was at risk of malnutrition.

During our inspection we saw people being treated with respect, however we also saw occasions where people were not treated with respect. For example, we saw staff enter bedrooms without knocking.

People told us that they could make some choices about their lives. One person told us “I can get up and go to bed when I feel like it”.

People told us that they had not always had a choice of nutritious food. One person told us “I don’t know what is for lunch as no one ever asks me what I want”. However we saw that people were offered choices of food and drink.

We found that people had lost weight and no action had been taken to address this. The staff were not trained to identify malnutrition and malnutrition screening tools were not used.

There were allegations of abuse being investigated at the home which the provider had not notified us as is required. The staff were knowledgeable as to how identify abuse and had received safeguarding training.

The staff received regular supervision and had completed a range of relevant training and the home had adequate processes for the administration of medication which was kept securely. The provider had some quality assurance systems but these needed to improve.

One visitor told us that they visited their relative three times a week and considered that people were able to make choices. Another visitor told us their relative had stayed for respite care before moving in permanently and knew the home.

People were offered a choice of food and drink at the lunchtime meal. Staff asked the person whether they had finished eating before they removed the person’s plate. People were addressed by their preferred name and spoken with politely by staff.

Visitors considered the staff to be kind and caring and that people were well looked after.

People were able to have their pets living with them in the home.

We found that people’s needs were not consistently identified and recorded. Care plans were not person centred and lacked details of interventions on how people should be supported to ensure their needs were met in a safe manner.

The inspection took place on 6 and 12 November 2014 and was unannounced. We last inspected Broadwindsor House on 28 November 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

Broadwindsor House provides accommodation for up to 21 people in 16 single and 2 shared rooms (7 with en suite facilities). People need support with their personal care. The home provides support for mainly older people, including people living with dementia. The home is a large, converted period property with accommodation provided over three floors. The home has accessible grounds and gardens. There were 13 people staying at the home at the time of 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 and associated Regulations about how the service is run.

The home was comfortable, clean and spacious. We recommended the provider consider how the environment could be better adapted to meet the needs of people living with dementia or sensory impairment. There was limited signage or visual cues to guide people about their location or promote interest or reminiscence within the home environment. Improvement was needed to ensure people’s needs for stimulation and meaningful activity were met. The care plans gave good detail about people’s interests and about ways in which each person could be engaged. However some people told us they would like to have more going on within the home or opportunities to go out more. We saw that efforts were made by the provider to hold events or trips from time to time, for example, which related to the season, however one person told us, “The care here is excellent but it gets very boring sometimes.”

People were able to see their friends and families as they wanted. There was plenty of space within the home for people to mix with others, sit quietly or have visitors in private. One person told us, “I thoroughly enjoy being left alone to do my own thing”. People and their relatives spoke highly of the service. One person told us, “it’s very nice here and I have settled here very quickly.” A relative told us, “the care here is excellent of my relative and of me. My relative is very vocal and would say if they had a problem.”

We found the service was effective and care was delivered in line with people’s individual care assessments. The care plans provided suitable guidance to helped staff understand each person and meet their health and welfare needs in a personalised way. The staff referred to the care plans to help meet each person’s needs safely. People told us they felt staff knew how to provide their care.

Staff sought people’s consent before offering care and patiently explained how they would assist them if needed. The registered manager and deputy manager understood their responsibilities to assess people’s mental capacity. A formal process was in place to ensure staff considered people’s best interests, with their representatives, if they were unable to give their consent to decisions about their care and treatment due to their mental impairment. Where people could not give valid consent to living in the home, formal safeguards had been applied, in accordance with the Mental Capacity Act 2005. This helped to ensure that restrictions on people’s liberty for reasons of their safety and wellbeing had been properly assessed.

People were treated with kindness and respect. Staff took time to speak with the people they were supporting and there was a calm and relaxed atmosphere in the home. We saw many positive interactions and people enjoyed talking to the staff in the home. People had a choice of meals, snacks and drinks, which they told us they enjoyed. Mealtimes were well organised and people had been involved in planning menus. Their feedback about the meals in the home and their choices was listened to and acted on.

The home was maintained to a clean, hygienic and safe standard. Regular checks of the premises and grounds took place to ensure compliance with all relevant guidance and legislation relating to health and safety. The provider told us that work had taken place to modernise some areas of the home and ensure optimum comfort for people, especially where they had mobility needs. This work was on-going and included internal decoration and improvements to bathing and shower facilities.

The home was adequately staffed including more experienced senior staff on duty as part of the rota. Staff worked as a team, communicating regularly during their work and using time effectively at handover to ensure important information was passed on to promote consistent care for each person. For people not well enough to join people downstairs or who chose to remain in their rooms, staff made sure they did not become isolated. For example, they visited their room to offer drinks, eat with them or sit and chat. There was a strong presence of the registered manager and deputy manager in the areas where care was being provided which helped to guide and support staff and monitor the quality of the service.

The provider had ensured relevant checks on new staff had been carried out. New staff completed induction training, the level of which depending on previous experience. The staff were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us how they would report any concerns to a senior person in the home.

The home had not received any formal complaints and people we spoke with told us they felt able to voice their concerns. We heard people expressing their thoughts and opinions towards staff and visitors.

Medicines were managed safely. Safe systems were in place for handling and storage of medicines and medicines were administered in a person centred and discreet manner.

Staff sought professional advice from healthcare professionals when needed and worked with people’s families to arrange access to treatment and advice as needed.

The registered manager provided leadership and was developing the staff team according to their experience and skills. Roles and responsibilities within the staff team were well understood and staff told us they felt comfortable giving feedback to the manager. The quality of the service was checked and actions taken to respond to issues or problems raised by people, their relatives, and staff, through the monitoring checks or through the local authority contract monitoring process. The registered manager was supported by the provider and they were aware of the need to improve meaningful activity for people and told us they were addressing this.