The inspection took place on 22 November 2016 and it was unannounced. The last inspection of this service took place on 14 September 2015, no breaches of regulation were found and an overall rating of requires improvement was achieved.

The service had a registered manger in place, who is the registered provider. 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.

People we spoke with and their relatives were positive about the care and provided at the service.

A health care professional we spoke with was complimentary about the service and they had no concerns to raise.

Staff understood they had a duty to protect people from harm and abuse. Staff knew how to report abuse and confirmed they would report any issues straight away. This helped to protect people.

People living at the service had their needs met by adequate numbers of skilled staff. People told us they felt safe living at the service. People lived the life they chose and were supported by caring attentive staff. End of life care was provided at the service.

People living at the service were provided with home cooked food. Their fluids and food intake was monitored to make sure people’s nutritional needs were maintained. People who required prompting or support to eat were assisted by patient and attentive staff. Staff gained help and advice from relevant health care professionals which helped to maintain their wellbeing.

People’s privacy and dignity was respected. People were involved in making their own decisions, about their care and treatment. People made decisions about what they wanted to do and how they wanted to spend their time. Staff reworded questions or information to help people understand what was being said. This promoted people’s independence and choice.

Medicine systems in operation were robust which helped to protect people’s wellbeing.

People’s views were sought along with those of their relatives. Information received was listened too and acted upon. There was a complaints procedure in place.

The quality of the service was monitored by the registered manager and staff to make sure the service met people’s needs and people remained happy living there. Regular audits of the service were undertaken which helped to monitor, maintain or improve the quality of service provided to people.

The inspection took place on 22 November 2016 and it was unannounced. The last inspection of this service took place on 14 September 2015, no breaches of regulation were found and an overall rating of requires improvement was achieved.

The service had a registered manger in place, who is the registered provider. 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.

People we spoke with and their relatives were positive about the care and provided at the service.

A health care professional we spoke with was complimentary about the service and they had no concerns to raise.

Staff understood they had a duty to protect people from harm and abuse. Staff knew how to report abuse and confirmed they would report any issues straight away. This helped to protect people.

People living at the service had their needs met by adequate numbers of skilled staff. People told us they felt safe living at the service. People lived the life they chose and were supported by caring attentive staff. End of life care was provided at the service.

People living at the service were provided with home cooked food. Their fluids and food intake was monitored to make sure people’s nutritional needs were maintained. People who required prompting or support to eat were assisted by patient and attentive staff. Staff gained help and advice from relevant health care professionals which helped to maintain their wellbeing.

People’s privacy and dignity was respected. People were involved in making their own decisions, about their care and treatment. People made decisions about what they wanted to do and how they wanted to spend their time. Staff reworded questions or information to help people understand what was being said. This promoted people’s independence and choice.

Medicine systems in operation were robust which helped to protect people’s wellbeing.

People’s views were sought along with those of their relatives. Information received was listened too and acted upon. There was a complaints procedure in place.

The quality of the service was monitored by the registered manager and staff to make sure the service met people’s needs and people remained happy living there. Regular audits of the service were undertaken which helped to monitor, maintain or improve the quality of service provided to people.

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. The care plans gave guidance to staff about how to deal with behaviours which may challenge the service. Information was provided on techniques staff should employ to manage any distress or agitation the person may experience.

Staff acknowledged people’s gestures and expressions if they were unable to communicate verbally. One person’s relative told us, “The staff talk to XXX really well; they seem to understand his wishes and choices.”

We noted people’s care plans gave information about their food preferences. One person’s care plan stated, “I only like plain food and like my food to look inviting.”

We looked around the home and observed a high overall standard of cleanliness. One relative told us, “I think the home is very, very clean.”

We saw each person’s care file contained an assessment of their ability to administer medication themselves and maintain their independence in this area.

The home was warm and comfortable. One person’s relative told us, “It’s a lovely home; the rooms are every so well kept.”

There was evidence that external contracts were in place that ensured specialist equipment was appropriately serviced and safe to use.

We used a number of different methods to help us understand the experiences of people who used the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences.

We spent time in the lounge and dining room and chatted to people who lived at the home. We observed the interaction between people and staff and we found communication and rapport to be positive. Staff displayed a good understanding of people’s individual needs and people responded well to interactions from staff (and vice versa).

We found most people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. In discussions, one person said ‘’I like it here, it’s nice’’.

Throughout our visit we observed positive interaction between the staff and people who use the service. The staff were respectful and polite towards people and showed a good understanding of their needs.

People using the service appeared relaxed and comfortable in their surroundings and were supported where possible to choose how they spent their time. We observed people using the service participating in a range of activities during the inspection. We also observed that staff had time to spend with people on an individual basis.