The inspection took place on 23 August and was unannounced.

The home provides residential and nursing care for up to 91 people. Some of the people at the home were living with a dementia. The home was purpose built and is set over two floors with the upstairs being a secure dementia area. There is a main lounge and dining area on each floor as well as smaller areas with comfortable seating. In addition there are a number of bungalows in the grounds for people who wish to remain more independent.

There was a registered manager for the home. 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.

Staff were kind and caring and supported people to be happy and contented. They knew people’s likes and dislikes and were able to offer suggestions for food or activities that would please the person. People’s privacy and dignity were supported and they were able to personalise their rooms to make them feel more like home. People were supported to make choices about how they received their care and could specify if they preferred male or female staff to assist them with their personal care.

People told us they felt safe living at the home and staff had received training in how to keep people safe from harm. Staff were protected against the risks associated with medicines, as staff ensured that medicines were stored, administered and destroyed safely and were available to people when needed.

There were enough staff available to meet people’s needs and the provider completed appropriate checks to ensure that they were safe to work with people living at the home. Staff had access to training which supported them to have the skills needed to provide safe appropriate care for people. They were also supported to gain nationally recognised qualifications in care. Staff received support and guidance from their line manager in regular supervisions and annual appraisals.

People’s rights were protected under the Mental Capacity Act 2005(MCA) and people has been appropriately referred to the local Deprivation of Liberty Safeguards authority when they were unable to make decisions about where they lived and were under constant supervision. Where people were able to make decisions for themselves their choices were respected.

People received care which met their needs and had been assessed so that risks to them had been identified and appropriate care and equipment was in place to keep them safe and healthy. However, review periods for risks were not always clearly identified and records did not always reflect people’s current needs. People were supported to maintain a healthy weight and to access plenty of fluids. People’s ability to eat safely was assessed and advice from healthcare professionals was followed. People were offered a choice of meals and were always offered an alternative if they did not like the meal they had chosen.

The provider had systems in place to monitor the quality of care people received and to gather the views of people using the service. The registered manager worked with a research organisation to ensure that the care provided reflected the latest guidance and used the guidance to make changes to the environment to support people’s wellbeing. They also worked with the local community to promote the needs of people living with a dementia and to help relatives understand people’s needs better.

The inspection took place on 15 December 2014 and was unannounced. At our last inspection the provider had been fully compliant with the regulations we inspected.

The home provided care for up to 93 people of all ages, including those who live with a dementia or who have a physical disability and who require nursing or residential care. The home was purpose built as a care home with the first floor of the building being a secure dementia unit. Each area of home was given a road name. The names used were all well-known town centre locations and would have been familiar to people. Pictures on the walls were also of well know local scenes in days gone by. There were also 10 bungalows in the grounds where people can live more independently but still be monitored and supported by staff. The home had a registered manager in place. 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 were protected from the risks of harm as staff had appropriate training to be able to identify risks to people’s health, safety and welfare. Records showed care was planned to keep people safe and to minimise the level of risk. Medicine was obtained, stored and administered safely.

There were enough staff to keep people safe and to ensure care was provided in a way which met people’s individual needs. Shifts were arranged to increase the level of staff working over the busy times of day such as when people were getting up or having lunch. The registered manager continually reviewed staffing levels against people’s needs and had the ability to increase staffing levels if needed. The provider carried out appropriate checked before employing people.

Staff received appropriate training to ensure they had the skills needed to care for people. They were supported to maintain and improve their skills with regular meetings to review the care they provided to people. Staff received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. These are laws which protect people’s rights when they are unable to make decisions for themselves. Records showed that appropriate mental capacity assessments were completed and where people did not have the ability to make decisions, best interest meetings were held.

Mealtimes were a relaxed and calm experience for people. They were offered a choice of food and meals were freshly cooked and appetising. Staff assisted people with their meals and spent time talking to the person about the meal. Where people did not want the meal they had previously chosen alternatives were offered. People were appropriately referred to health care professionals to assess if they could eat safely or needed help maintaining a healthy weight.

People received care from attentive and engaged staff who knew how to protect people’s privacy. Staff knew people’s care needs and offered support in a gentle and respectful manner. People were supported to bring in furniture from home and to decorate their rooms to their own taste. People were offered choices about the care they received and their choices were respected.

Care plans reflected people’s needs and were updated when needs changed. They were used by staff to see how people liked to receive care. Activities co-ordinators supported people to pursue individual hobbies as well as take part in group activities. Increased activities in the in the unit reserved for people who lived with dementia allowed staff to personalise activities and people were calm, relaxed and engaged in what they were doing.

The registered manager had multiple systems to receive feedback on the care that was provided to people. These included residents’ and relatives’ meetings, a comments box and annual questionnaires. The registered manager was available to people who used the service, relatives and the staff and responded appropriately and compassionate when concerns were raised. The registered manager looked to continually improve the level of care people received and engaged with national recognised projects to ensure staff had appropriate skills and knowledge. There was a robust system of checks and audits to identify any problems with the service people received. Where problems were identified action was taken to resolve the issue.

There were 92 people living at Cedar Falls. We spoke with 10 people and and with six visitors. We spoke with eight members of staff and the manager. We observed daily routines and interactions between staff and people who used the service. Some people had complex needs which meant they were not able to tell us about their experiences of care and support. We spoke with their relatives where possible to obtain their views.

People were all complimentary about staff and the service that they received. One person said "I like living here. I love my breakfast. I order a cooked breakfast every day. Staff are kind and helpful". A relative who had discussed aspects of care with staff said "I am 100% happy with the care. The staff are very good".

People were encouraged to make everyday decisions. Where they were unable to make more complex decisions the provider acted in accordance with legal requirements.

Care records contained detailed information about people's needs. Staff knew how they wished to be supported. Health care needs had been met. Relatives told us they were involved and kept informed of any changes in people's health or personal care needs.

There was a safe system of medication in place. People received their medicines safely and as prescribed.

Effective staff recruitment procedures ensured that people were protected from harm against inappropriate staff.

The complaints procedure was available and copies given to people who used the service and their relatives.

We spoke with several people living in the home who told us they were satisfied with the service.

People looked well cared for and the staff provided people with dignified and person centred care. The atmosphere was very relaxed and the environment felt homely.

One person we spoke with told us, “The staff are very nice. The food is great and if you don’t fancy what’s on the menu you can ask for something else. I’m quite satisfied with everything.”

Another person said, “It’s nice in here isn’t it. Guess what they gave me for breakfast? I had porridge with honey. It was great and a nice cup of tea. I’m being very well looked after.”

We spoke with a person that had moved in to the home two weeks previously. They said, “I have no faults at all, everyone has been very, very kind and helpful.”