This inspection took place on 9 May 2018 and was unannounced.

Darland House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is part of the health services provided by Medway Community Healthcare (MCH) and is registered to provide accommodation and personal care for up to 40 people who are living with advanced dementia. The accommodation was provided across four units, over two floors. A lift was available to take people between floors. There were 39 people living in the service at the time of the inspection.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

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. The registered manager was supported in the day to day management of the service by a head of service and a clinical lead.

People told us they felt safe. There were sufficient staff deployed to meet people's needs in a timely and unhurried manner.

People's medicines were managed and administered in a safe way by staff who had been trained to carry out the task.

People were protected from the risk of harm or abuse because the provider had effective systems in place which were understood and followed by staff. People were protected from the risk of the spread of infection.

People continued to receive effective care. People were supported by staff who were trained and competent in their roles.

The provider was working within the requirements of the Mental Capacity Act (2005). The registered manager and staff demonstrated they understood the principles of the Act. Staff had received MCA training and sought people's consent before providing assistance.

People's health care needs were monitored and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by kind and caring staff who took time to get to know people and what was

important to them. Staff treated people with respect and respected their right to privacy.

People were involved in planning and reviewing the care they received which helped to ensure people received a service which met their needs and preferences.

There were daily activities for people which they could choose to join in with. However, not everyone was engaged in activities during our inspection. We made a recommendation about this.

Complaints were taken seriously and responded to. People's religious and cultural needs were understood and met by staff.

The provider had effective systems in place to monitor and improve the quality of the service provided. People and their families had opportunities to put forward their ideas and suggestions to improve the service they received.

The inspection was carried out on 25 January 2016 and was unannounced.

At our previous inspection on 14 August 2014, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The breaches were in relation to safe recruitment and supporting nursing staff to gain the skills needed to manage some emergency medical situations. The provider sent us an action plan with timescales showing how and when the regulations would be met.

At this inspection, we found that the registered manager and provider had taken action to address the breaches from the previous inspection.

The service provided accommodation and personal care for up to 40 people who are living with advanced dementia and is part of the health services provided by Medway Community Health Care NHS, (MCH). The accommodation was provided over two floors. A lift was available to take people between floors. There were 38 people living in the service when we inspected.

There was a registered manager employed at the service. 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 Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. The provider had a dedicated system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. The registered manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. The premises were undergoing a refurbishment. This was to modernise the decoration and design to meet current published guidance for services delivering to people living with complex developed dementia. Equipment in the service had been well maintained.

People had access to qualified nursing staff who monitored their general health, for example by testing blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Recruitment policies were in place. Safe recruitment practices had been followed befor

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The home had a manager who is registered with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was not in day to day charge of the home, this had been delegated to the home manager.

This inspection was unannounced. Darland House is a home that was formerly part of the National Health Service (NHS) but has now become a social enterprise. There were 39 people living in the home when we inspected. Staff provided nursing care and support to adults diagnosed with dementia. Accommodation is spread over two floors, divided into four units. Each unit provided ten spaces for people who had high care dependency needs. High care dependency levels meant that some people received care or nursing in bed, required specialist equipment to meet their needs or may have needed constant supervision or higher staffing input.

The provider had recruitment policies that had been followed. However, we found that recruitment had not fully complied with the requirements of the Health and Social Care 2008. The registered manager had not carried out robust checks which ensured that only suitable staff were employed to work with vulnerable adults. You can see what action we told the provider to take at the back of the full version of the report.

People received care from staff who had been trained to meet their individual needs. Staff had used good systems to help them quickly identify any changes in people’s needs. Such as monitoring people’s health and wellbeing and seeking people’s views about their health. However, nursing staff were not able to describe to us how they could apply their training to emergency situations if people were choking or bleeding. You can see what action we told the provider to take at the back of the full version of the report.

Dementia could affect people’s ability to make decisions and could impair their cognitive abilities. This meant that some people were able to tell us their views of the home, while others were unable to communicate this verbally. The home provided care to a client group facing difficult behaviours brought on by their complex dementia.

The registered manager had a good understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS is legislation which ensures that people who are unable to make certain decisions for themselves were protected.

All of the people we talked with as part of the inspection told us they were happy with the home and felt safe. We observed staff had good professional relationships with the people they cared for. People were encouraged to join in activities and those that could move freely around the home. At the same time staff ensured people were kept safe. There were a range of activities available which people could chose to join in with. Staff were kind and caring, treated people with respect and maintained their dignity.

Staff had received safeguarding training and showed a good understanding of what their responsibilities were in preventing abuse. They knew the procedures for reporting any concerns they may have and had confidence the registered manager would respond appropriately to any concerns they raised.

There we appropriate staffing levels at the home. The registered manager told us staffing levels were kept under review and adjusted according to the dependency levels of people who lived at the home. People received care and treatment in a timely manner.

Where appropriate, people’s families had been involved in planning their care. Staff asked people about their preferences and choices.

People had accessed appropriate health, social and medical support as soon as it was needed. Staff were caring and treated people with compassion and kindness. We spent time in the communal areas and observed staff interactions with people who lived in the home.

The registered manager had made links with the local community. They had promoted family involvement and people took part in meaningful activities in the home or their local community.

Staff said they felt well supported and were aware of their rights and their responsibility to share any concerns about the care provided at the home. Managers monitored incidents and risks to make sure the care provided was safe and effective. The registered manager used a range of systems to make sure that there were enough staff to care for people safely.

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment. When people were unable to give consent decisions were made in their best interest following good practice guidelines and the principles of the Mental Capacity Act 2005.

We found that peoples complex and diverse needs were understood by the staff and were met. People were provided with meaningful activities which took into account up to date research into dementia.

People were offered choices at every meal time and could choose where they ate their meals. We saw that people were encouraged to drink and were offered snacks throughout the day. We saw that people were given the assistance they needed to eat and drink in a sensitive and discreet way.

The service had effective systems in place for minimising risks associated with infection control. All areas of the home were clean, there were no unpleasant odours, and staff received regular training updates to refresh their knowledge.

The recruitment procedures at the service were sufficiently robust to ensure the safety and wellbeing of people living there.

The service had a complaints procedure in place, and had not received any complaints since the last inspection.

We spoke with a relative of a person living at the home, staff and the members of the management team. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We found that people were receiving the care and support they needed. We saw that staff assisted people in a caring and sensitive way and understood people’s complex needs.

We saw that staff treated people with respect and with regard for their privacy and dignity. A relative we spoke with said that Darland House was “Marvellous” and “I can’t fault the place”.

Staff said that they received the training and support they needed to enable them to care for the people living at the home.