This was an unannounced inspection carried out on 1 November 2016.

Delph House can provide accommodation and personal care for 22 older people. It can also accommodate people who have sensory needs, who have a physical disability or who live with dementia. There were 17 people living in the service at the time of our inspection most of whom were older people who lived with dementia.

The service was operated by a company which acted as the registered provider. The company was formed by two directors. One of them was the managing director who was personally involved in overseeing the running of the service. They regularly called to the service to see how things were going. There was also a registered manager who 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. In this report when we speak about both the directors of the company and the registered manager we refer to them as being, ‘the registered persons’.

At our inspection on 2 and 3 November 2015 there were three breaches of legal requirements. We found that some people had not been consistently supported to eat and drink enough to stay well. In addition, we found that some people had not received all of the care and reassurance they needed when they became distressed. We also found that quality checks had not been robustly completed and this had led to shortfalls in the service not being quickly resolved. After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. They said that all of the necessary improvements would be completed by 15 December 2015. At the present inspection we found that the necessary improvements had been made to ensure that the three legal requirements had been met. However, we noted that some quality checks still needed to be strengthened further. This was necessary to better enable the registered persons to quickly resolve some remaining problems with how the service was run.

At this inspection we also found that staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. Medicines were safely managed but some additional steps needed to be taken to reduce the risk of accidents. There were enough staff on duty to provide people with the care they needed but a background check had not been completed before a new member of staff had been appointed.

Staff had been provided with support and guidance and they knew how to care for people in the right way. Most people enjoyed their meals but some of them wanted to have more choice. Staff had ensured that people had received all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Although staff respected people's privacy and promoted their dignity this was not fully reflected in the arrangements used when people saw the hairdresser. Confidential information was kept private.

People received all of the practical assistance they needed and had been encouraged to pursue their hobbies and interests. There was a system for quickly and fairly resolvin

This was an unannounced inspection carried out on 2 and 3 November 2015. This was our first comprehensive inspection since the service was re-registered on 10 April 2015. On this date we registered a private limited company to take over the running of the existing service. The company had purchased the service from the previous owners who were a partnership. One of the members of this partnership also used to the registered manager. The new owners had arranged for the existing registered manager to continue in their post. We were told that this had been done so that people living in the service did not experience any disruption with the change of ownership and continued to receive the care they needed.

Delph House provides accommodation for up to 22 older people some of whom live with dementia. There were 18 people living in the service at the time of our inspection.

As we have noted above, 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 this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The first breach referred to the provision that was in place to support people to eat and drink enough. The arrangements were not robust or reliable. The second breach referred to the provision made to support people who had special communication needs and who could become distressed. They had not always been offered consistent or effective support to reassure and comfort them. The third breach referred to the way in which quality checks had been completed. They were not rigorous or effective and this had resulted in a number of shortfalls not being quickly identified and resolved. These breaches had increased the risk that people would not always safely and responsively receive all of the care they needed. You can see what action we told the registered persons to take in relation to each of these breaches of the regulations at the back of the full version of this report.

Although staff knew how to report any concerns so that people were kept safe from harm, the arrangements to protect people from the risk of financial abuse were not robust. People had not been fully supported to stay safe by avoiding accidents and medicines had not always been correctly managed. There were enough staff on duty but background checks on new staff had not always been completed.

Staff had not received all of the support they needed and did not have all of the skills that were necessary for them to reliably assist people in the right way. This included caring for people so that they had enough nutrition and hydration. However, staff recognised when people were unwell and had arranged for them to receive the necessary healthcare services.

Staff had helped to ensure that people’s rights were respected by supporting them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. The safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people’s rights were being protected.

Although people were treated with kindness and compassion staff had not always respected people’s choice about the gender of staff who provided them with close personal care. Staff recognised people’s right to privacy and they respected confidential information.

Although people had been consulted about the care they wanted to receive, they had not been fully supported to pursue their hobbies and interests. People had been helped to meet their spiritual needs and there was a system for resolving complaints.

Although people had been involved in the development of the service, they had not benefited from staff acting upon good practice guidance. The service was run in an open and inclusive way that encouraged staff to raise any concerns they had.